I apologize for not having the definitive references. This is just to
point out that there is a controversy about certain NSAIDs and cartilage
repair.
INFLAMMATION INDUCED CARTILAGE DAMAGE IS COX-2 MEDIATED AND CAN BE
PREVENTED BY CELECOXIB
*Mastbergen, S C (B-Searle); +*Lafeber, F P J G; *Bijlsma, J W J
http://www.jbjs.org/ORS_2001/pdfs/0643.pdf
"Direct effects of NSAIDs on cartilage have frequently been reported to
be adverse, though beneficial as well neutral effects have been reported
as well."
Harvard Health
http://www.harvard-magazine.com/issues/ja96/health.html
"Questions have been raised about the effect of NSAIDs on joint
cartilage since reports in the 1960s found that some arthritis patients
experienced hip joint destruction after taking high doses of
indomethacin. Although two subsequent investigations debunked the
connection, some researchers point to more recent experimental studies
in animals indicating that high doses of NSAIDs do, in fact, damage
cartilage cells."
http://www.ahcpub.com/ahc_root_html/hot/sponsored/cox-2_table5.html
Hot topics in Health Care
Table 5. Adverse Effects of NSAID Therapy
Bone/Cartilage
Joint erosions, decreased repair of cartilage damage
GI
Gastroduodenal ulcers, strictures, esophagitis, gastritis, colitis,
small and large bowel erosions
Renal
Acute and/or chronic renal failure, fluid and electrolyte imbalances,
hyperkalemia, hematuria, nephrotic syndrome with interstitial nephritis,
papillary necrosis
Cardiovascular
Exacerbation of hypertension, exacerbation of congestive heart failure,
arrhythmia
Hepatic
Elevated transaminases, choleostasis, hepatic failure (rare)
CNS
Headache, tinnitus, vertigo, tremor, depression, somnalence, altered
mental status, aseptic meningitis
Hematologic
Thrombocytopenia, hemolytic anemia, agranulocytosis, leukopenia,
eosinophilia, aplastic anemia
Pulmonary
Exacerbation of asthma, cough, respiratory depression, laryngeal and
pharyngeal edema
Dermatologic
Skin rash, photosensitivity, Stevens Johnson syndrome, pemphigoid
reaction, erythema multiform, urticaria, angioedema
Murray
Murray E. Maitland PhD PT
University of South Florida
School of Physical Therapy
12901 Bruce B. Downs Blvd
MDC 077
Tampa, Florida, USA
33612-4766
Telephone (813) 974-1666
Fax (813) 974-8915
Email [log in to unmask]
-----Original Message-----
From: - for physiotherapists in education and practice
[mailto:[log in to unmask]] On Behalf Of paul gurnett
Sent: Thursday, February 05, 2004 5:52 PM
To: [log in to unmask]
Subject: Re: contradictions
Hi Murray,
Please can you expand on "The use of NSAID'S and the potential effect on
cartilage healing/health" ?
Regards,
Paul.
Paul Gurnett. MCSP. SRP.
Chartered and State Registered Physiotherapist.
----- Original Message -----
From: "Murray Maitland" <[log in to unmask]>
To: "Paul Gurnett" <[log in to unmask]>
Sent: Thursday, February 05, 2004 7:38 PM
Subject: Re: contradictions
> Will:
> We are not alone when it comes to apparent contradictions that need
> further understanding. The use of NSAID meds and the potential effect
on
> cartilage healing/health is a good example. Antipyretics have also
gone
> through some degree of controversy. Fever might be helpful in some
> cases. The analogies go on.
>
> The paradoxical relationships between exercise and energy, exercise
and
> the reduction of pain in osteoarthritis, producing oxidants and having
> net anti-oxidants confuses many people including myself.
>
> Interesting stuff
>
> Murray
>
> Murray E. Maitland PhD PT
> University of South Florida
> School of Physical Therapy
> 12901 Bruce B. Downs Blvd
> MDC 077
> Tampa, Florida, USA
> 33612-4766
>
> Telephone (813) 974-1666
> Fax (813) 974-8915
>
> Email [log in to unmask]
>
>
> -----Original Message-----
> From: - for physiotherapists in education and practice
> [mailto:[log in to unmask]] On Behalf Of Will Remigio LLU
> Sent: Thursday, February 05, 2004 1:04 PM
> To: [log in to unmask]
> Subject: Re: contradictions
>
> It is funny sometimes how we selectively decide to set the
permeability
> level
> of our belief membranes to accept or reject things because we feel we
> are all
> for good evidence. And we want so bad to be certain and to be on the
> Right
> side.
>
> Things in PT that are considered simple we tend to accept face value
> such as
> the application of RICE principle. Ice for instance, ( this has
puzzled
> me
> for a while and maybe someone might have an explanation). We like to
> recomend
> and apply to people after trauma. People after trauma are usually seen
> by an
> MD who prescribes Anti inflamatory drugs. Then they come to PT. we
apply
> ICE
> because we don't presecribe AIDrugs. We want ice to be effective so we
> really
> try to cool down the metabolism of the tissue involved and thereby
block
>
> circulation there, maybe inhibiting sypathetic efference. Then we are
> doing a
> disservice to the Anti inflamatory drug because THE DRUG is not
getting
> there
> since we have been periodically applying ice ( A vaso constrictor ) to
> the
> tissue .
> On what side are we?
> For us to be evidence based there is a pre requisite, as I see it :
That
> we
> are sensible and use good common sense and intuitiveness AS WELL and
> don't
> discard things based only on someone elese's judgements or accepted
> stardards
> about THings but be willing to try, test to learn and unlearn as well.
>
> There is more to science than meets the eyes, specially medical
science!
> That's what my experience tell me over and over. Being open to this is
> being
> vulnerable to and probably that's a safer place.
>
> Will
>
> > Well said, Blaise, and thanks for your thoughtful comments (and
> > support).
> >
> > Regards -
> >
> > Billi
> >
> > At 02:39 PM 1/22/2004, you wrote:
> > >Dear Contributors
> > >
> > >This has indeed been a fascinating thread to follow. At the risk
of
> being
> > >burned by the list for adding my own comments...
> > >
> > >I am a great believer in the application of the best current
> evidence....to
> > >a point. Some elements have always troubled me about the models
> which
> > >have been hastily embraced from other disciplines (particularly
> > >the 'heirarchy of evidence' from EBM - systematic reviews of RCTs
> ++good,
> > >empirical evidence ++ungood) for they seem to reject elements of
the
> > >evidence continuum that are in my own opinion, extremely important;
> namely
> > >qualitative research and clinical (empirical) evidence.
> > >
> > >I am heartened by some of the comments that much more esteemed and
> > >experienced professionals than I have contributed to the thread.
> Mainly
> > >because I agree with them. RCTs obviously work for drug trials,
but
> I am
> > >less convinced when there are multiple variables - as there are in
> most PT
> > >treatments.
> > >
> > >After much reflection, my own way of rationalising this, which I
hope
> is
> > >not just hokum but a way of balancing available evidence, goes like
> this:
> > >Looking at evidence as a constellation, with the patient at the
> > >centre...and evaluating the available quantitative and qualitative
> studies
> > >(in recommended ways) I can see what gravity they exert on the
> presenting
> > >problems of the person I'm treating. Presently, I rely heavily on
> studies
> > >that I read, but my anticipation is that once I build up a bank of
> > >clinical/experiential knowledge, this will come into play as an
> equally
> > >valid form of evidence.
> > >
> > >
> > >Practitioners like Billi, it appears to me, keep the curiosity of
> applied
> > >scientific practice alive by evaluating/developing new methods in
> > >practice. As a profession we still rely on things that do not
> respond
> > >well to being analysed by double blind RCTs, but that doesn't prove
> that
> > >it's quackery either. But, I also know it's also down to us to
find
> > >methods that are robust to evaluate the merit of new methods
> > >
> > >Hmmm. Questions, questions...always questions...If I found the
> answers
> > >I'd probably pack it in.
> > >
> > >Once again, many thanks
> > >
> > >Blaise Doran
> > >Student Physiotherapist
> >
> > TheraTogsT are now available!
> > See www.theratogs.com for details...
> > ===========================================
> > Providing top-quality education, tools, and resources
> > for practitioners in neuromotor rehabilitation.
> > ===========================================
> > Progressive GaitWays, LLC
> > [log in to unmask] . http://www.gaitways.com
> > (888) 634-0495 . (970) 728-7028 fax
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