STRONG RECOMMENDATION Five studies (three moderate quality and two high quality) compared oral nonsteroidal anti-inflammatories (NSAIDs) with placebo for treatment of symptomatic osteoarthritis of the hip and showed improvement in pain and function scores with NSAIDs (Baerwald 2010, Kivitz 2001, Makarowski 2002, Schnitzer 2011, Svensson 2006). Compared to placebo, all five studies reported on pain and uniformly reported improvement in pain with the use of oral NSAIDs. The Western Ontario McMaster Arthritis Index (WOMAC) score was reported in all studies, all of which reported improvement in WOMAC function with NSAIDs compared to placebo. Three articles compared efficacy of a NSAIDs against each other: Schnitzer (2011) found that lumiracoxib showed similar efficacy to celecoxib; Kivitz (2001) found that celecoxib 200mg/day and 400mg/day showed similar efficacy to naproxen; Makarowski (2002) reported similar efficacy between valdecoxib 10mg and naproxen.
Benefits/Harms of Implementation
Although oral NSAIDs are widely utilized to treat osteoarthritis of the hip, there are contraindications to their use. Contraindications that should be considered include, but are not limited to, patients with chronic kidney disease or patients with significant cardiac conditions that may be at an elevated risk of myocardial infarction.
Outcome Importance
The use of non-opioid medications such as NSAIDs for nonoperative treatment of symptomatic osteoarthritis of the hip is extremely important to minimize the use of opioids.
Cost Effectiveness/Resource Utilization
NSAIDs are widely available and an extremely cost-effective treatment for symptomatic osteoarthritis. However, there is limited comparative data on the cost-effectiveness of oral NSAIDs compared to other nonoperative treatments of osteoarthritis of the hip.
Acceptability
This recommendation should be readily implemented as it does not influence a major change in clinical practice. Oral NSAIDs are commonly used to treat symptomatic osteoarthritis of the hip. It provides further evidence to support and guide this clinical practice.
Feasibility
Oral NSAIDs are widely available. Thus, this recommendation should be easily implemented with no apparent barriers to adoption.
Future Research
Future research is warranted to better understand the adverse events with oral NSAID use, particularly in patients at higher risk. Further studies are also needed to compare the different types of oral NSAIDs as well as dosing and duration of treatment. Future studies are needed to establish efficacy within certain subgroups and populations.
- Baerwald, C., Verdecchia, P., Duquesroix, B., Frayssinet, H., Ferreira, T.. (2010). Efficacy, safety, and effects on blood pressure of naproxcinod 750 mg twice daily compared with placebo and naproxen 500 mg twice daily in patients with osteoarthritis of the hip: a randomized, double-blind, parallel-group, multicenter study. Arthritis & Rheumatism, 62(12), 3635-44.
- Kivitz, A. J., Moskowitz, R. W., Woods, E., Hubbard, R. C., Verburg, K. M., Lefkowith, J. B., Geis, G. S.. (2001). Comparative efficacy and safety of celecoxib and naproxen in the treatment of osteoarthritis of the hip. Journal of International Medical Research, 29(6), 467-79.
- Makarowski, W., Zhao, W. W., Bevirt, T., Recker, D. P.. (2002). Efficacy and safety of the COX-2 specific inhibitor valdecoxib in the management of osteoarthritis of the hip: a randomized, double-blind, placebo-controlled comparison with naproxen. Osteoarthritis & Cartilage, 10(4), 290-6.
- Schnitzer, T. J., Dattani, I. D., Seriolo, B., Schneider, H., Moore, A., Tseng, L., Sallstig, P., Rebuli, R., Maxwell, T.. (2011). A 13-week, multicenter, randomized, double-blind study of lumiracoxib in hip osteoarthritis. Clinical Rheumatology, 30(11), 1433-46.
- Svensson, O., Malmenäs, M., Fajutrao, L., Roos, E. M., Lohmander, L. S.. (2006). Greater reduction of knee than hip pain in osteoarthritis treated with naproxen, as evaluated by WOMAC and SF-36. Annals of the Rheumatic Diseases, 65(6), 781-4.