Degenerative
joint disease (DJD) is a common disorder characterized by
chronic pain and limitation of activity, for which treatment with a nonsteroidal anti-inflammatory
drug (
NSAID) is often useful. The anti-inflammatory activity of the
NSAID tolmetin sodium has been well described, being comparable in efficacy to
indomethacin and effective for the relief of the acute and chronic symptoms that accompany DJD. To examine specifically the effect of
tolmetin in controlling the
pain and functional limitation in DJD of the spine,
tolmetin was tested against placebo in a double-blind, two-segment, crossover study. Twenty-six patients (mean age, 62.5 years; range, 42-79 years) received three weeks of
tolmetin 1,200 mg/d and three weeks of placebo. The results showed that
tolmetin provided significantly greater relief of symptoms than placebo in virtually all measurements of
joint pain and stiffness: tenderness,
pain at rest,
pain on motion, intensity of
joint pain (P less than 0.001), and duration of morning stiffness (P = 0.002). Statistically significant improvement was noted in two of the three measures of cervical range of motion (P less than or equal to 0.01) and in all assessments of
daily living activities (P = 0.001 in four parameters; P = 0.02 in a fifth parameter). Global evaluations of response to treatment by both patients and investigator also demonstrated significant effects (P less than or equal to 0.002). Significantly more placebo patients (13 of 26) than
tolmetin patients (two of 26) found the medication ineffective and discontinued treatment prematurely (P = 0.01). No serious or limiting adverse reactions were seen during placebo or
tolmetin therapy. The most frequently reported side effects on both
therapies were gastrointestinal.(ABSTRACT TRUNCATED AT 250 WORDS)