Osteoarthritis is one of the most common
joint diseases and is a major cause of chronic disability in the elderly, second only to
cardiovascular disease. Although, in addition to important nonpharmacological measures,
paracetamol is recommended as first-line
therapy in
osteoarthritis because of its
analgesic efficacy and tolerability profile, its efficacy is often disappointing and the more recent guidelines from the European League Against
Rheumatism (EULAR) highlight how
NSAIDs may be a valid alternative in patients with an inadequate response to
paracetamol. The American College of Rheumatology (ACR) 2000 guidelines state that
NSAIDs may even be used as initial treatment in patients with
osteoarthritis of the knee and moderate-to-severe
pain and
inflammation. Data from several clinical studies suggest that
NSAIDs provide superior
analgesia to
paracetamol. Little evidence is available to distinguish one
NSAID from another in terms of efficacy, whilst their gastrointestinal (GI) tolerability profile remains a main concern and a key discriminating factor in selecting a
NSAID.
Nimesulide is a
NSAID with a multi-factorial mode of action which is particularly suitable in the symptomatic treatment of states characterised by
acute pain, such as
osteoarthritis flares. In particular, its proven efficacy, a fast onset of the
analgesic action, its protective effect against the degradation of cartilage and a demonstrated low incidence of gastrointestinal adverse events compared with other
NSAIDs make it a particularly valuable option in the symptomatic treatment of patients with joint
osteoarthritis.