Recommendations from others The American Pain Society 2002 guideline recommends acetaminophen for mild pain from osteoarthritis.5 For moderate to severe pain and inflammation, a COX-2 inhibitor was the first choice, unless there is significant risk of hypertension or kidney disorder. For active rheumatoid arthritis, the addition of a COX-2 agent to disease-modifying anti-rheumatic drugs (DMARDs) is advised unless there is uncontrolled hypertension or renal disease.6 However, these recommendations came out before the data on the cardiovascular effects of some COX-2 inhibitors.
The American College of rheumatology recommends the use of a COX-2 agent for osteoarthritis or pain unresponsive to acetaminophen. Their 2000 guidelines warn that due to potential renal toxicity, COX-2 inhibitors should not be used for patients with severe renal insufficiency, and used with caution in cases of mild to moderate renal insufficiency.
In 2005, these guidelines were amended to include the recommendation that patients with increased cardiovascular risk be cautioned about the risks associated with COX-2 inhibitor use.7
TABLE
Celecoxib is associated with a decreased risk of hypertension and renal dysfunction
| CELECOXIB | ROFECOXIB | |
|---|---|---|
| Hypertension | 0.83 (95% CI, 0.71–0.97) | 1.55 (95% CI, 1.29–1.85) |
| Peripheral edema | 1.09 (95% CI, 0.91–1.31) | 1.43 (95% CI, 1.23–1.66) |
| Renal dysfunction | 0.61 (95% CI, 0.40–0.94) | 2.31 (95% CI, 1.05–5.07) |
| Source: Zhang J, Ding EL, Song Y, JAMA 2006.3 | ||