Applying the evidence in osteoarthritis: strategies for pain management.

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.