News January 2003 Issue

In the News: 01/03

Can Arthritis Medications Put You At Heart Attack Risk?
A study published in 2001 in the Journal of the American Medical Association found that two popular arthritis drugs, Celebrex and Vioxx, were associated with an increased risk of stroke and heart attack. The news has been reported widely in major national magazines and newspapers. Is the media blowing smoke? According to researchers at the Cleveland Clinic, it’s no joke. In fact, they suggest that physicians whose patients have coronary artery disease or are at high coronary risk should use caution when prescribing these drugs.

Dr. Steven Nissen, vice-chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic and a member of the FDA Advisory Panel that reviewed the drugs, says “These coxib drugs are enormously popular, but safety issues need to be addressed.”

Use of these drugs to manage arthritis has grown dramatically since their release in 1998. They block the cyclo-oxygenase (COX-2) receptor, and their selectivity means that fewer gastrointestinal side effects occur than with traditional non-steroidal anti-inflammatory drugs. But this same selectivity may prove a liability by increasing the propensity for clotting and increasing the risk of heart attack.

Cleveland Clinic researchers analyzed four trials involving 18,604 patients who used these drugs. All trials showed a trend toward an increase in heart attacks and/or blood-clotting, though the trend decreased when aspirin was used in conjunction with the drugs.

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New Breakthrough In Cartilage Repair
M.I.T. engineers have developed a new technique for repairing cartilage. It involves growing cartilage cells within a gel outside the body, then delivering the cell-seeded gel into a damaged joint. Engineers at the school’s Center for Biological Engineering claim that tissue will grow and integrate with the normal cartilage surrounding it while the gel slowly degrades, leaving behind a functioning tissue. The procedure is claimed to have significant advantages over the current FDA-approved procedure, which consists of extracting cartilage cells from a patient, coaxing them to multiply outside the body, then implanting the new cells into the damaged area—an expensive procedure and, according to Prof. Alan Grodzinsky, co-author of the M.I.T. study, “a procedure that does not result in the generation of true articular cartilage.” The M.I.T. team claims the cartilage gel could be implanted arthroscopically through a small external incision, which would not only be less expensive but would reduce the recovery time for the patient.

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Is Knee Arthroscopy As Osteoarthritis Fix A Sham?
A blockbuster study published in the New England Journal of Medicine in July claimed that arthroscopic surgery of the knee to relieve the pain of osteoarthritis is of no help. The placebo-controlled study, conducted by the Houston Veterans Affairs Medical Center and Baylor College of Medicine, reported that while the 180 study participants often said they felt better after surgery, tests of knee function revealed that the operation had not helped at all. With nearly a quarter of a million Americans undergoing the procedure each year, eyebrows were raised by health insurers, who pay out more than a billion dollars a year for the operation.

Response, from Dr. William Tipton, executive vice president of the American Academy of Orthopedic Surgeons, was swift. “We applaud the authors [of this study]. Evidence-based medicine should be a guiding light in today’s health-care delivery system, and this study confirms the conventional orthopedic wisdom on the limited value of arthroscopic cleansing of arthritic knees. However, the weaknesses include a potential selection bias caused by the number of patients who decided not to participate and the nonspecific indications for arthroscopy.” Adds orthopedic surgeon Dr. Jack Andrisj of the Cleveland clinic, “The flaw is that the study did not account for other variables among patients. For example, there is no accounting for angular deformity, nor the extent of osteoarthritis. The study has many strengths, but it still cannot answer the question of the value of arthroscopic debridement for OA of the knee ‘across the board.’”