Editor's Correspondence |

Interpretation of Therapies for Knee Arthritis

Colleen Christmas, MD; Lainie Moncada, MD
Arch Intern Med. 2003;163(15):1862. doi:10.1001/archinte.163.15.1862-a.
Text Size: A A A
Published online


We read with great interest the recent article by Case et al,1 but had major concerns regarding the conclusions these authors draw from such a well-performed study. Interestingly, the authors only demonstrate that diclofenac sodium use provides benefit at 2 and 12 weeks in osteoarthritis (OA) compared with baseline using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale (but not the Lequesne). Wisely, they argue strongly in favor of placebo-controlled, longer-term trials and, in fact, found a significant placebo effect in 2 of the 4 WOMAC subgroups at 12 weeks. In what may represent the authors' bias, however, when presenting their results they do not compare the diclofenac-treated patients at 12 weeks with either the acetaminophen-treated patients or the placebo groups at 12 weeks (they compared acetaminophen with placebo at this time point and found no difference). By simple "eyeball" test, it does not appear that diclofenac use was any more efficacious than placebo at 12 weeks. If this is indeed the case, shouldn't the title of the article be, "The Lack of Efficacy of Acetaminophen or Diclofenac in Treating Symptomatic Knee Osteoarthritis"? As it is now, one might misinterpret their findings to suggest that diclofenac is superior to acetaminophen in this study. Further, it is concerning that a less complete description was given for the reasons for dropout in the diclofenac group compared with the acetaminophen group. Specifically, was drug toxicity a problem?

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Topics
PubMed Articles