Four-way, multicenter, crossover trial of ibuprofen, fenoprofen calcium, naproxen, and tolmetin sodium in osteoarthritis: comparative clinical profiles.

One hundred forty-one subjects with osteoarthritis completed this double-blind, multicenter, crossover trial comparing four nonsteroidal anti-inflammatory (NSAI) agents after single-blind aspirin stabilization. Preferences of both patients and physicians showed the following rank order from most to least preferable: tolmetin sodium, naproxen, ibuprofen, fenoprofen calcium. By all but three of more than 20 measures of efficacy, tolmetin sodium and naproxen were the more effective pair and fenoprofen calcium and ibuprofen the less effective pair of the four. Eight of nine measures of tolerability suggested the following rank order from best to worst tolerated: ibuprofen, naproxen, tolmetin sodium, fenoprofen calcium, aspirin. Few differences among the newer NSAI agents compared in this study achieved statistical significance. Nevertheless, the tolerability-efficacy relationships that emerge from studies of this type can help to define rational approaches to the use of these drugs in rheumatic diseases.

Growing pains: fact or fiction?

Growing pains are recurrent limb pains peculiar to children. Brief episodes of leg pains occurring intermittently at night are typical, but the clinical spectrum is variable. A diagnosis of growing pains can be made with certainty only after other possible conditions have been ruled out by appropriate studies and after the child has been observed carefully for a period of months. The two diseases most often confused with this syndrome are rheumatic fever and juvenile rheumatoid arthritis. Aspirin and supportive measures are beneficial.