Comparison of aceclofenac with piroxicam in the treatment of osteoarthritis.

A multicentre, double-blind, randomised, parallel group study was undertaken to investigate the efficacy and safety of aceclofenac (123 patients, 100 mg twice daily) in comparison to piroxicam (117 patients, 20 mg once daily and placebo once daily) in patients with osteoarthritis of the knee. The treatment period of two months was preceded by a washout period of one week duration. On completion of the study, patients in both aceclofenac and piroxicam-treated groups exhibited significant improvement in pain intensity and functional capacity of the affected knee, as represented by the Osteoarthritis Severity Index (OSI) (p < 0.0001 and p < 0.001 respectively). This was further substantiated following the patient's assessment of pain intensity using the Visual Analogue Scale (VAS), in which significant improvements were demonstrated at all time points for each treatment group (p < 0.001). Although both treatment groups showed a significant improvement in all investigator's clinical assessments (functional exploration of the knee, knee flexion and extension (EXT)), there were no significant differences between the groups. There was, however, a more rapid improvement in knee flexion in the aceclofenac group after 15 days of treatment. Both aceclofenac and piroxicam were well tolerated by patients, the most commonly reported adverse events being gastrointestinal, although their incidence was low. Only 24 patients on aceclofenac, as opposed to 33 on piroxicam complained of dyspepsia, epigastralgia and pyrosis. While 7 patients in each group were withdrawn because of adverse events, only one patient with piroxicam was withdrawn because of severe upper gastrointestinal bleeding. Twice as many reports of fecal blood loss were made in the piroxicam group in comparison to the aceclofenac group. In summary, this study confirms the therapeutic efficacy of aceclofenac and suggests that it is a well-tolerated alternative NSAID to piroxicam in the treatment of osteoarthritis.

A Case of Multiple Osteonecrosis in a Patient with HIV: Effect of Joint Lavage.

A 35-year-old male former abuser of i.v. drugs, who was known to be human immunodeficiency virus (HIV) positive for 3 years, was found to have osteonecrosis (ON) involving both internal femoral condyles and humeral heads. No causes other than the HIV were evident. Joint irrigation, applied by means of an irrigation-withdrawal system, provided some relief and functional improvement. A literature search for references to the potential association of osteonecrosis with HIV infection showed a number of reports and three with multiple sites, suggesting that osteonecrosis can be considered a manifestation of HIV infection. The underlying pathogenic mechanisms remain obscure but are proposed to be related to immune alterations caused by HIV infection itself. HIV should be considered an etiological factor in patients with a diagnosis of multiple ON. Irrigation of the accessible regions of the joints involved may be an effective therapeutical choice to help control the symptoms.