NSAIDs Are Associated with Lower Depression Scores in Patients with Osteoarthritis

This study looked at whether or not NSAIDs, as an addition to antidepressant therapy, could decrease depressive symptoms in patients with osteoarthritis.  The study was a multicenter, double-blind, placebo-controlled study with patients who have active osteoarthritis.  Each participant was put into one of three groups: placebo group, ibuprofen 800 mg (three times a day) or naproxen 500 mg (two times a day) group, or Celebrex 200 mg (one time a day) group.  The patients were tested for major depression using the standard health questionnaire-9 (PHQ-9) scale.  Each person was tested at baseline, after two weeks of treatment and after six weeks of treatment.

The results showed that all three groups had similar average PHQ-9 scores at the baseline screening and at the last screening, after six weeks of treatment.  However, there was a detectable difference in change of PHQ-9 score between the groups with the ibuprofen/naproxen group and the Celebrex group having lower scores of .31 and .61 respectively.

The study concludes that NSAID usage in patients with osteoarthritis shows a trend of reduction in depressive symptoms.  I, however, do not believe there was enough evidence in the trial to conclude this.  Additionally, I believe they mistook correlation with causation.  Each group, in addition to a decrease in depression, also saw a decrease in pain.  As we have learned in class, pain can cause depression.  So while NSAID usage may correlate with decreased depression, it may have to do with the pain relief and not the specific mechanism of action of NSAIDs.  To disprove this, NSAIDs should also be compared to other pain relievers with different mechanisms of action.

Rupa IL, Gandhi s, Aneja A, et al. NSAIDs Are Associated with Lower Depression Scores in Patients with Osteoarthritis. Am J Med. 2013;126(11).

http://www.amjmed.com/article/S0002-9343(13)00358-6/abstract

Combining provider and patient intervention for the management of osteoarthritis

As with many chronic medical conditions, osteoarthritis is a condition that requires constant care and attention in order to properly manage the pain and disability that comes with the condition. Unfortunately, patients often go home from health facilities and immediately forget the exact medication regimens or additional treatments that they need to continue properly caring for themselves.  While the consequences may not be life threatening, they heavily affect a patient’s general health and quality of life.  In the case with osteoarthritis, physical activity and weight management are key elements of managing hip and knee osteoarthritis but many adults with osteoarthritis are physically inactive or overweight. Furthermore, many treatments such as physical therapy, joint injections, and pain medications are often underused. This article describes a study in which researchers examined the effect of combined patient and provider intervention for managing osteoarthritis.

In this study, primary care providers were randomly assigned to either an osteoarthritis intervention group or a usual care control group. About 10 patient participants were enrolled from each of 30 PCPS. If in the osteoarthritis intervention group, providers received the provider intervention and patients received the patient intervention. Both groups continued on with usual medical care and those in the control group received no additional intervention.

On the patient side, interventions in this study focused on weight management, physical activity, and cognitive behavior pain management strategies. Interventions were carried out via telephone calls, which took place twice per month for the first six months and monthly for the last six months. They were carried out by a counselor with training in osteoarthritis and behavior change. The counselor used motivational interviewing and included goal setting and action planning in the intervention.

On the provider side, interventions included providing the PCPs with patient-specific osteoarthritis treatment recommendations, such as referring the patient to a physical therapist or recommending a topical NSAID. Moreover, PCPs received patient-specific recommendations.

The outcome of this study was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which is a self-reported measure of lower extremity pain, stiffness, and function. The Short Physical Performance Battery (SPPB) was also used and includes 3 tests of balance, a timed 8-foot walk, and 5 chair stands. Finally, researchers also collected “process measures” related to behaviors or outcomes intermediate to changes in symptoms.

The results of this study showed that WOMAC scores were 4.1 points lower in the osteoarthritis intervention group, demonstrating that combining patient and provider intervention resulted in modest improvement in self-reported physical function in patients with hip and knee osteoarthritis.

Although this was a rather small study done in only one hospital, I believe that it is a stepping-stone for future treatment plans of chronic conditions. This study presents a different aspect of interventions that is not commonly seen: intervening on both the patient and provider side. People often view interventions as something that is done solely on the patient side. Furthermore, I believe that pharmacists can play a major role in intervening with both patients and primary care providers once patients leave the health facility. A patient’s medication management is a vital element of receiving adequate care for his or her health condition and pharmacists can care for patients by helping providers with specific drug therapy problems or any drug-related issue.

 

Allen K, Yancy W, Bosworth H, et al. A Combined Patient and Provider Intervention for Management of Osteoarthritis in Veterans: A Randomized Clinical Trial. Ann Intern Med. 2016;164(2):73-83

 

http://annals.org.pitt.idm.oclc.org/article.aspx?articleid=2478159