American journal of therapeutics
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Decisions must be made when assigning analgesics, and such decisions involve comparing efficacy and adverse effects. The rules for assessing efficacy by systematic review and by large clinical trials are becoming clearer all the time. It is known, for instance, that trials that are not randomized, are not double-blind, or are too small will exaggerate efficacy. ⋯ The rules on how to collect and use evidence on adverse effects are less clearly formulated than they are for efficacy. For safety at or above therapeutic dose, the rules of evidence-gathering are necessarily different, and randomized trials are rarely an adequate or sufficient source. Databases of patient experience, with all the caveats, may be the most reliable data from which to work.
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Osteoarthritis is the most common form of arthritis, its prevalence increasing with age: as much as 80% of the population over 75 years show radiologic signs of the condition. Symptoms include pain, stiffness, and functional impairment; however, not all patients are symptomatic. Management starts with nonpharmacologic interventions, followed by pharmacologic means, and ultimately by surgical intervention. ⋯ They make use of educational occupational, and physical advisers, and they use their medication on demand. The basis of this self-administered pharmacologic management is paracetamol-acetaminophen, sometimes in combination with NSAIDs. A promising option for the future is the development of symptomatic slow-acting drugs for osteoarthritis that possess structure-modifying properties.