Why should we expect a structure-modifying osteoarthritis drug to relieve osteoarthritis pain?

摘要

In patients with knee osteoarthritis (OA) the real problem, for the clinician and the patient, is not radiographic OA but painful OA. As noted by Liang, 'x-rays don't weep'. Patients weep. In this issue of the Annals, Snijders et aP report results of a randomised controlled (RCT), placebo-controlled trial of doxycycline (doxy) in patients with symptomatic knee OA. Their primary end point was the difference in the proportion of subjects in the two treatment groups who achieved a clinical response at 24 weeks, as judged by OMERACT-OARSI responder criteria. Secondary outcomes included joint pain, stiffness, function, quality of life, OA-related medication use and side effects of treatment. The results showed no difference between doxy and placebo with respect to symptomatic benefit; about one-third of each treatment group met the responder criteria. The authors conclude that doxy is ineffective in reducing symptoms of knee OA over 24 weeks.