Good News For Runners: Less ‘wear’ on joints, delayed disabilities

SORRENTO, Italy – New research among long-distance runners shows that osteoarthritis (OA), often called "wear and tear" arthritis, is not caused by "wear" alone.

At a symposium sponsored by Boehringer Ingelheim here last week, Prof. Jim Fries, of Stanford University, USA, presented new data showing that long-distance runners in the study actually developed disability much more slowly than non-exercisers. They reached a given level of disability 12 years later in life than non-exercisers, and enjoyed regular pain-free activity.

These new results come from a 13-year study. It involved 538 runners (from runners’ clubs) and 423 controls, with an average age of 58. Each year, doctors assessed the participants for disability, pain, osteoporosis and X-ray progression of osteoarthritis.

Although a few subjects in either group experienced disability initially, by the end of the trial, 20 percent of the control participants had disabilities, compared with just five percent of runners. Men and women experienced similar low disability scores.

Among the non-runners, women were far more likely than men to experience disability as time went on. Running delayed the time to a disability score of 0.1 by 12.8 years.

The study also found that runners have greater bone density and less bone mineral loss over time.

However, Fries warned of the type of exercise that involves "tears" around the joint. "This accelerates the development of osteoarthritis, particularly of the knee. Internationally, the most frequent cause is football (soccer). In the US, it is American football. Even ballet dancers are at increased risk of OA, at the base of the great toes," Fries said.

Danger from NSAIDs

Over-use of standard, non-steroidal anti-inflammatory drugs (NSAIDs) in sports ailments is widespread and may lead to serious side-effects, according to Prof. Denis McCarthy of the University of New Mexico, USA.

"Joggers, skiers and young to middle-aged adults engaged in rough sports use large amounts of NSAIDs," McCarthy said at the symposium. "The drugs used are often purchased over-the-counter, but may be obtained by prescription through a general practitioner or sports doctor. All of these NSAIDs are dangerous if used in high doses."

McCarthy highlighted the potential problems involved with conventional NSAIDs, namely their adverse effects on the gastrointestinal tract.

"Of those hospitalized with gastrointestinal bleeding, about two-thirds are using a prescription-free NSAID, half of them in conjunction with a prescription NSAID as well. Morbidity, healthcare costs and time lost from work are substantial," he said.

"Because complication often occurs with short-term use, a COX-2 selective inhibitor is both safer and more cost-effective in younger patients," he added.

Large-scale study

A new, large-scale, observational study has confirmed the favorable overall, gastrointestinal and cardiovascular tolerability of the COX-2 selective inhibitor meloxicam (Mobic) under prescribing conditions, despite the inclusion of many patients with gastrointestinal or cardiovascular history.

These data were discussed at the symposium for rheumatologists in Sorrento. They provide important news to patients and prescribing physicians over the safety profile of meloxicam amid growing concern in the medical community over the cardiovascular side-effects of some COX-2 selective anti-rheumatic drugs and the gastrointestinal safety of others.

Cardiovascular events with the selective COX-2 inhibitors have been highlighted with data from rofecoxib, showing a greatly increased chance of an event compared with naproxen. A similar trend was seen in the clinical development of etoricoxib. A recent analysis of one-year data on celecoxib has demonstrated no safety advantage in upper gastrointestinal events compared with ibuprofen or diclofenac.

The new meloxicam data come from a three-month, large-scale prospective observational cohort study in Europe, in 4,000 medical practices, with 13,307 patients receiving meloxicam at doses of 7.5 mg or 15 mg.

The study took place under realistic prescribing conditions with a substantial portion of high-risk patients enrolled: 12 percent had a previous history of serious gastrointestinal disease, 24 percent had at least one concomitant cardiovascular disorder, and 26 percent were receiving concomitant antihypertensive medication.

In addition, 43 percent of patients previously used standard NSAIDs without success, and a fifth had experienced an NSAID-related adverse drug reaction.

Despite these high-risk conditions, doctors rated meloxicam treatment a success in 85 percent of patients and rated its tolerability as good or very good in 94 percent of patients. Quality of life and daily functions improved in up to 64-84 percent of patients in various areas.

Only 0.8 percent of patients reported gastrointestinal adverse reactions, with the few major effects linked to incorrect or over-use of meloxicam. No cardiovascular adverse reactions were reported.

Mobic is a selective COX-2 inhibitor developed by Boehringer Ingelheim and indicated for the symptomatic treatment of painful osteoarthritis, rheumatoid arthritis and ankylosing spondylitis (indications may vary from country to country).

Mobic has been used by an estimated 70 million patients in 100 countries worldwide. It is classified pharmacologically as a selective COX-2 inhibitor, offering a balance between reliable efficacy and overall safety, including a favorable gastrointestinal profile.– PLG News & Views