The role of anti-inflammatory drugs in the treatment of osteoarthritis: a European viewpoint.

Despite the fact that there is no scope for an inflammatory process in a strict definition of osteoarthritis (OA), inflammation nevertheless seems to be of great relevance in understanding not only the occurrence of the disease but also its propensity and/or persistence. Longitudinal epidemiologic studies suggest that inflammation--defined by the presence of synovitis within the joint cavity--is a potent predisposing factor for cartilage breakdown. Nonsteroidal anti-inflammatory drugs (NSAIDs) have demonstrated their beneficial short term, rapid-acting effect. However, two questions remain: the choice of NSAIDs versus analysis as first line therapy for symptomatic treatment in OA, and the long-term structural effect of such therapy.