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We read with great interest the recent article by Case et al,¹ but had major concerns regarding the conclusions these authors draw from such a well-performed study. Interestingly, the authors only demonstrate that diclofenac sodium use provides benefit at 2 and 12 weeks in osteoarthritis (OA) compared with baseline using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale (but not the Lequesne). Wisely, they argue strongly in favor of placebo-controlled, longer-term trials and, in fact, found a significant placebo effect in 2 of the 4 WOMAC subgroups at 12 weeks. In what may represent the authors' bias, however, when presenting their results they do not compare the diclofenac-treated patients at 12 weeks with either the acetaminophen-treated patients or the placebo groups at 12 weeks (they compared acetaminophen with placebo at this time point and found no difference). By simple "eyeball" test, it does not appear that diclofenac use . . . [Full Text of this Article]

Colleen Christmas, MD; Lainie Moncada, MD
Baltimore, Md