Piroxicam is used for anti-inflammatory and analgesic effects in the symptomatic treatment of rheumatoid arthritis, osteoarthritis, and other inflammatory conditions.
The potential benefits and risks of piroxicam therapy as well as alternative therapies should be considered prior to initiating piroxicam therapy. The lowest possible effective dosage and shortest duration of therapy consistent with treatment goals of the patient should be employed.
Rheumatoid Arthritis and Osteoarthritis
Piroxicam is used in the symptomatic treatment of acute and chronic rheumatoid arthritis and osteoarthritis.
When used in the symptomatic treatment of rheumatoid arthritis or osteoarthritis, piroxicam has relieved pain and stiffness and has increased range of motion and functional activity. Anti-inflammatory and analgesic effects of piroxicam usually are observed during initial treatment of rheumatoid arthritis or osteoarthritis with a progressive increase in response occurring over 8-12 weeks. Piroxicam appears to be only palliative in these conditions and has not been shown to permanently arrest or reverse the underlying disease process. Most clinical studies have shown that the anti-inflammatory and analgesic effects of usual dosages of piroxicam in the treatment of rheumatoid arthritis or osteoarthritis are at least equal to those of usual dosages of salicylates, ibuprofen, indomethacin, or naproxen. In controlled clinical trials of 12-weeks' duration, 20 mg of piroxicam daily was as effective as 3-4.2 g of aspirin daily in patients with rheumatoid arthritis or 2.6-3.9 g of aspirin daily in patients with osteoarthritis.
Patient response to oral NSAIAs is variable; patients who do not respond to or cannot tolerate one NSAIA might be successfully treated with a different agent. However, NSAIAs are generally contraindicated in patients in whom sensitivity reactions (e.g., urticaria, bronchospasm, severe rhinitis) are precipitated by aspirin or other NSAIAs.
(See Cautions: Precautions and Contraindications.)
In the management of rheumatoid arthritis in adults, NSAIAs may be useful for initial symptomatic treatment; however, NSAIAs do not alter the course of the disease or prevent joint destruction. Disease modifying antirheumatic drugs (DMARDs) (e.g., azathioprine, cyclosporine, etanercept, oral or injectable gold compounds, hydroxychloroquine, infliximab, leflunomide, methotrexate, minocycline, penicillamine, sulfasalazine) have the potential to reduce or prevent joint damage, preserve joint integrity and function, and reduce total health care costs, and all patients with rheumatoid arthritis are candidates for DMARD therapy. DMARDs should be initiated early in the disease course and should not be delayed beyond 3 months in patients with active disease (i.e., ongoing joint pain, substantial morning stiffness, fatigue, active synovitis, persistent elevation of erythrocyte sedimentation rate [ESR] or C-reactive protein [CRP], radiographic evidence of joint damage) despite an adequate regimen of NSAIAs. NSAIA therapy may be continued in conjunction with DMARD therapy or, depending on patient response, may be discontinued.
Piroxicam has been administered concomitantly with a fixed regimen of gold compounds and corticosteroids, but it has not been established whether these combinations are more effective than any of the drugs alone.
Other Inflammatory Conditions
Piroxicam has been effective at higher than usual dosages (i.e., 40 mg daily) for the symptomatic relief of acute gouty arthritis. In one study in patients with gouty arthritis, analgesic effects reportedly occurred within 2-4 hours after the initial dose of piroxicam, and relief from pain and swelling was complete after 5 days of therapy with the drug.
Piroxicam has been used for symptomatic relief of ankylosing spondylitis. The drug appears to be as effective as phenylbutazone (no longer commercially available in the US) or indomethacin for the management of this condition, but is generally better tolerated.
Piroxicam has also been used for symptomatic treatment of acute musculoskeletal disorders. The drug appears to be as effective as phenylbutazone (no longer commercially available in the US), but may be less effective than indomethacin for the management of these conditions.
Piroxicam has been used for symptomatic relief of postoperative or postpartum pain. For the relief of episiotomy pain, piroxicam appears to be as effective as aspirin.
Piroxicam has also been used for symptomatic relief of dysmenorrhea. In patients with severe dysmenorrhea, piroxicam decreased severity of cramps and supplemental analgesic (e.g., acetaminophen) requirements.
Results from a large, prospective, population-based cohort study in geriatric individuals indicate a lower prevalence of Alzheimer's disease among patients who received an NSAIA for 2 years or longer. Similar findings have been reported from some other, but not all, observational studies.