Patient case (clinical description): A 47-year-old woman comes to the office complaining of pain in the calf and knee when she bends down. The pain limits her activity. Her medical history is significant for osteoarthritis, for which she uses nonsteroidal anti-inflammatory drugs (NSAIDs) for the past two years. She is living with her husband and has 3 children. She doesn't smoke but drinks alcohol occasionally. Her vital signs are normal. On physical examination, there is a small effusion in the right knee. The effusion grew a little larger and she developed a tender swelling in the popliteal fossa and calf. Both the pain and swelling worsened as she bent and straightened her knee.

Patient's own account: I'm a 47-year-old woman, married with 3 kids. I don't smoke and I drink occasionally. I went to the doctor because of pain in my calf and knee when I was bending down. This has been limiting my daily activities. I have been diagnosed with osteoarthritis for which I have taken anti-inflammatory drugs for the past 2 years. The doctor saw a small fluid buildup in my right knee. This buildup became a bit bigger and I have a swollen calf. The pain is worse when I bend and straighten my knee.

Clinical trial: Long Term Safety and Efficacy Study of Tanezumab in Subjects With Osteoarthritis of the Hip or Knee

Eligibility criteria:
Inclusion Criteria:

          -  A diagnosis of osteoarthritis of the index hip or knee based on American College of
             Rheumatology criteria with Kellgren Lawrence X ray Grade of 2 as diagnosed by the
             Central Reader

          -  Currently receiving a stable dose regimen of oral NSAID (naproxen, celecoxib,
             diclofenac, aceclofenac, loxoprofen, ibuprofen, meloxicam, nabumetone, sulindac or
             ketoprofen) as described in the protocol along with a history of insufficient pain
             relief from, inability to tolerate or contraindication to taking acetaminophen and,
             tramadol or opioid treatments. Subjects must also maintain a stabilized, protocol
             specified NSAID dose regimen for at least the final 2 or 3 weeks of the Screening
             period

          -  WOMAC Pain subscale score of at least 5 in the index knee or hip at Screening

          -  Be willing to discontinue all non study pain medications for osteoarthritis and not
             use prohibited pain medications throughout the duration of the study

          -  Female subjects of childbearing potential must agree to comply with protocol specified
             contraceptive requirements

        Exclusion Criteria:

          -  Subjects exceeding protocol defined BMI or body weight limits

          -  History of other diseases specified in the protocol (eg, inflammatory joint diseases,
             crystalline diseases such as gout or pseudogout) that may involve the index joint and
             that could interfere with efficacy assessments

          -  Radiographic evidence of protocol specified bone or joint conditions in any screening
             radiograph as determined by the central radiology reviewer

          -  A history of osteonecrosis or osteoporotic fracture

          -  History of significant trauma or surgery to a knee, hip or shoulder within the
             previous year

          -  Planned surgical procedure during the duration of the study

          -  Presence of conditions (eg, fibromyaliga, radiculopathy) associated with moderate to
             severe pain that may confound assessments or self evaluation of osteoarthritis pain

          -  Signs or symptoms of carpal tunnel syndrome in the year prior to Screening

          -  Considered unfit for surgery based upon American Society of Anesthesiologists physical
             classification system for surgery grading, or subjects who would not be willing to
             undergo joint replacement surgery if required

          -  Contraindications to magnetic resonance imaging

          -  History of intolerance or hypersensitivity to the oral NSAID (naproxen, celecoxib or
             diclofenac) the subject could be randomized to receive or any of its excipients or
             existence of a medical condition or use of concomitant medication for which the use of
             this NSAID is contraindicated

          -  History of intolerance or hypersensitivity to acetaminophen or any of its excipients
             or existence of a medical condition or use of concomitant medication for which the use
             of acetaminophen is contraindicated

          -  Use of prohibited medications without the appropriate washout period prior to
             Screening or Initial Pain Assessment Period

          -  History of cancer within 5 years of Screening, except for cutaneous basal cell or
             squamous cell cancer resolved by excision

          -  Subjects with signs and symptoms of clinically significant cardiac disease as
             described in the protocol

          -  Diagnosis of a transient ischemic attack in the 6 months prior to Screening, diagnosis
             of stroke with residual deficits that would preclude completion of required study
             activities

          -  History, diagnosis, or signs and symptoms of clinically significant neurological
             disease such as but not limited to peripheral or autonomic neuropathy

          -  History, diagnosis, signs or symptoms of any clinically significant psychiatric
             disorder

          -  History of known alcohol, analgesic or drug abuse within 2 years of Screening

          -  Previous exposure to exogenous NGF or to an anti-NGF antibody

          -  History of allergic or anaphylactic reaction to a therapeutic or diagnostic monoclonal
             antibody or IgG fusion protein

          -  Poorly controlled hypertension as defined in the protocol or taking an
             antihypertensive that has not been stable for at least 1 month prior to Screening

          -  Evidence of protocol defined orthostatic hypotension at Screening

          -  Disqualifying score on the Survey of Autonomic Symptoms questionnaire at Screening

          -  Screening AST, ALT, serum creatinine or HbA1c values that exceed protocol defined
             limits

          -  Presence of drugs of abuse in screening urine toxicology panel

          -  Positive hepatitis B, hepatitis C or HIV test results indicative of current infection

          -  Participation in other investigational drug studies within protocol defined time
             limits

          -  Pregnant, breastfeeding or female subjects of childbearing potential who are unwilling
             or unable to follow protocol required contraceptive requirements

          -  Other severe acute or chronic medical or psychiatric condition or laboratory
             abnormality that in the judgment of the investigator, would make the subject
             inappropriate for entry into this study
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.


Eligibility (NLI label): Entailment