Patient case (clinical description): A 66-year-old woman comes to the office due to joint pain in the hands and periodic morning stiffness that lasts less than 15 minutes.  The pain is moderately severe and worsens with daily activity. The patient used Tylenol with minimal relief.  Past medical history is notable for hypertension and hypercholesteremia.  Physical examination shows firm nodules over the distal interphalangeal joints, bilaterally. The patient has pain in her knees as well. The knees are stiff in the morning for less than 30 minutes and become worse with climbing stairs. She has some sensation of bone friction during activity. X-ray shows narrowing of the joint space, subchondral bone sclerosis and osteophyte formation along the joints.

Patient's own account: I'm a 66-year-old woman and I went to my doctor's office because of a bloody joint pain in my hands that has been lasting for a while. The pain comes and go in the morning usually. I feel like a stiffness that last less than 15 minutes. The pain is moderately severe but it gets worse when I'm using my hands. I used Tylenol which helped a little. Apart from that, I suffer from hypertension and high cholesterol. The doctor made me notice that I have bumps around both of my hand joints. I also suffer from my knees and they are also stiff in the morning for around 30 min. It's even worse when I climb up the stairs! I also feel like my bones are rubbing against each other when I'm moving. The X-ray showed that I have narrow joint space, I have sclerosis, and abnormal growths of bone along my joints.

Clinical trial: A Study of the Efficacy and Safety of 2PX in Patients With Pain Due to Osteoarthritis of the Knee

Eligibility criteria:
Inclusion Criteria:

          -  Male and female out-patients, 40 years or older.

          -  Subjects with documented OA of either one or both knees, as defined by the American
             College of Rheumatology (ACR) criteria ([Altman R, Asch E, Bloch D, et al (1986)]);
             i.e.knee pain and at least 3 out of the following 6 criteria in the target joint:

               -  age >50 years

               -  stiffness < 30 minutes

               -  crepitus

               -  bony tenderness

               -  bony enlargement

               -  no palpable warmth

          -  Radiological evidence of joint space narrowing in the target joint within 8 weeks
             prior to randomisation.

          -  Subjects with chronic, moderate to severe OA pain of the target knee:

               -  present for more than 3 months, and for ≥ 20 days per month.

               -  not controlled by, or intolerant of, oral NSAIDs, paracetamol, COX-2 inhibitors
                  or weak opioids.

               -  intensity at least moderate (i.e., actual WOMAC (pain questions 1-5) ≥ 10) on
                  WOMAC OA index LK 3.1 at Visit 1, in the target knee, as recalled over the last
                  24 hours.

        Exclusion Criteria:

          -  Subjects with any moderate to severe pain of other origin (e.g., fibromyalgia) which
             could confound assessment or self-evaluation of pain due to OA in the target knee.

          -  Subjects with any prosthesis fitted to the target knee.

          -  Subjects requiring treatment with any of the following agents/therapies within the
             specified periods or at any time during the study are excluded from participation:

          -  Any potent/strong opioid in the 4 weeks prior to randomisation (i.e., an opioid
             assumed to cause withdrawal symptoms upon abrupt discontinuation).

          -  Any topical or subcutaneously applied analgesic agents (e.g., capsaicin, NSAIDs)
             applied to the target knee within 7 days prior to randomisation.

          -  Any treatment which could alter the degree or nature of baseline OA pain planned
             within the study period.

          -  Intra-articular injections of corticosteroids in the target knee within the 2 months
             prior to randomisation.

          -  Intra-articular injections of hyaluronan in the target knee within 6 months prior to
             randomisation.

          -  Avascular necrosis in the target knee within 6 months prior to randomisation.

          -  Arthrosynthesis of the target knee within 12 months prior to randomisation.

          -  Arthroscopy of the target knee within 6 months prior to randomisation.

          -  Major trauma to the target knee within 6 months prior to randomisation.

          -  Infection in the target knee within 6 months prior to randomisation.

          -  Subjects who have previously been treated with 2PX.

          -  Subjects who have received an investigational drug or used an investigational device
             within the 30 days prior to randomisation.

          -  Subjects with a significant psychiatric disorder, in the opinion of the investigator,
             or subjects receiving strong anti-psychotic medication.

          -  Subjects with documented or suspected alcohol or drug abuse.

          -  Any ongoing or past history of malignant disease within the 5 years immediately prior
             to randomisation (with the exception of basal cell carcinoma).

          -  Pregnancy or ongoing lactation

          -  Female subjects of childbearing potential unwilling to use adequate contraceptive
             measures throughout the duration of the study. For the purpose of this study, adequate
             contraception is defined as:

               -  oral, injected or implanted hormonal methods of contraception; OR

               -  placement of an intrauterine device (IUD) or intrauterine system (IUS); OR

               -  barrier methods of contraception: Condom or occlusive cap (diaphragm or
                  cervical/vault caps) with spermicidal foam/gel/film/cream/suppository Note: Male
                  sterilisation or abstinence are not acceptable methods of birth control and would
                  preclude enrolment in the study.

        Note: For post-menopausal women: less than 12 months since the last spontaneous menstrual
        bleeding will exclude the patient unless they are willing to utilise acceptable methods of
        contraception for the duration of the study.

          -  Male subjects able to conceive, who are unwilling to use barrier methods of
             contraception throughout the duration of the study

          -  Subjects unable to comply with the study assessments.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 40 Years old.


Eligibility (NLI label): Entailment