This review included five randomized controlled trials with a total of 4465 participants. The evidence reviewed suggests that celecoxib controls the symptoms of rheumatoid arthritis (RA) to a similar degree to that of the active comparators examined (naproxen, diclofenac and ibuprofen). When compared to placebo, the percentage of patients showing improvement by four weeks were 42/82 (51%) in the twice-daily celecoxib 200mg group and 43/82 (52%) in the twice-daily celecoxib 400mg group; these were significantly different from the placebo group in which 25/85 (29%) improved. At six months this study found a reduced rate of upper gastrointestinal complications with celecoxib but there is also evidence to suggest that these benefits may not be evident in the long-term and that celecoxib offers no additional benefit in patients who are also receiving cardio-prophylactic low dose aspirin.
For an individual with RA the potential benefits of celecoxib need to be balanced against the uncertainty that the short-term reduced incidence of upper gastrointestinaI complications are maintained in the long-term and its increased cost in comparison to traditional non-steroidal anti-inflammatory drugs.