Effects on muscle performance of NSAID treatment with piroxicam versus placebo in geriatric patients with acute infection-induced inflammation. A double blind randomized controlled trial

• Published in: BMC musculoskeletal disorders Vol. 12; no. 1; p. 292
• Main Authors: Beyer, Ingo, Bautmans, Ivan, Njemini, Rose, Demanet, Christian, Bergmann, Pierre, Mets, Tony
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30-12-2011; BioMed Central; BMC
• Subjects: Age Factors; Aged; Aged patients; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Belgium; Chemokines; Chi-Square Distribution; Communicable Diseases - complications; Communicable Diseases - diagnosis; Communicable Diseases - drug therapy; Communicable Diseases - metabolism; Communicable Diseases - physiopathology; Cytokines; Cytokines - blood; Double-Blind Method; Drug therapy; Evolution; Female; Gene expression; Geriatric Assessment; Hand Strength; Health aspects; heat shock protein; Hospitalization; HSP27 Heat-Shock Proteins - metabolism; HSP70 Heat-Shock Proteins - metabolism; Humans; Inflammation - diagnosis; Inflammation - drug therapy; Inflammation - etiology; Inflammation - metabolism; Inflammation - physiopathology; Male; Mortality; Muscle Fatigue - drug effects; muscle performance; Muscle Strength - drug effects; Muscle, Skeletal - drug effects; Muscle, Skeletal - metabolism; Muscle, Skeletal - physiopathology; Musculoskeletal diseases; Nonsteroidal anti-inflammatory drugs; NSAID; Physiological aspects; Piroxicam; Piroxicam - therapeutic use; Placebos; Teaching hospitals; Time Factors; Treatment Outcome; Belgium
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/1471-2474-12-292

Inflammation is the main cause of disease-associated muscle wasting. In a previous single blind study we have demonstrated improved recovery of muscle endurance following celecoxib treatment in hospitalized geriatric patients with acute infection. Here we further evaluate NSAID treatment with piroxicam in a double blind RCT and investigate the role of cytokines and heat shock proteins (Hsp) with respect to muscle performance. We hypothesized that NSAID treatment would preserve muscle performance better than antibiotic treatment alone, by reducing infection-associated inflammation and by increasing expression of cytoprotective Hsp.
Consecutive admissions to the geriatric ward were screened. 30 Caucasian patients, median age 84.5 years, with acute infection-induced inflammation and serum levels of CRP > 10 mg/L were included and randomized to active treatment with 10 mg piroxicam daily or placebo. Assessment comprised general clinical and biochemical parameters, 25 cytokines in serum, intra-and extracellular Hsp27 and Hsp70, Elderly Mobility Scale (EMS) scores, grip strength (GS), fatigue resistance (FR) and lean body mass (LBM). Patients were evaluated until discharge with a maximum of 3 weeks after treatment allocation.
EMS scores, FR and grip work (GW), a measure taking into account GS and FR, significantly improved with piroxicam, but not with placebo. Early decreases in IL-6 serum levels with piroxicam correlated with better muscle performance at week 2. Basal expression of Hsp27 in monocytes without heat challenge (WHC) was positively correlated with FR at baseline and significantly increased by treatment with piroxicam compared to placebo. Profound modifications in the relationships between cytokines or Hsp and changes in muscle parameters were observed in the piroxicam group.
Piroxicam improves clinically relevant measures of muscle performance and mobility in geriatric patients hospitalized with acute infection-induced inflammation. Underlying mechanisms may include modifications in the cytokine network and increases in monocytic expression of cytoprotective Hsp27.
ISRCTN: ISRCTN96340690.