The bottom line on using Celebrex

Researchers hope to learn more about the safety of celecoxib from a clinical trial being conducted by researchers at the Cleveland Clinic, who are testing the drug against ibuprofen and naproxen in some 20,000 patients who have or are at high risk of heart disease. Results are expected in several years.

In the meantime, we continue to believe that celecoxib should be used as a last resort, and only by people who are at low risk of heart disease or stroke, high risk of gastrointestinal problems, or who have not responded to less risky alternatives. Patients who have diabetes, heart disease, elevated cholesterol levels, or high blood pressure should be especially cautious about using the drug.

Consumer Reports medical advisers recommend the following drugs for:

Most people with osteoarthritis: Generic acetaminophen. When used at recommended doses it is generally the safest drug and often provides adequate relief.

People who don't get adequate relief from acetaminophen or can't take it for health reasons: Generic ibuprofen or naproxen. Those drugs are cheaper than other NSAIDs, and less likely than aspirin to harm the stomach.

People at high risk of heart attack: Naproxen. While aspirin is also safe for the heart, the doses needed to control pain pose unacceptable risks to the stomach.

People at high risk of gastrointestinal bleeding: Combine ibuprofen or naproxen with a stomach-protecting drug such as omeprazole (Prilosec and generic), or possibly consider celecoxib if you're also at low risk of heart disease.

Regardless of which drug you opt for, use the lowest effective dose for the shortest period of time possible. In addition, take these other steps to reduce the risks or your need for drugs:

• Try nondrug measures to ease pain, such as losing excess weight, engaging in low-impact aerobic activities, and adopting joint-saving strategies. For example, wear low-heeled shoes that provide firm support; avoid sitting in low or armless chairs, since getting up from them can be difficult; keep warm, since cold can stiffen the joints; don't sit or stand in one position for extended periods; try not to lie on the affected area while sleeping; and, for knee pain, lay a pillow lengthwise under your leg while sleeping.
• Consider alternative therapies, including acupuncture, massage, supplements that contain glucosamine sulfate (not hydrochloride), and creams that contain the ingredient capsaicin (Zostrix and generic).
• Talk with your doctor about which drug is safest for you.
• Periodically reduce your dosage to see whether you can get by with less.
• See your doctor if you experience any gastrointestinal symptoms. If you take medication most days, get blood tests every few months for anemia (a sign of stomach bleeding) and liver or kidney problems. And control any coronary risk factors, especially high blood pressure, which can be worsened by NSAIDs.