Magazine article Drug Topics

Reexamination of NSAIDs Urged for Upcoming Epidemic

Magazine article Drug Topics

Reexamination of NSAIDs Urged for Upcoming Epidemic

Article excerpt

Until more effective remedies are available, nonsteroidal antiinflammatory drugs (NSAIDs) must continue to be the mainstay of treatment for the millions of arthritic Americans--now 14 million and increasing fast who take them regularly. So noted two experts at a recent American Medical Association media update on arthritis in New York City.

But patients will pay a price, they warned. "NSAIDs revolutionized treatment by relieving pain, stiffness, and other disabling symptoms," said David Y. Graham, M.D., professor of medicine at Baylor College of Medicine, Houston, and chief of gastroenterology at the VA Medical Center there. "But too often doctors and patients forget that these are dangerous drugs."

The risk of a life-threatening gastrointestinal event--a major bleed, usually-- is, at a minimum, about 2% per year of use, Graham noted. Chance of hospitalization or death is about 1.5% in rheumatoid arthritis patients. "With the millions of people at risk, GI damage from NSAIDs is now a major healthcare problem," he said.

Endoscopic studies show all NSAIDs can cause peptic ulcers. "More than 10% of patients receiving them will have an endoscopically recognizable ulcer on any given day. This is at least five to 10 times higher than in patients not taking NSAIDs," said Graham.

NSAID-induced ulcers may be one of the most difficult to recognize of all peptic ulcers, he added. "Some may be acute rather than chronic; others may be H. pylori-associated ulcers that, by chance, occur in NSAID users. Still others may erupt in patients with coincident H. pylori infection. "As our people age, more and more will have H. pylori infection, use NSAIDs for arthritis, and suffer from ulcers," Graham predicted. "By the year 2020, one in five Americans will have arthritis."

Ironically, NSAIDs effectively reduce joint inflammation for the same reason they may injure the lining of the GI tract: They inhibit the synthesis of prostaglandins, which play a critical role in the inflammation process.

"Prostaglandins also protect the gastric mucosa by reducing acid production, stimulating the secretion of protective mucus and bicarbonate, and encouraging adequate blood flow," said Graham. "Without prostaglandins, ulcers, bleeding, and perforation can occur."

One should stop NSAID use in an arthritic patient with an ulcer to allow the ulcer to heal, Graham advised. "If possible, consider other agents." Simple analgesia with acetaminophen is often enough, he said. …

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