Monday, August 8, 2011

Review of NSAIDs Effects & Side Effects for Arthritis Pain

Recently I gave in and went to see a rheumatologist after more than 3 months of intense morning stiffness and swelling of my hands (especially around the PIPs and MCPs) and wrists which improved during the day but never went away.  It had gotten to the point where I could no longer open small lid jars (decreased strength), do my push-ups or pull ups (pain and limited wrist motion), and OTC products (Tylenol, Advil, etc) weren’t working.  I can’t take Aleve due to the severe esophagitis it induces.  I didn’t want to write a prescription for my self-diagnosed (without) lab arthritis.

BTW, all the lab work came back negative with the exception of a slightly elevated sed rate and very weakly positive ANA.  The rheumatologist was impressed with the swelling, pain, and stiffness and was as surprised as I by the normal lab work.  He thinks (and I agree) that I am in the early presentation of rheumatoid arthritis.  He wrote a prescription for Celebrex and told me to continue with the Zantac I was already taking (thanks to the Aleve).  The Celebrex is helping.

So I was happy to see this article (full reference below) come across by twitter feed.  H/T to @marcuspainmd: Useful review of NSAIDs effects & side effects for arthritis pain http://cot.ag/oHxQDX

A major disadvantage of NSAID use is the gastrointestinal side effects. These range from abdominal pain, nausea, diarrhea, and dyspepsia to more serious events, such as gastric or duodenal ulcers, anemia, and bleeding, or perforated ulcer. These side effects are due to the simultaneous inhibition of COX-1 and COX-2.

As many as 25% of chronic NSAID users will develop ulcer disease

2%–4% will bleed or perforate, especially those who have been designated as being in a high-risk category

The overall risk for these complications in patients taking NSAIDs was approximately 2.4.

High-risk patients are those with a history of complicated peptic ulcer disease or multiple (at least two) risk factors; moderate-risk patents are those with one to two risk factors, ie, age 65 years, high-dose NSAID therapy, previous history of an uncomplicated ulcer, concurrent use of aspirin (including low-dose), corticosteroids, or anticoagulants; and low-risk patients are those with no risk factors.

The two methods employed to prevent the development of peptic ulceration and mucosal injury in patients taking NSAIDs:

(1) prophylaxis with a proton pump inhibitor or a prostaglandin analog (such as misoprostol) or high-dose histamine 2-receptor antagonist (H2RA)

(2) with substitution of a traditional NSAID by a COX-2 inhibitor

The article on ulcer formation in COX-2 (Celebrex) vs NSAIDS:

Goldstein et al14 determined gastroduodenal damage
from endoscopy after 4, 8, and 12 weeks of treatment with celecoxib 200 mg twice daily or naproxen 500 mg twice daily in 537 patients with osteoarthritis or rheumatoid arthritis.

The cumulative incidence of gastric and duodenal ulceration for celecoxib was 9% and for naproxen was 41%. In the group that received celecoxib, the occurrence of ulcers was significantly associated with a number of factors, including H. pylori positivity, concurrent aspirin usage, and a history of ulcers.

 

It’s a really nice review article and is open source.

 

 

 

REFERENCES

Combination therapy versus celecoxib, a single selective COX-2 agent, to reduce gastrointestinal toxicity in arthritic patients: patient and cost-effectiveness considerations;  Marina Scolnik, Gurkirpal Singh; Open Access Rheumatology: Research and Reviews 2011:3 53–62

6 comments:

Chrysalis Angel said...

I'm glad you went and are receiving treatment. Hopefully in keeping down the inflammation is will hold off the damage. Arthritis is the pits. I hope you feel better soon.

Mal Content said...

Just because I am nosy....and sorry to hear that you probably have RA...but what does it affect more...your quilting or your surgery?

rlbates said...

At this point neither too much though I notice it when retracting in the OR. I have some trouble using my rotary cutter (wrist). Oddly enough it's not been the things that require a fine touch or light grip/grasp. It's when I need hand and wrist strength (lifting pans in the kitchen, opening child-proof caps, helping move a patient from the OR table onto the gurney)

Healthcare Social Network said...

Many thanks for this, it is actually very good to encounter a web-site that genuinely gives very good info instead of posting rubbish.

SeaSpray said...

I'm sorry you have to deal with this Ramona. It has to be extremely frustrating in your hands. Thankfully your labs were good and mild where elevated.
You're an active person and I can't imagine much would keep you down. Thankfully this med will help provide relief.

When I tore my meniscus, but just hoped the pain would go away (never got evaluated for a year)
I used to live on I-Buprofen. Then a doc put me on Naprosen (sp?) and for the 1st time I began developing gerd. Got off that and never had that problem again. then back to 600 mg I-Buprofen because even tho I did have it repaired, I had developed OA in knees. Then the urologist told me NSAIDS bad for kidneys. So, now on the worst days I will take a couple tramadl or 4 if a long active day in which I am going to be on feet a lot. It never completely gets rid of pain..just helps take edge off. But, some days are okay(tolerable) and I don't take any. Losing weight will certainly help and has already.

Julie said...

Thanks for sharing your real-world experience!