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Caution Urged for Treating Arthritis with NSAIDs

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By Deborah Cooper • • July 13, 2000

Although NSAIDs are the most popular class of drug for treating the pain associated with arthritis, new studies indicate that long-term use can cause multiple health problems, and consequently, patients using these drugs are being urged to consult physicians on a regular basis while using these drugs.

Non steroidal anti-inflammatory drugs (NSAIDs )are a class of drugs that relieve the stiffness and pain associated with many forms of arthritis. A study published in the Journal of Rheumatology followed the drug use patterns of more than 10,000 patients over a three-year period and found that NSAIDS comprised 57 percent of prescriptions. The next most common medication was corticosteroids at 23 percent, followed by disease modifying antirheumatic drugs. The patients, whose average age was 67, tended to use NSAIDs for about three months.

With such a high level of usage, scientists have examined long-term side effects. Researchers at the Hennipin County Medical Center in Minnesota found that regular, long-term use of NSAIDs, including the new Cox-2 inhibitor types such as refecoxib, should be closely monitored by a physician.

The study, published in the Annals of Internal Medicine, warned that refecoxib can adversely affect kidney function and decrease the kidney’s ability to filter waste products. The rate of this decline was about the same for older versions of this class of drug such as indomethacin.

This conclusion affects a wide range of patients, including people who are on salt-restricted diets, those with impaired kidney function, hypertension, congestive heart failure or liver disease.

In another new study published last month, NSAIDs caused a ten-fold increase in the risk of congestive heart failure. While that fact is itself disturbing, it may also mean that NSAIDs are implicated in 19% of all hospital admissions. Although some earlier experimental studies showed adverse effects in patients with preexisting congestive heart failure (CHF), this was the first study to monitor the increased risk of CHF in the general NSAID-using population.

Congestive heart failure is a disorder in which the heart loses its ability to pump the blood efficiently and has serious results affecting many organs of the body. There are numerous potential causes such as high blood pressure, anemia and kidney disease and is a leading cause of death.

The drugs did not cause actual physical damage to the heart itself, but the Australian team of scientists found that NSAIDS are capable of causing short-term changes in the mechanisms of blood circulation (hemodynamics) through the inhibition of prostaglandin synthesis. Prostaglandins are the hormone-like agents responsible for symptoms of inflammation like pain and redness. “The effect of NSAIDs has been to accelerate the problem,” researchers concluded in the Archives of Internal Medicine.

The serious implications of the study mean that doctors need to advise and monitor patients much more carefully when dealing with NSAIDs. Patients should be careful to avoid using these medications for minor problems and carefully consider whether they are appropriate for long-term therapy.

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