Gastrointestinal disease associated with nonsteroidal anti-inflammatory drugs: new insights from observational studies and functional status questionnaires

Article Abstract:

Aspirin, indomethacin, and ibuprofen are some of the common nonsteroidal anti-inflammatory drugs (NSAIDs) that are used to treat rheumatoid arthritis. A major side effect of these drugs is to cause erosion of the mucosal lining of the digestive tract, with peptic ulcers frequently resulting. The risk of developing such complications of drug therapy can be assessed in terms of relative, absolute, or attributable risk. NSAID therapy is associated with a three- to five-fold greater risk relative to that for arthritis patients not taking these drugs. The absolute risk (calculated as relative risk times baseline risk) of gastrointestinal complications and the attributable risk (the proportion of disease, or hospitalization, among the population that can be attributed to exposure to the drug), has been estimated in a study by Fries and coworkers, reported in the September 1991 issue of the American Journal of Medicine. In a group of 2,747 arthritis patients, the rate of gastrointestinal hospitalizations attributable to NSAID use was 75 percent, compared with 29 percent in a group of elderly Medicaid recipients whose rate of use of NSAIDs was much lower. The study also identified other characteristics that increase the risk of ulceration, and most of these factors, such as older age, current steroid use, and drug dosage, had been previously identified. However, linkage of risk of a gastrointestinal event to the extent of functional disability in the 2,747 arthritics was an important new finding. Although deaths as well as hospitalizations from gastrointestinal complications were higher among NSAID users, they had little effect on overall mortality. Deaths from kidney and lung disease were also higher in these patients, but whether any of these factors were linked to the disease process in rheumatoid arthritis or to other variables needs more study. Findings from this research should improve physicians' abilities to better evaluate and balance risks from arthritis and from treatment, so that the most appropriate treatment programs can be identified for each patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Nonsteroidal anti-inflammatory drug-associated gastropathy: incidence and risk factor models

Article Abstract:

Aspirin, indomethacin, and ibuprofen are some of the common nonsteroidal anti-inflammatory drugs (NSAIDs) that are used to treat rheumatoid arthritis. These drugs can erode the mucosal lining of the digestive tract and cause peptic ulcers. Gastrointestinal (GI) disorders are considered to be the most common drug toxicity in the US, and they carry a high risk of death. However, estimating the magnitude of the problem and developing treatment strategies are difficult due to lack of information. To better understand the prevalence of NSAID-associated GI disorders and risk factors associated with development of the disorders, information from a data base containing records of 2,747 patients with rheumatoid arthritis (RA) and 1,091 patients with osteoarthritis was analyzed. Patients were from a variety of geographical locations and treated at a number of medical practices, clinics, or centers. Among RA patients, the rate of GI hospitalizations during NSAID treatment was 1.58 percent, GI-related rehospitalization during NSAID use was about four times higher, and the GI death rate during NSAID treatment was 0.19 percent per year. Rates of these events among patients with osteoarthritis may be less, but too few subjects were studied to determine the significance of this observation. Older age, previous GI effects during NSAID use, and use of prednisone (a steroid frequently used to treat RA) concurrently with NSAIDs were significantly related to hospitalization for GI problems. Severity of disability, disease duration, and NSAID dose were also important. Consideration of these factors allows identification of almost all patients with NSAID-related GI problems, and further study should identify ways in which this national medical problem can be diminished. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Running, osteoarthritis, and bone density: initial 2-year longitudinal study

Article Abstract:

Increased physical activity is associated with a decreased risk of cardiovascular disease, as well as with weight reduction, a decrease in blood pressure, and improved mood. However, there is also a concern that running, a form of exercise for 15 million Americans, may increase the risk of osteoarthritis (OA), a long-term joint disease. OA is characterized by the destruction of joint cartilage, and overgrowth, malformation, and impaired function of the bone within the joint. The relation between long-term physical impact, as experienced with running, osteoarthritis, and osteoporosis (loss of bone content) was assessed in 34 runners and 34 nonrunners aged 52 to 74 years. Bone density was decreased in all subjects over the two-year follow-up, particularly runners who had stopped running routinely, although runners had greater bone density than nonrunners. X-ray findings associated with OA were increased in all groups over the two-year period of study, and female runners more frequently had bone malformations within the knee than nonrunners. The results show that running is not associated with an increased risk of OA, with the exception of bone malformation in women runners. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Physiological aspects, Osteoarthritis, Running, Bone densitometry

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