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The Underreporting Of Arthritis Drug Use... Are You Taking "Poison" And Not Telling Your Doctor?

Oct 25, 2007
Non-steroidal anti-inflammatory drugs (NSAIDS) are among the most commonly used over-the-counter medications. Examples include Advil (ibuprofen), Aleve (naproxen), and Orudis (ketoprofen).

They are so ubiquitous in their use that often people don't think about them nor do they even consider them to be medicines.

A recent U.S. study suggested people underreport their use of these common but potentially dangerous over-the-counter pain medications even to their doctors.

Unfortunately, this practice is risky. NSAIDS have known serious side effects. They can damage the liver, can cause bone marrow problems, and can also lead to abnormal kidney function and kidney failure.

Fluid retention, aggravation of hypertension, and congestive heart failure are other potential problems. In addition, NSAID use has been linked to cardiovascular events such as stroke and heart attack. This latter issue is what caused the removal of Vioxx from the market by the FDA. Most people aren't aware of the fact, though, that all NSAIDS- as a class- carry the same type of risk.

Because of drug interaction, NSAIDS have the ability to alter blood levels of other drugs leading to side-effects. A particularly severe problem can occur in patients who are taking blood thinners like Coumadin (warfarin) and then start NSAIDS. There are two major pathways that allow normal clotting of blood. NSAIDS inhibit platelet function. Platelets allow clotting of blood via one pathway. In a patient who is taking a blood thinner where the other pathway is also blocked, there is the danger of excessive bleeding occurring.

Deaths have also been reported because of acute allergic reactions that affect the respiratory system or skin.

Another set of common but no less potentially life-threatening issues are gastrointestinal complications such as bleeding, ulceration and perforation. These problems can occur without causing warning symptoms. Scientists theorize that the pain-relieving properties of these medicines mask the symptoms.

With millions of people taking NSAID pain medications daily, it's estimated that more than 100,000 U.S. citizens are hospitalized each year with ulcers and gastrointestinal bleeding linked to NSAID use.

Dr. David Johnson and his colleagues at Eastern Virginia Medical School surveyed patients at a private gastroenterology practice. Nearly 1-in-5 study participants noted use of a NSAID that hadn't been reported verbally to nursing staff, including 8 percent who reported daily use.

The researchers found 22 percent didn't believe the medications were important enough to report, while 30 percent didn't mention use of the drugs because they weren't prescribed by a physician.

The authors noted that this practice.... reflects a common misperception that these medications are insignificant or benign, when actually their chronic use -- particularly among the elderly and those with conditions such as arthritis -- is linked to serious and potentially fatal GI injury and bleeding.

The data was presented at the 2007 annual meeting of the American College of Gastroenterology.

Author's note: given the multiplicity of potential side-effects, patients should be counseled to report over-the-counter NSAID use. This is particularly important in the older population, since this is the group at greatest risk for complications.

Also not to be taken cavalierly, is the use of acetaminophen (Tylenol). This drug, when taken chronically, can lead to kidney damage as well as liver damage. A patient will sometimes say, "I'm only taking Tylenol...what's the big deal?"

The big deal is that long term use of this analgesic has its own set of safety issues.

Bottom line: There are no 100% completely safe drugs (and that includes herbal remedies). Patients need to report everything they are taking when they see their physician.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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