What do the heart people say about your arthritis medicines?
by Nathan Wei, MD
The American Heart Association has issued guidelines that support previous statements made by the cardiology community in regards to arthritis pain killers.
In a statement published February 26, 2007, in the cardiology journal, Circulation, the association says these arthritis pain killers do increase the risk of heart attack and stroke, and doctors need to alter the way they prescribe the
se pain relievers to people at risk for, or who have, heart disease. These guidelines include all non-steroidal-anti-inflammatory drugs (NSAIDS) including COX-2 inhibitors such as Celebrex. Author Dr. Elliott M. Antman, a professor of medicine at Harvard Medical School and Brigham and Women's Hospital, said in a prepared statement, "We advise physicians to start with non-pharmacologic treatments such as physical therapy and exercise, weight loss to reduce stress in joints, and heat or cold therapy. If the non-pharmacologic approach does not provide enough pain relief or control of symptoms, we recommend a stepped-care approach when it comes to prescribing drugs," Antman continued.
"Take into account the patient's health history and consider acetaminophen, aspirin and even short-term use of narcotic analgesics as the first step," the cardiologist said. "If further relief is needed, physicians should suggest the least selective cox-2 inhibitors first, moving progressively toward more selective cox-2 inhibitors, which are at the bottom of the list, only if needed. All drugs should be used at the lowest dose necessary to control symptoms and prescribed for the shortest time possible."
A number of studies have concluded that the use of NSAIDs increase the likelihood of cardiovascular disease complications in people with, or at risk for, heart disease.
A meta-analysis found that cox-2 selective NSAIDs were associated with an 86 percent increased risk of heart attack, added Dr. Antman, who also noted that two non-cox-2 NSAID drugs -- diclofenac and ibuprofen -- may also increase the risk of heart problems. In recent years, the U.S. Food and Drug Administration has added warning statements to NSAIDs (with the exception of aspirin) about an increased risk of cardiovascular events when taking these drugs.
Author's note: People should realize that these warnings are not just for prescription NSAIDS but also for over the counter anti-inflammatory drugs. Drugs that patients can try before going to NSAIDS include acetaminophen (Tylenol), tramadol (Ultram), and narcotic analgesics. Unfortunately, all these medicines have potential side effects as well. Injections of glucorticoid or viscosupplements may be helpful in certain situations. Patients who already have cardiac risk factors should make sure those risk factors are being managed.
Topical agents can help with minor pain relief. Certain antidepressant drugs are helpful for pain as are a new class of drug called GABA stimulators (Neurontin, Lyrica).
Physical therapy is a useful adjunctive modality. Regular exercise is also an option since it increases flexibility, increases endorphin production, reduces fatigue, increases muscle strength, and relieves stress. The problem is that many patients with arthritis can't exercise because they hurt too much... and staying off their arthritis medicine is not going to help that!
In the final analysis, this is a situation where risk and benefits must be carefully weighed and quality of life must enter into the equation as well.
About the Author
Nathan Wei, MD, FACP, FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland (http://www.aocm.org). He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and consultant to the National Institutes of Health. For more info: {a href=" http://www.arthritis-treatment-and-relief.com/arthritis-treatment.html"}Arthritis Treatment