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What is the level of risk you're willing to take with medications available to treat arthritis?

From the FDA Consumer Magazine, March-April 2005 by Carol Rados

Few people with arthritis would be willing to stop taking a medication that works, especially when nothing else has. But what if joint pain and stiffness are inevitable if you don't take the medication, yet heart problems could occur if you do? Health officials say that, as with any drug, only you and your doctor can determine the level of risk that is acceptable with medications currently available to treat arthritis.

The unsettling news in late 2004 that the popular anti-inflammatory arthritis drugs Vioxx (rofecoxib), Celebrex (celecoxib), and Bextra (valdecoxib) could cause a heart attack or stroke or aggravate high blood pressure has left some patients wondering whether they should keep taking them.

Data from clinical trials showed that cyclooxygenase-2 selective agents, better known as COX-2 inhibitors, may be associated with an increased risk of serious cardiovascular problems, especially when used in high doses or for long periods in patients with existing cardiovascular disease, or in very high-risk situations, such as immediately after heart surgery. COX-2 inhibitors are the newest subset of non-steroidal anti-inflammatory drugs (NSAIDs). COX-2 inhibitors were developed specifically to decrease the well-recognized gastric side effects and intolerance associated with the use of some NSAIDs.

Traditional NSAIDs, such as aspirin or ibuprofen, act by blocking the production of a family of chemicals known as prostaglandins, which are not only important in the development of inflammation, but also play an important role in maintaining the integrity of the stomach lining. At least two enzymes are involved in this inflammation, namely cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). Traditional NSAIDs inhibit both COX-1 and COX-2. Unfortunately, this non-selective inhibition of both COX enzymes also inhibits those prostaglandins involved in some of the important "housekeeping" functions of the body, such as helping blood to clot and protecting the stomach from ulceration.

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