The American College of Rheumatology is advising physicians to follow current treatment guidelines and manufacturers' dosage recommendations for NSAIDs. Treatment guidelines exist to help doctors choose the best options for their patients, based on current scientific studies.
The Arthritis Foundation said in a statement that the findings about the drugs should not have any immediate impact on the clinical use of them.
"Non-steroidal anti-inflammatory drugs continue to play an important role in the management of arthritis pain," says John H. Klippel, M.D., president and CEO of the Arthritis Foundation. "Patients who derive benefit from these drugs should remain on their treatment regimen, and discuss concerns with their physicians," he says.
But Charles A. Birbara, M.D., a rheumatologist and associate professor of medicine at the University of Massachusetts Medical School in Worcester, Mass., says that he has prescribed COX inhibitors cautiously in older people or those with cardiovascular or renal disease ever since early clinical studies discovered a possible risk in this patient population.
"I'm not always willing to take a risk with my patients, because we clearly don't have a complete understanding of all the potential clinical issues associated with use of these drugs," he says. Even before the controversy, Birbara notes that the long-term effects of COX-2 agents were unknown. Besides, he says, there are other treatment options available that are equally effective.
"There are so many wonderful things happening with respect to current therapies of arthritis," he says. "Clearly, we are so much better able to control inflammatory arthritis with new biologic agents." Birbara adds that so many people whose lives were diminished by joint disease can now look forward to an unrestricted lifestyle, which was "not even imaginable just a few short years ago."
Richard Shirley, 64, an avid birdwatcher from Wrentham, Mass., battled rheumatoid arthritis in nearly every joint in his body for more than 25 years before he saw Birbara. He couldn't button his shirt cuffs, walk frontward down a flight of stairs, or get in and out of a car without a struggle. At times, his hands were so swollen he couldn't grasp small objects or make a closed fist. Shirley had his wedding ring resized so it would fit.
