By Dr. W. Gifford Jones
September 9, 2001
"Please write more about non steroidal anti inflammatory drugs (NSAID's) in treating osteoarthritis." This request follows a previous article about "Mobicox" which along with Celebrex and Vioxx have added a new "88 percent" dimension to the treatment of a common painful condition.
Since I've been suffering from the pain of an arthritic hip following a tennis injury I have more than a casual interest in this disease. So to get the latest information I attended the Annual European Congress on Rheumatology in Prague, Czech Republic.
If you have osteoarthritis, the wear and tear type, you have lots of company. This problem accounts for half of all chronic conditions in people aged 60 and over.
It's a debilitating condition. 80 percent of patients experience some degree of limitation of movement and 25 percent cannot perform normal daily activities. That's why I receive so many letters asking for help.
Treating the pain of arthritis is a risky affair. A study from the United Kingdom used an optical instrument to examine the stomachs of patients using the older NSAID's.
The results were shocking. Doctors reported that after two months one in five NSAID users have an ulcer that is present but not causing symptoms. That one in 70 has a painful ulcer, one in 150 a bleeding ulcer and one in 1,200 will die from a gastric hemorrhage.
This means that in the U.S. 107,000 people are hospitalized every year due to gastrointestinal side effects of NSAIDs. And of these 16,500 people die! In Canada 1,900 die from serious uncontrolled gastrointestinal problems.
Obviously I'm more aware of these dangers than the average person. But like you I want to decrease these risks when it's impossible not to treat the pain.
Studies presented by several world authorities at the conference had reassuring news about the new NSAIDs. We've been aware that these new medications were kinder to the stomach, but not sure of the extent.
Now studies show that the new NSAIDs decrease the risk of ulcer complications by 88 percent. This is a huge benefit that enables everyone to sleep better. ‘ 0*0*0* The 88 percent figure also means that fewer patients on the new NSAIDs have to stop these drugs due to side effects. It also results in decreased visits to doctors for upset stomachs. Equally important, less expensive hospitalizations from either bleeding ulcers or ones that perforate the stomach. In the U.S. it's estimated that NSAID side effects costs one billion annually.
But I wanted another question answered at this meeting. I wanted to determine whether the new NSAIDs had any adverse effect on either the cardiovascular system or kidneys.
Dr. Gurkipal Singh from Stanford University Medical Center in the U.S. who conducted studies on Mobicox presented reassuring data. An analysis of 15,000 patients revealed no greater risk of either cardiovascular problems or injury to kidneys. This is contrary to what has been seen with some of the other treatments in this class.
DR Henry M. Rinder, Yale School of Medicine, had this to say, "Mobicox has been prescribed in over 45 million cases worldwide and we are pleased to see these new data on this drug".
So why are new NSAIDs so much better than the older ones? ¡ Dr. John Wallace, Professor of Pharmacology, University of Calgary, said, "Products such as Mobicox represent a promising new generation of NSAID-class drugs. Unlike older NSAIDs new products target particular enzymes that reduce pain and inflammation, while limiting the impact on enzymes that protect the lining of the stomach."
The new NAIDs are contraindicated in patients who have experienced asthma, itching or allergic reactions after taking aspirin or other NSAIDs.
Researchers stressed that keeping fit helps to prevent osteoarthritis. For instance, women who are severely overweight are three times more likely to develop this disease and need a total hip replacement. Obese men are twice as likely to require this operation.
Today's epidemic of obesity and an aging population mean more cases of osteoarthritis in the future.
The cost of caring for these people will be enormous. Today Canada's health budget is 75.2 billion. It's incredible that Health Canada estimates that 10.8 billion is spent just on medicines for arthritis.
Some contend that the newer NSAIDs are more expensive. But they forget that the use of Mobicox at 78 cents a day will save health care dollars when patients suffer from fewer complications. Besides, when this medication gets me back on the tennis court I'll gladly pay the 85 cents a day.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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