By Dr. W. Gifford Jones
October 5, 2003
Elephants normally win when fighting a mouse. But for once the mouse has won. A Canadian company has beaten the U.S. and achieved an historic first. Dimethaid Research has developed a non-oral NSAID" (nonsteroidal anti-inflammatory drug) to treat osteoarthritis. And since it's locally applied it dramatically reduces the risk of stomach complications associated with oral NSAIDs.
It's estimated that three million Canadians suffer from osteoarthritis. It's the wear-and-tear type of arthritis which presents a challenge for patients day after day. Some people have had to give up a favourite sport, gardening or taking their daily walk. Others find it increasingly difficult to navigate the stairs or carry out household chores. Today, with an aging population, there's a huge need for this safe and effective remedy.
Dr. Peter Tugwell, Professor of Medicine at the University of Ottawa, recently presented his findings on Pennsaid to the European Congress of Rheumatology in Lisbon, Portugal.
The study was conducted on 622 Canadian patients suffering from knee osteoarthritis. The purpose was to compare Pennsaid with the maximum daily dose of oral diclofenac, a nonsteroidal anti-inflammatory drug.
Researchers found Pennsaid was as effective as the oral dose of NSAID in relieving pain and the physical impairment of arthritis. And since it's applied locally there is much less likelihood of the complications associated with oral NSAIDs.
Why is Pennsaid such an historic event? For years the standard treatment of arthritis has been the use of oral NSAIDs. They have helped millions of patients in North America. But treating arthritis with them has always been a risky affair. Every year 1,900 Canadians die from the complications of these drugs.
It's a worldwide problem. A study in the United Kingdom used an optical instrument to examine the stomachs of patients using the older NSAIDs. The results were shocking. Doctors reported that after two months of use one in five patients had a stomach ulcer without symptoms, one in 70 a painful ulcer, one in 150 a bleeding ulcer and one in 1200 died from a gastric hemorrhage.
In a Danish study, researchers tracked 207,000 people for 19 years who had been on NSAIDs to determine the extent of intestinal bleeding. It showed that NSAIDs increased the risk of bleeding five times. For those over 75 years of age the risk was 27 times greater. And in the U.S., 107,000 people are hospitalized every year due to the intestinal side-effects of NSAIDs and 16,500 die. It's a huge price to pay for pain relief.
But in addition to life-threatening complications many patients using oral NSAIDs complain of abdominal pain , dyspepsia, nausea, diarrhea and there may be abnormalities in liver function tests.
This happens because the early NSAIDs destroyed an enzyme called COX-1 which normally protects the stomach's lining from inflammation.
So researchers did the obvious thing. They designed new NSAIDs such as Celebrex, Mobicox and Vioxx to preserve COX —1 and protect the stomach. Studies show these NSAIDs are an improvement, but they have not eliminated serious complications.
There is another aspect of NSAID medication that is rarely explained to patients suffering from arthritis. I frequently see patients swallowing NSAIDs as if they were like M&M candies. They have never been informed that NSAIDs are powerful drugs that can have adverse effects on kidneys, particularly aging ones.
The availability of a stomach-friendly NSAID fills a big void in therapy. Initially, Pennsaid solution is applied onto the knee four times daily. Later as the pain subsides fewer daily applications may be required. The most common side-effect involves a minor skin reaction at the site of application.
Pennsaid will undoubtedly save lives and be a godsend for those suffering from arthritis. But it will also help to save millions of dollars spent treating the complications of oral NSAID medication.
Doctors and patients have waited a long time for a locally applied NSAID. So if you're suffering from osteoarthritis ask your doctor about Pennsaid. It could be a major step in returning to a more comfortable life. And let me know if you are helped by Pennsaid.
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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