Recent Considerations in Nonsteroidal Anti–inflammatory Drug Gastropathy


Recent Considerations in Nonsteroidal Anti–inflammatory Drug Gastropathy

Gurkirpal Singh, MD

Department of Medicine, ARAMIS Postmarketing Surveillance Program,
Stanford University of Medicine, Palo Alto, California 94303, USA

The Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) Post-Marketing Surveillance Program (PMS) has prospectively followed patient status and outcomes, drug side effects, and the economic impact of illness for >11,000 arthritis patients at 8 participating institutions in the United States and Canada

Analysis of these data indicates that:

  1. osteoarthritis (OA) and rheumatoid arthritis (RA) patients are 2.5—5.5 times more likely than the general population to be hospitalized for NSAID-related GI events;

  2. the absolute risk for serious NSAID-related GI toxicity remains constant and the cumulative risk increases over time;

  3. there are no reliable warning signals- >80% of patients with serious GI complications had no prior GI symptoms;

  4. independent risk factors for serious GI events were age, prednisone use, NSAID dose, disability level, and previous NSAID-induced GI symptoms; and

  5. antacids and H2 antagonists do not prevent NSAID-induced gastric ulcers, and high-risk NSAID users who take gastro-protective drugs are more likely to have serious GI complications than patients not taking such medications.

The author concludes:

Currently, limiting NSAID use is the only way to decrease the risk of NSAID-related GI events.

No one has yet calculated the total cost for hospitalizing the 107,000 patients, or the pain and suffering experienced by the families of those 16,500 individuals who die, simply for using NSAIDs for pain relief.

Research has clearly demonstrated that Omege-3 Fatty acids provides the same level of pain relief as NSAIDs, and investigators have reported that rheumatoid arthritis patients, consuming omega-3 dietary supplements, were able to either lower or discontinue their background doses of nonsteroidal antiinflammatory drugs.

Considering that patients with arthritis are one of the leading group-users of NSAIDs, perhaps it’s time for medical guidelines to recommend Omega-3 fatty acids FIRST for pain relief, before resorting to the more dangerous NSAIDs.