Researchers tackle arthritis sufferers' dilemma
Pain-relievers can cause ulcers
April 4, 1997
Web posted at: 11:15 p.m. EST (0415 GMT)
From Correspondent Andrew Holtz
PALO ALTO, California (CNN) -- Pain is a constant companion
for millions of people with arthritis, and relief comes with
Pain-relievers such as ibuprofen, naprosyn and others can
have serious and even life-threatening side-effects such as
ulcers and gastrointestinal bleeding.
One option is anti-ulcer medication.
"We have found a very well-tolerated drug that has been shown
to be effective against ulcers produced by painkillers," says
Dr. Ali Taha of Eastbourne General Hospital in Eastbourne,
That drug is famotidine, known by the brand name Pepcid. It
received considerable attention in an article in the
prestigious New England Journal of Medicine last year.
But it was followed by an article in the Archives of Internal
Medicine warning that the tactic might backfire. Researchers
said suppressing stomach problems with acid blockers like
Pepcid, which are also known as H2 antagonists, might raise
the risk of potentially dangerous bleeding ulcers.
Acid blockers double the risk of ulcers
"You're given a false sense of security," says Dr. Gurkirpal
Singh of Stanford University. "It turns out in our study
that 1,400 people who were taking H2 antagonists and antacids
on a prophylactic basis, actually have more than twice as
high a risk of getting a serious (gastrointestinal)
The apparently contradictory nature of the research leaves
doctors and patients in the middle.
"From a clinician's point of view, sometimes we get answers
to questions that are not always entirely clear," says Dr.
Ronald van Vollenhoven of Stanford. "So then we have to
really start thinking about the individual patient."
And sometimes doctors are out of the loop altogether.
Several anti-inflammatory pain relievers are available over
the counter. And some acid blockers can be purchased without
a prescription, which means patients could be combining them
without their doctors knowing it.
Promising drug still being researched
Everyone agrees it is best to reduce the number of drugs
taken whenever possible, and finding the right kind of drugs
to fight arthritis may also help reduce the need for
One such drug, called a Cox-2 inhibitor, shows promise of
delivering the pain-relief demanded of anti-inflammatory
drugs without triggering ulcers.
Until such drugs appear on pharmacy shelves, however,
rheumatoid arthritis patients and their doctors will have to
keep performing a balancing act between controlling pain and
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