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Spring 2005

Medications for Arthritis Pain Scrutinized for Safety

Every drug has side effects, but the extent may stay unknown until the medication is broadly used

Study results indicating that cox-2 inhibitors—members of a popular class of arthritis medication—may cause heart attack or stroke in certain patients has sparked concern about their role in arthritis pain management and the suitability for continued use.

Cox-2 inhibitors can benefit patients with osteoarthritis (“wear and tear”) or inflammatory (rheumatoid) arthritis by their ability to reduce pain with less harm to the stomach than traditional non-steroidal anti-inflammatory drugs (NSAIDS), explains UCLA rheumatologist Morris Kokhab, M.D. Arthritis patients often need medication to alleviate joint pain, stiffness and swelling, and repeated use of aspirin or NSAIDS increases the risk of stomach distress, including ulcers.

“I suggest that patients with risk factors for cardiovascular disease, including high blood pressure, diabetes and lipid disorders, avoid cox-2 inhibitors until further data are revealed,” says Dr. Kokhab. “The Federal Drug Administration recently recommended—with its highest level of warning—to keep cox-2 drugs available to those without cardiovascular risk. Physicians should regularly monitor these patients’ blood pressure and check for any swelling of the lower extremities.”

“Every drug has side effects, but the extent may stay unknown until the medication is broadly used,” explains Edgar Arriola, PharmD., coordinator of UCLA’s Drug Information Center. “Drug studies are usually relatively small (between 100 and 1,000 participants) and focus on the usefulness of a medication for a specific symptom. Consequently, drug trials may fail to reveal side effects that may develop when the drug is more widely used by a variety of patients.

” Dr. Kokhab adds, “Most patients benefit from treatment plans that include a combination of oral medications, with or without cox-2 drugs, as well as other complementary treatment modalities such as exercise, topical analgesics and cartilage injections that can provide significant relief.”

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