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| |  ACR MEETING: Two Types Of Arthritis Carry Different, Measurable Risks Of Drug-Related GI Bleeding PALO ALTO, CA -- Nov. 10, 1998 -- For decades, people with arthritis have tried to balance the need for pain relief against the risk of stomach bleeding from non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen. New scientific data and a questionnaire-based tool can now help them weigh their risk of experiencing this serious side effect. The degree of bleeding risk, it turns out, is strongly influenced by the form of arthritis the person has. New research conducted at Stanford University School of Medicine shows that the NSAID-related bleeding risk is about 50 percent higher in rheumatoid arthritis patients than in osteoarthritis patients, said Gurkirpal Singh, MD, a senior research scholar and clinical assistant professor of medicine (immunology and rheumatology) at Stanford. Osteoarthritis is the more common, "wear and tear" form of the disease. Rheumatoid arthritis is generally more severe and involves an immune system disorder. An estimated 22 million Americans suffer from osteoarthritis, and approximately two million others suffer from rheumatoid arthritis. The newly discovered difference in bleeding risks may reflect some interaction between the pain medication and the disease process, Singh suggested. His recent work also confirmed that, in people with either form of arthritis, gastrointestinal bleeding can result even from the low doses recommended in over-the-counter NSAIDs. "Scientifically we have shown that the diagnosis of osteoarthritis or rheumatoid arthritis directly correlates with the amount of bleeding risk in predictable ways. We have known for decades that NSAIDs are associated with stomach bleeding, but we had never documented precisely what the effects were and how much NSAID people could take before they were at risk," he said. Singh will describe his group’s findings in two papers presented Nov. 9 and 10 at the annual meeting of the American College of Rheumatology, held in San Diego. To help arthritis patients of both types gauge their individual risk of NSAID-related stomach bleeding, Singh and his colleagues developed a simple questionnaire called the SCORE test, which is slated to be unveiled in Los Angeles later this month by a coalition of nonprofit, governmental and pharmaceutical organizations. "Millions of people throughout the world are willing to take some risk if it means relief from severe, disabling pain. We needed a risk/benefit system, and that’s what we’ve done," said Singh. The risk-calculating questionnaire is based on studies of 6,386 rheumatoid and osteoarthritis patients whose cases were tracked for an average of nearly five years each. The questionnaire asks about the patient’s age, overall health, type of arthritis, previous history of gastrointestinal bleeding, previous NSAID side effects, and length of time on prednisone (a steroidal medication prescribed for rheumatoid arthritis and other conditions). "The score [derived from the answers to these questions] is a reliable and accurate predictor of serious NSAID-related gastrointestinal events," Singh said. "This will allow patients and physicians to weigh the potential risk/benefit ratio of NSAID therapy in an individual case. Treatment strategies can be tailored to an individual’s personal needs and risk profile." It’s too soon to extend these findings to NSAID users who don’t have arthritis, he cautioned. "While we have every confidence that the general conclusions about side effects apply to persons who take NSAIDs for conditions other than arthritis -- headaches, for example -- we don’t have scientific evidence that the results will be the same," said Singh. "Also, as we learned from the differences between the gastrointestinal risks faced by osteoarthritis and rheumatoid arthritis patients, people’s risk of side effects seems to be influenced by the condition that drew them to the NSAID in the first place." Confusion over NSAIDs The first step for protection against NSAID side effects is awareness, he said. "There has been much confusion about NSAIDs and their risks and benefits. For example, some people mistakenly believed that because they were taking an over-the-counter dose, they weren’t at risk of side effects," Singh said. "Similarly, physicians need to be alerted to monitor for symptoms on a regular basis to ensure that the doses they are recommending are not resulting in complications." One alternative for people at high risk of gastrointestinal side effects is to try a non-NSAID pain reliever such as acetaminophen, Singh noted. However, acetaminophen doesn’t provide relief for everyone, and many people will need to continue using NSAIDs, he said.
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