Recent Considerations in Nonsteroidal
Anti–inflammatory Drug Gastropathy

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM: American Journal of Medicine 1998 (Jul 27);   105 (1B):   31S–38S

Singh G

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

Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.

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.

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

Ongoing ARAMIS research is aimed at developing a simple point-score system for estimating individual risks of developing serious NSAID-related GI complications.

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