In the News: 12/04
Vioxx R.I.P.: What Now For Arthritis Pain?
Since Vioxx has now vanished from pharmacy shelves, what’s the arthritis sufferer to do? According to Arthritis Advisor Editor-in-Chief Dr. Kenneth Marks, you have plenty of options.
First, you can switch to another COX-2 inhibitor. Pfizer, which manufactures Celebrex as well as Bextra, recently released data from a study of 6,000 patients which revealed that Celebrex does not heighten the risk of heart attack or stroke. The company also announced plans for a new study of the drug in osteoarthritis patients who have preexisting heart disease. “Unfortunately,” says Dr. Marks, “since Bextra is newer to the market, much less is known about it. Do we know enough to say it’s safe. The answer is no.” As we went to press, Pfizer had in fact issued a warning to doctors that Bextra might increase the risk of heart attack and stroke in coronary-artery bypass patients.
A second strategy is to stick with standard front-line drugs, like ibuprofen and naproxen, whose effectiveness, safety, and side effects are universally known. “Some patients were prescribed Vioxx,” says Dr. Marks, “because it was new and sexy.” Dr. Eric Topol, chairman of cardiovascular medicine at The Cleveland Clinic, chided the effectiveness of the entire class of coxibs in a recent issue of the Journal of the American Medical Association, claiming they’re not worth taking because of their “marginal efficiency, heightened risk, and excessive cost.” If you’re concerned about gastrointestinal problems, combine a front-line nonsteroidal anti-inflammatory drug (NSAID) with a stomach-friendly medication like Nexium, which inhibits stomach acid. Although Nexium, a proton pump inhibitor, is primarily designed to ward off acid reflux, it works well in combination with traditional pain relievers.
A third alternative is a combination drug like Arthrotec, which combines the pain-reliever diclofenac with misoprostol, a synthetic prostaglandin known to protect the stomach lining.
Finally, there’s the old standby—Tylenol—which Dr. Marks calls “the wonder drug of our time.” It’s best for mild to moderate arthritis, and when used with a dietary supplement such as glucosamine and chondroitin sulfate, it can often reduce your need for medications altogether.
Bottom line: Although COX-2 inhibitors do have a lower risk of gastrointestinal side effects, they provide no better pain relief than NSAIDs, which are far less expensive and available over the counter.
Prednisone Puts RA Patients At Pneumonia Risk
If you’re taking prednisone for rheumatoid arthritis, you’re running a higher risk of contracting pneumonia than patients on biologic drugs. That finding, presented during a recent meeting of the American College of Rheumatology, was supported by a two-and-a-half-year study of 15,966 long-term arthritis patients. Biologic drugs—such as adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade)—mimic the effects of substances naturally made by the body’s immune system. Although beneficial, they have been associated with increased rates of infection. While researchers found that participants who used biologic drugs were 30 percent more likely to get pneumonia, those on prednisone, the corticosteroid most often prescribed to treat inflammation, were 170 percent more likely to contract the disease.
It’s Conclusive: Barometer, Thermometer Do Affect Joint Pain
If you’re like most arthritis sufferers, you probably think that the weather influences your joint pain—and a recent study proves you right. Researchers at the Tufts New England Medical Center recently merged data from a large-scale glucosamine trial (across 41 states) with National Oceanic and Atmospheric Administration data to compare the influence of barometric pressure and air temperature on trial participants with knee arthritis. Their findings: Changes in barometric pressure have a very strong association with increased knee pain. Cooler temperatures were also consistently, though not as strongly, associated with increased pain. No significant association was found with dew point or precipitation.