Nearly every arthritis sufferer has taken a traditional painkiller like
aspirin or Aleve. They are a great solution for relieving pain and
inflammation, but there's a definite downside. These drugs often lead to more
trouble including upset stomach and bleeding ulcers.
There are some 20 traditional nonsteroidal anti-inflammatory drugs or
NSAIDs, including aspirin, ibuprofen (Advil and Motrin), naproxen (Aleve),
indomethacin (Indocin), and piroxicam (Feldene).
Rheumatoid arthritis (RA) is perhaps the most common inflammatory arthritis in the world, says Gary S. Firestein, MD, professor of medicine, dean and associate vice chancellor of translational medicine at the University of California, San Diego School of Medicine. In the United States, an estimated 1.3 million people have the disease, and it affects two to three times as many women as men. And RA may be on the rise in women, according to a 2010 Mayo Clinic study. After decades of decline, the incidence...
These drugs can bother the GI tract in a number of different ways, says
Robert Hoffman, MD, chief of rheumatology at the University of Miami Miller
School of Medicine. "Gastritis, esophageal reflux disease [heartburn or
GERD], and bleeding ulcers are all problems that can develop from
Though there are a few things you can do to reduce stomach upsets, there are
no guarantees that serious problems won't develop - serious enough to mean
hospitalization and even death, he adds. Older people with other medical
problems are at especially increased risk.
"If you're taking NSAIDs on a chronic basis, there's a very high
percentage risk that you will develop significant symptoms," says Hoffman.
The bottom line: "Don't treat an arthritis problem on your own. See a
To keep yourself safe:
Use short term only. The FDA advises that over-the-counter
NSAIDs be taken only for 10 days or so. Some people can control their pain this
way, with no serious risks.
Take with food and water. Taking painkillers with a glass
of water and a bit of food seems to ease stomach upsets. Sometimes taking an
NSAID with an antacid or calcium supplement can help.
Stop bad habits. Alcohol and cigarette smoking will up your
risk of stomach problems.
Change time of day. Taking an NSAID in the afternoon or
evening sometimes eases stomach upsets.
Check with your pharmacist. Are you taking other
medications besides an NSAID? Some medications taken together can increase your
risk of side effects. For instance, a blood thinner like Coumadin plus an NSAID
can increase your risk of bleeding. Talk with your pharmacist or a doctor if
you're taking another medication and an NSAID.
Know symptoms of trouble. "Sour stomach, abdominal
pain, dark stools, bright blood in stools, and passing out -- these are all
symptoms of problems like stomach ulcers," says Hoffman. However, many
people don't have any symptoms even though they have serious or
life-threatening bleeding, he adds. Another symptom is vomiting blood or
material that looks like coffee grounds.
See a doctor for persistent pain. If you need extended
relief for ongoing pain, get yourself to a doctor. There may be something more
serious ailing you besides arthritis. A doctor can also ascertain if you have
symptoms of stomach problems. Your doctor can offer other specific treatments.
Also, certain non-NSAID painkillers like Tylenol (acetaminophen) appear to be
safe when taken under a doctor's supervision for some forms of arthritis.
Consider a second medication. Taking a second drug can
reduce your risk of side effects related to traditional NSAIDs, says Hoffman.
Among the options: an acid-blocking drug like Prilosec; an acid-reducing drug
like Zantac; a histamine blocker like Tagamet; or an ulcer-preventive drug like
Cytotec. A few combination drugs do include an NSAID plus a stomach-protective
drug; these are available by prescription only.
Originally published June 2005.
Medically updated September 2006.
SOURCES: Robert Hoffman, MD, chief of rheumatology,
University of Miami Miller School of Medicine. Arthritis Today's Drug Guide
2005. WebMD Medical News: "NSAID Pain Drugs
Injure Small Intestine.""NSAID
Pain Drugs Injure Small Intestine."