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Arthritis study should provide relief when choosing pain medication
Choosing an arthritis pain reliever in a pharmacy aisle isn't as simple
as it sounds - there are a dizzying number of choices available. And
what about a prescription medicine, rather than an over-the-counter
"Is one safer than another?s questions Dr. Stephen Coyle, chief medical
officer at Winnipeg's Misericordia Health Centre, "We don't know - many
have never been compared before." Coyle is about to start comparing
arthritic drugs in the PRECISION study, hoping to find out which is
safest for arthritic patients who are at high risk of cardiovascular
disease - such as heart attack or stroke.
The study will compare the effectiveness of Celebrex, Ibuprofen and
Naproxen (available by prescription in Canada, but over-the-counter in
the United States) in patients with osteoarthritis or rheumatoid
All three drugs are pain relievers called nonsteroidal
anti-inflammatory drugs, or NSAIDs. Ibuprofen and Naproxen are referred
to as traditional NSAIDs, but Celebrex is called a COX-2 inhibitor
because it blocks, or inhibits, an enzyme in the body called COX-2 that
causes pain and inflammation.
"There have been some questions raised about the safety of both the
COX-2 inhibitors and traditional NSAIDs in people who have or are at
high risk for heart disease," explains Coyle. "This study is important
because large numbers of people who need long-term treatment for
arthritis pain are elderly and more likely to be at risk for
cardiovascular disease. We want to make sure they are getting the right
kind of therapy."
Patients in the study will take one of the three medications for six
months, with Coyle and research nurse Anne Tesarski monitoring pain
"We'll start with the lowest possible dose and increase
until people have enough pain relief that they can do their activities
of daily living," says Coyle. Neither the patients nor the researchers
will know which medication the patients are taking to rule out any
bias. Coyle is quick to point out all patients will be given a
protective drug for their stomachs as well.
"All these arthritic drugs produce stomach ulcers," he
explains, "In fact, 30 per cent of all admissions to emergency rooms in
North America for adverse drug reactions are for stomach bleeding."
This is where another "safety" aspect of the study
comes into play - patients are educated about the risk of stomach
bleeding when they buy these over-the-counter medications for
"temporary relief of pain."
According to Coyle, there are numerous other things
people could be doing to reduce their arthritic pain rather than taking
medication, such as: weight loss, exercise and strength training,
taking food supplements and more.
So why study these three arthritic drugs if people
shouldn't necessarily be taking them anyway? "People will continue to
take them," says Coyle. "And we need to find out which is safest."
Coyle has two hypotheses: he predicts one of the medications will be
safer than the other two. In other words, people taking that drug will
have a lower risk of suffering a heart attack or stroke. He also thinks
there will be a decrease in stomach bleeding because people are taking
a protective medication.
Misericordia Health Centre is just one centre participating in the PRECISION study - there will be 20,000 patients worldwide.
Misericordia Health Centre provides an array of
specialized programs including our Eye Care Centre of Excellence,
long-term and interim care, urgent care, ambulatory clinics, diagnostic
imaging, laboratory services and pediatric dental surgery. Misericordia
also operates the internationally recognized Provincial Health Contact
Centre, including Health Links-Info SantŽ.
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