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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 choice?

"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 arthritis.

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 levels.

"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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