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COX-2 Inhibitors

Program: Arthritis: Controlling Joint Pain and Disability
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Andrew Schorr:

Okay. So that's a warning about the over-the-counter medicines. So what about prescriptions, though? We have some drugs, we were warned about some when we mentioned these COX-2 inhibitors. Some were taken off the market. Where do they fit in? What do we have now? And how useful are they?

Dr. Dugowson:

They actually are wonderful drugs when used properly because for people who have more than occasional joint pain we need a fairly powerful anti-inflammatory. The name for all of these drugs is nonsteroidal anti-inflammatories, and what that means is it's not prednisone or steroids. And so they are an alternative to an even more powerful drug, prednisone or cortisone. So they are very commonly used. And the most common side effects are either stomach or more recently we've discovered that fluid retention, hypertension and then other cardiovascular risks including heart attack are associated with the use of especially higher doses of the COX-2 drugs.

Andrew Schorr:

Some people were really upset when some of these drugs were pulled. If they didn't have cardiac problems they said, This was given me pain relief and you're taking it away from me. What are my options?

Dr. Dugowson:

Well, I think the American College of Rheumatology's position is very useful in this regard. There are people who have a very low risk. They're young, healthy, have no risk of hypertension or heart disease and have a very disabling condition, like RA or lupus or spondylitis, and they and their physician, often a rheumatologist, have said, well, we think that the risks and the benefits at least for the short term or for right now are very important either for the quality of their life, their ability to take care of the family or their job. So I think that the FDA has heard that to some extent. It continues to be a very difficult question, however, because if people don't use these drugs correctly or if they don't assess their own risk level, the risk to them can be very high. So it is complicated and it's something the patient and their doctor really need to walk through pretty carefully. If you are older, if you have had a heart attack, if you have hypertension, if you have clotting problems, all of those are reasons to stay away from these riskier drugs.

Andrew Schorr:

Okay. So we've talked about pain and the medicines that are available. If somebody has pain, and you started earlier on about tennis elbow, but if somebody has recurring pain in their joints when do they go to the doctor and what do they say? How do they advocate for themselves so they get the proper diagnosis and care?

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