Kickas.org Forums Treatments, Drugs and Alternatives AS Pharmacy Worried about relying in NSAIDs

Ba ha, four-thirds! Dow you crack me up. Four thirds of me is ready for bed and sleep and drugs and vitamin C.

My first Rheumy put a sample of indocin in my right hand and a coupon for prevacid in my left hand. He promised me it would eat my guts. I never took it because he scared me to death about it. To hear that Bradford is successful with it, hmmmm, maybe I should have tried it.

I taken many other nsaids and after a time all have hurt my guts. So glad for you Mig that you have never had NSAID gut pain! That is awesome. Prior to my Dx, I ate advil like candy and my disease got progressively worse. I think, after studying about Klebs proliferation etc, I did that to myself with the advil eating habit.

I can tell you, nsaid gut pain is a pain like no other. You think you are going to puke or die, but not sure which will come first if you don't quickly down another stomach protector tablet.

My latest experiment has been to take half a dose of celebrex (which you can't do, lol, so ie: 200mg once per day) and then one Etodolac pill once per day. Usually Etodolac is taken twice a day, so you see I'm taking half of each one, a combination!!! It has worked amazing for me for the last six months. My doc said it was OK, but now the mail order Rx co. is balking at the concurrent use of 2 nsaids. Anyway, the diet DOES work for me, but I can cheat cheat cheat and still feel fairly decent with these two meds, plus ranitidine (my acid blocker).

My luck is running out however, my stomach is starting to talk to me, AND the meds effectiveness is waning. SO back to eating broccoli and meat for me. sigh. Ahhh the life of an AS kicker.

Night all.

Dow - you are such a clown. <LOL> Four thirds...haha

Phew, take care Donette. An NSAID gut is...horrible. They had me chuckng up as well - and the spasms of pain. Ohhh-errrr.

Good you can eat broccoli, I can't touch it (and I loove it) but does a right number on my gut. As for meat, OK if a white meat. Which is diff here in Fr. as they use so many antibiotics in their meat rearing. (Said to be most of all the European countries). Article in latest mag. Bridgitte Bardot, on the intensive rearing of rabbits and the amount of antibiotics they use in the rearing. Help. I had been buying rabbit, thinking, OK. Should be good. Not! Sigh. Also covered other foods and farmed fish, plus the sprays used on fruit an vegetable (grapes came in for a pounding, but I knew about grapes as being covered in chemicals, which one can't wash off easily!) Most interesting. Am struggling a tad with the Fr. but, getting the gist, so getting there. Oh yes, and pre-washed salads and vegetables! The water used is full of yet more...chemicals. So Always re-wash pre-washed salads and vegetable. Never trust to what comes straight off the supermarket shelves, and peel all root vegetables.

OK. Get on with my medical notes in poreparedness for the consultants. Send to em (well'ish) in advance, give em a chance to get info under their belts...!!

(Typoes an all guys, eyes still cr&p)

NSAIDs in ankylosing spondylitis.
Miceli-Richard C, Dougados M.

Rheumatology Department, René Descartes University, Paris, France.

Abstract
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) effects in Ankylosing Spondylitis (AS) are only suspensive but because of their rapid efficacy on inflammatory symptoms they are the first-line treatment in AS. Short term efficacy of NSAIDs in AS is observed for most patients but the correlation of NSAID intake with the long term prognosis and its potential influence on the structural progression of the disease is still unknown. Therefore, and due to the gastrointestinal side effects of these drugs, daily practice is mostly in favour of discontinuous intake of NSAIDs, following the clinical relapses. However, the recent introduction of specific Cox-2 inhibitors, with a lower risk of severe gastrointestinal adverse events, may modify this attitude. Moreover, some patients are inadequately relieved of pain and inflammation by NSAIDs. The number of NSAIDs to be tested and for each NSAID, the optimal dosage that must be used before categorizing a patient as "refractory to NSAID therapy" have to be clarified. The recent determination of response and remission criteria for NSAIDs therapy is the first step towards well-defined guidelines for short-term and long-term management of NSAIDs in AS.

PMID: 12463450 [PubMed - indexed for MEDLINE]

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Gastrointestinal lesions associated with spondyloarthropathies.
Orlando A, Renna S, Perricone G, Cottone M.

Department of General Medicine, Pneumology and Nutrition Clinic, V Cervello Hospital, Palermo University, Palermo, Italy. ambrogiorlando@alice.it

Abstract
Subclinical gut inflammation has been described in up to two-thirds of patients with spondyloarthropathies (SpA). Arthritis represents an extra-intestinal manifestation of several gastrointestinal diseases, including inflammatory bowel disease (IBD), Whipple's disease, Behcet's disease, celiac disease, intestinal bypass surgery, parasitic infections of the gut and pseudomembranous colitis. Moreover about two-thirds of nonsteroidal anti-inflammatory drug users demonstrate intestinal inflammation. Arthritis may manifest as a peripheral or axial arthritis. The spondyloarthropathy family consists of the following entities: ankylosing spondylitis, undifferentiated spondyloarthritis, reactive arthritis, psoriatic arthritis, spondyloarthritis associated with IBD, juvenile onset spondyloarthritis. This topic reviews the major gastrointestinal manifestations that can occur in patients with SpA and in nonsteroidal anti-inflammatory drugs users.PMID: 19468992 [PubMed - indexed for MEDLINE]PMCID: PMC2686900Free PMC Article

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Ankylosing Spondylitis
Ankylosing spondylitis, commonly referred to as arthritis of the spine, .... Long-term use of NSAIDs may have a damaging effect on chondrocyte (cartilage) ...
ankylosing-spondylitis.blogspot.com/ - Similar

[PDF] Pharmacotherapy (excluding biotherapies) for ...
continuous use of NSAIDs is not advisable. Grade D. 96.8%. 4. Systemic glucocorticoid therapy is not recommended in patients with ankylosing spondylitis, ...
www2.courses.vcu.edu/ptxed/as/download/Joint%20Bone%20Spin...

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Cannot get away from the fact that gut and the spondy monster are indeed all too often bedfellows. Even one-third would be sufficient to raise the lid on the matter - which cannot be ignored, nor brushed under the carpet. One has to be aware, very aware, of the problems associated with and between gut and AS. (V. lucky for those who are not so compromised! Sure do wish I were not. 'Smile'.)

Rafts of info out there covering the problem. So think we can lay it to rest. Some are affected, some are not. But to be aware, that one might indeed be in the majority, of those who are affected.

This is a good 'general' paper: EULAR and ASAS research aired-

http://thejns.org/doi/pdf/10.3171/FOC/2008/24/1/E4

Medical management of ankylosing spondylitis
ALEXANDER A. KHALESSI, M.D., M.S.,1BRYAN C. OH, M.D.,1 AND MICHAEL Y. WANG, M.D.2
1Department of Neurological Surgery, University of Southern California, Los Angeles, California;
and 2Department of Neurological Surgery, University of Miami, Florida

"PIn the following literature review the authors consider the available evidence for the medical management of patients
with ankylosing spondylitis (AS), and they critically assess current treatment guidelines. Medical therapy for axial disease
in AS emphasizes improvement in patients’ pain and overall function. First-line treatments include individualized physical therapy and nonsteroidal antiinflammatory drugs (NSAIDs) in conjunction with gastroprotective therapy. After an adequate trial of therapy with two NSAIDs exceeding 3 months or limited by medication toxicity, the patient may undergo tumor necrosis factor–a blockade therapy. Response should occur within 6–12 weeks, and patients must undergo tuberculosis screening. Evidence does not currently support the use"

(snip...) "Nonsteroidal antiinflammatory drug and coxib toxicity profiles center around gastrointestinal and cardiovascular complications. Nonsteroidal antiinflammatory drugs confer a dose-dependent increased risk of gastrointestinal bleeding (RR 5.36, 95% CI 1.79–16.10). Gastroprotective agents such as misoprostol, H2 blockers, and proton-pump inhibitors mitigate this risk (RR 0.40, 95% CI 0.03–0.74).Coxibs pose a lower overall risk of serious gastrointestinal toxicity but are associated with considerable diarrhea and dyspeptic symptoms. [color:#993399][b](Don't tell me about it, exactly as you warned me those many years ago Mig. Horrible: exacerbated RefluxGERD)[/b][/color] Coxibs further carry an increased risk of thromboembolic complications such as myocardial infarction or stroke. Relative risks of rofecoxib 2.30 (95% CI 1.22–4.33), valdecoxib 3.7 (95% CI 1.0–13.5) and naproxen 2.0 (no CI available) bear out this class effect. Data regarding the cardiovascular complications of NSAID use are under investigation.15 According to the ASAS/EULAR guidelines, NSAIDs are therefore the first-line drug treatment for AS patients with pain and stiffness. In the face of increased gastrointestinal
risks, either a nonselective NSAID plus a gastroprotective
agent, or a selective cyclooxygenase-2 inhibitor should be used. Evidence does not currently support the use
of local or systemic corticosteroid therapy in patients with
AS spinal disease. Class Ib evidence exists that local corticosteroid injections may provide short-term palliation of
sacroiliitis symptoms (ES 1.92, 95% CI 0.53–3.35) and Class IV evidence supports local steroid injections for enthesitis.16"

(snip...) "Disease-Modifying Antirheumatic Drugs Sulfasalazine and methotrexate represent the most widely used DMARDs. Individual Cochrane reviews exist regarding the utility of these agents in the treatment of AS.
Unfortunately, neither agent meaningfully modifies pain or functionality attributable to AS spinal disease.4,5 Eleven randomized trials examined sulfasalazine use in patients with AS and contributed to the Cochrane metaanalysis. 6 Although erythrocyte sedimentation rate (mean –4.79, 95% CI –8.80 to –0.78) and morning stiffness
(–13.89 on a 100-point visual analog scale; 95% CI –22.54
to –5.24) improved significantly with sulfasalazine, back
pain (ES –2.38, 95% CI –5.78 to 1.03) and physical function
(ES 0.20, 95% CI –0.77 to 1.18) did not improve. Moreover, common toxicities (RR 2.37 for adverse event,
95% CI 1.58–3.55) include gastrointestinal symptoms, mucocutaneous, hepatic, or hematological manifestations.13
The Cochrane review of methotrexate examined 116 patients with AS across 3 trials and found no significant improvements in BASDAI or BASFI. Pooled results for spinal pain (ES –0.05, 95% CI –0.48 to 0.38) and function (ES 0.02, 95% CI –0.40 to 0.45) failed to achieve statistical significance relative to placebo. Methotrexate toxicities
included nausea (RR 2.12, 95% CI 1.50–2.98) and hepatic
abnormalities (RR 4.12, 95% CI 2.22–7.63). In an observational
study of 14 patients, the authors estimated that 21% of patients taking methotrexate must stop the drug due to toxicity.4Bisphosphonates and thalidomide remain other areas of open DMARD investigation in AS. Maksymowych et al.14 published a Class III study involving high-dose pamidronate and reported significantly improved function (ES
0.73, 95% CI 0.29–1.17) and axial pain (p = 0.003). Anecdotal evidence supports the use of thalidomide for axial pain, but current ASAS/EULAR guidelines found thalidomide’s
toxicity profile prohibitive.15The DMARDs, including sulfasalazine and methotrexate, therefore do not currently enjoy empirical support for their use in axial AS disease. Sulfasalazine may have a limited
role in treatment of peripheral joint symptoms.5 Tumor Necrosis Factor and Interleukin Inhibitors."

(snip...) anti-TNF THerapy: "inhibitors is rapid, and the therapeutic effect persists for 3 years with continuing treatment. Treatment cessation results in a high incidence of relapse. Due to the rapid onset, ASAS/EULAR established a 6–12-week time frame to Neurosurg. Focus / Volume 24 / January 2008
Medical management in ankylosing spondylitis3 identify nonresponders and terminate therapy.15 The need for rapid identification of patients with AS not experiencing the benefits of TNFa blockade is to spare the patient any therapeutic risks.14 The TNFa inhibition increases the patient’s susceptibility to common upper respiratory infections and tuberculous disease; screening for Mycobacterium tuberculosis is now a prerequisite for therapy initiation. Infliximab may precipitate a positive antinuclear antibody titer, and the incidences of demyelinating disease and lupuslike syndromes, although anecdotally reported, remains unknown.2" (more...)



I left in some extra info as it was very interesting and of course pertinent to treatment of AS!

(Apologies - tried to do summat about the line endings, but didn't work! Always diff when dealing with columnar input...!)

28yrs on NSAID! Man you are god gifted! I took NSAID once a week on an avg. (olfen 50mg), specially before long flights , but luckily I can manage my pain without any meds and only with LSD and walking

Arindam

on daypro now. not sure how much good its doing, too soon to know, but doesn't seem to be causing any edema or even gastritis.

i'm really thinking one can't lump them all together, i've taken so many now, and my personal experience is how very very different they all are.

that really surprises me! i would never in 1000 years have guessed that. would have bet against it very very strongly.

never ceases to amaze me how much i learn and how often i am surprised.

i think we each just need to try them and see what happens.

of course i have one thing going for me that not everyone has. my gastritis is very painful, just a little bit of inflammation in my tummy, and i'm warned. so i probably don't have to worry about dying from a bleeding ulcer unknowing of what is going on. so a little bit of gastritis pain and i can back off whatever is causing it, whereas others might need to be scoped or something to make sure nothing bad is happening down there. if i didn't have this gastritis pain to use as a guide, think i'd be a bit more apprehensive than i am with this experiment.

just my two cents.

Naproxen helps me significantly, including staving off full-blown iritis if I take a couple at the first warning signs of eye irritation!

Unfortunately I overdid it; after taking one (or sometimes two) Aleve everyday for 1.5 years, heartburn started coming on
Whoops, so much for that advice from a doc that one Aleve a day was such a small amount, don't need to worry about digestive issues... luckily the heartburn cleared up quickly once I switched from Aleve to NSD for my standard anti-inflammation strategy.

Still, I keep a bottle of Aleve around for occasional use, and have had to use it quash eye irritation when my diet experiments went awry. I recall you're prone to that stupid iritis as well, so definitely keep that in mind if your eyes ever start to feel irritated.

Oh, that is really good to know about it helping against early signs of iritis! I will definitely remember! Last year's attack started with a whole week of non-specific eye pain, before it suddenly went light-sensitive and I knew it was time to go see the eye doc right away....thank you very much!!

Been taking Relafen for my AS for sometime now....... no problems whatsoever with this NSAID....take 2 tabs once a day.