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Get A Grip On Arthritis
and other inflammatory disorders
Conventional Treatments for Inflammation
Research is currently underway using drugs to inhibit the inflammatory process, instead of just masking the symptoms. The goal is to control pro-inflammatory immune cytokines like Interleukin-1 (IL-1), Interleukin-6 (IL-6), prostaglandins and histamine, among others. Carl Germano and William Cabot, in their book Nature's Pain Killers, state that, "IL-1 is directly responsible for breaking down collagen and other connective tissue, increasing inflammatory prostaglandin production and dilating blood vessels - all actions that create pain. IL-6 is a powerful pro-inflammatory factor that contributes to the symptoms of dozens of inflammatory conditions, including rheumatoid arthritis." Bad prostaglandins also cause pain. They are made from enzymes called Cox enzymes. Cox-2 enzymes generate inflammation that causes pain. The goal in preventing inflammation is to halt or control the release of the immune messengers creating the assault on healthy cells and tissues.
Until recently, the goal of conventional medication for treatment of inflammatory conditions has focused largely on controlling pain, with mixed results.
PAIN MEDICATION DANGERS
North Americans spend over US$3.9 billion on over-the-counter pain medications. Acetaminophen is the most com-monly used painkiller, followed by non-steroidal anti-inflammatory (NSAIDs) such as ibuprofen and finally aspirin. More pain medications are purchased for the control of arthritis symptoms than for any other disorder.
Despite the popularity of the various pain medications, their safety is not guaranteed. Unintentional overdoses of acetaminophen are very common. Patients who are in severe pain may be tempted to take too many tablets. The dosage recommendations must be followed carefully. When taken in higher than recommended doses, acetaminophen causes liver damage, particularly when it is combined with alcohol. Acetaminophen overdose is the leading cause of acute liver failure and causes ten percent of all cases of kidney failure. Most people do not realize that they are mixing a deadly concoction when they combine alcohol (even a couple of drinks) with acetaminophen, but liver toxicity can occur even when taking as little as two extra doses per day, combined with alcoholic beverages.
Long-term use of NSAIDs causes 20,000 deaths in the U.S. annually. In addition, over 120,000 North Americans are hospitalized each year, suffering from the side effects of NSAIDs. Side effects include gastrointestinal complaints (bleeding, nausea and vomiting), liver damage, stomach ulcers, allergic reactions, immune system depression, mental confusion and kidney failure. Adverse drug interactions are common and central nervous system toxicity can occur with some of the NSAIDs. Patients receiving corticosteroids and NSAIDs together have a 15 times greater risk for peptic ulcer disease than those who are receiving no medication. The New England Journal of Medicine reported that NSAIDs are the cause of 15 percent of all drug-induced cases of kidney failure.
NSAIDs and Joint Destruction
There is also evidence that NSAIDs are counterproductive when it comes to our joints. A study published in The Lancet found that NSAIDs contribute to cartilage destruction. Yes, you read that correctly! NSAIDs can cause joint destruction. I reported years ago on a study that examined 294 hip X-rays, finding that the hip joints of patients taking NSAIDs had greater joint destruction than the hip joints of patients not taking NSAIDs. Now a new animal study published in The Journal of Bone and Mineral Research has also shown bone repair problems related to NSAIDs. Researchers at the University of Medicine and Dentistry in New Jersey gave 253 rats with broken bones either Vioxx, Celebrex, Indomethacin or no drug. The rats given Vioxx or Celebrex took more than two months to fully heal, and the new bone that formed had a weakened shell. Some bone experts say the results are so compelling that doctors should explain the risk of taking such drugs when treating bone injuries or in relation to spinal surgery.
In addition to concerns about joint damage, Celebrex, a newer type of NSAIDs touted as much safer than earlier versions, may not, in fact, be so safe. Research performed at the University of Pennsylvania Medical Center has found that Celebrex may increase the risk of heart attack and/or stroke. Celebrex is a sulfa drug, like some antibiotics and oral diabetes drugs, and those with sulfa allergies must avoid it. Sulfa allergies affect five percent of the population.
Celebrex, which is much more expensive than common arthritis drugs, is also no better than earlier NSAIDs in terms of undesirable gastrointestinal side effects. Based on evidence of a large clinical trial, researchers found there is a stronger chance than previously thought for users of Celebrex to develop ulcer problems. The trial compared patients taking Celebrex with patients taking ibuprofen and Voltaren (also known as diclofenac). The results showed that there is, in fact, no difference among the three drugs when it comes to gastrointestinal illness. Many arthritis sufferers taking Celebrex have found that the gastrointestinal problems they had with NSAIDs still occur when taking Celebrex. Dr. Simon Huang, a Vancouver rheumatologist who led local clinical trials on Celebrex, found that "although Celebrex has been found to reduce ulcers in the upper GI tract, the effects on the lower GI tract are unknown." In July 2002 Health Canada issued a warning about Celebrex. Ten deaths and over 70 cases of severe gastrointestinal bleeding have occurred in Canadians taking Celebrex over the last three years.
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