Are Seniors at Increased Risk for Complications from Arthritis Medications?

Arthritis in the hands ranging from mild to severe

Arthritis can be – well a pain! Arthritis pain can be an intermittant ache or a stabbing pain.  Since arthritis isn’t like having an ear infection, take an antibiotic for a week or so, and it is gone – arthritis once you have it, is here to stay.  Seniors, even children with arthritis, can be miserable enough with painful arthritis that they resort to numerous kinds of pain medications, physical therapy, even surgery.

There are a number of pain medications for arthritis – they won’t cure it – just relieve some of the pain for awhile.  The main type of OTC (over the counter) arthritis medications are the NSAIDS.  This is a class of anti-inflammatory drugs such as ibuprofen (Advil, Motrin, Naproxen, Naprosyn, Aleve, aspirin and others.  These drugs are also associated with a risk of cardiovascular complications such as high blood pressure and upper GI (gastrointestinal) stomach bleeding.  More recent research now also implicates slow release and enteric coated NSAIDS when used regularly and the entire GI system, meaning the intestines. It is also now known that they can interfere with the low-dose aspirin (which is cardio protective) that you take to help prevent heart attacks.  The National Institutes of Health indicates that there is a higher risk of having a heart attack or stroke with long term use of the other NSAIDS, which can increase blood pressure, worsen congestive heart failure and cause cardiac events.  Even though aspirin is an NSAID, it is considered protective of the heart.

The NSAIDS can cause an increase in the risk of bleeding in the stomach, and intestines and also increase the amount of bleeding in those people that take aspirin, clopidogrel (Plavix), or warfarin (Coumadin).  NSAIDS can also cause fluid retention, something that people with heart failure need to avoid.

Frequently, especially in seniors/elderly, there will be chronic use of an NSAID for  arthritis, then perhaps a fall that causes substantial pain, such as a fracture of the ribs or fracture of vertebrae.  The hospitalist at the emergency room may prescribe a high dose of Ibuprofen to get over the hump of the initial pain and reduce inflammation.  Be sure your prescribing doctor knows if you are already taking aspirin, Coumadin, or Plavix.  Also be sure to tell the doctor if you have ever had a bleeding ulcer or gastritis with bleeding, or a pre-existing bowel disease such as diverticulitis or inflammatory bowel disease.  If you have had or now have these conditions you will probably have to be more closely monitored for both upper and lower GI complications, and they will have to be taken into consideration when the doctor prescribes the appropriate pain reliever.

Monitor your blood pressure and if it increases, or you start with stomach pain, or pain in the intestinal area then call your primary care doctor right away, explain your symptoms and that you are taking Ibuprofen or another NSAID. Your primary care doctor may then prescribe something gentler on the gastrointestinal system and or less of a cardiac risk.

The triple threat is the use of Iboprofen, aspirin and alcohol at the same time, this increases the risk of gastrointestinal bleeding.  When taking Ibuprofen and other NSAIDs be sure to eat food when you take the medicine, it helps protect the lining of the stomach.

If you have been on chronic NSAID use or recent high dose NSAIDs and you have undiagnosed blood loss, ask your doctor to consider whether the blood loss could be related to the NSAIDs and blood loss in the intestines.  There are many people who have iron deficiency anemia due to blood loss caused by the chronic use of NSAIDS for arthritis pain, back pain or sports injuries.

Another drug commonly prescribed for Osteoarthritis is Diclofenac.  Brand names include Voltaren, Cambia, Cataflam, Voltarol, Zipsor.  These may be available as slow release or enteric.  Be aware that these drugs are also NSAIDS and that any of these NSAIDS taken long term, or at high dosages, can cause ulcers, bleeding, or holes in the stomach or intestines.

Don’t feel completely safe because the NSAID taken is a slow-release or enteric coated formulation.  These may be considered safer for the stomach, but can cause problems in the lower GI (intestines).  Enteric coated formulations are designed to dissolve in the intestines, and it is now known that the “small intestine is a main site of NSAID induced chronic blood loss.” (Neal M. Davies, Univ. of Sydney, Journal of Pharmaceutical Science)

Seniors/elderly may be taking multiple medications for complicated medical conditions and may not be aware of the dangers lurking in the drugs they take, so it is always a good idea for their family members to keep an up-dated listed of their current medications.  Keep this list with you (I recommend in your wallet), then if you have to make a trip to the doctor’s office or emergency room for your elderly parent, you will have important information needed by the doctors and staff.  It is also a good idea to keep a typed list of current medications with primary care doctor’s name and phone number prominently display on the refrigerator door so emergency medical personnel will have access to it.  Also put an (ICE) In Case of Emergency telephone number on this list.  If your senior/elderly family member has a cell phone put an ICE  contact number in there also – police and medical personnel look for this information.

Ask your doctor if you need to stop taking NSAIDS before surgery.  Always ask your doctor what is right for you and your individual medical condition.  Only your doctor can balance the risk with the benefits these medications may provide.

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