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Arthritis sufferers face risk vs. relief option

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Dec. 23--Seventy-five-year-old Emma Parson had taken two doses of Celebrex a day for three years, right up until she saw a television report Friday that said the arthritis drug has been linked to heart attacks and strokes.

Then this week, the Portsmouth woman heard the news that the over-the-counter pain reliever Aleve -- another drug she has taken in the past -- also has potential health risks.

"I thought, 'Oh, my Lord, what in the world am I going to take?'" Parson said.

It has not been the best of times for people who suffer from arthritis or other pain-crippling diseases.

First, the anti-inflammatory drug Vioxx was removed from the market in September after studies showed that it increases the risk of heart attacks and strokes. Then, last week, the same link was made to Celebrex, which is in the same class of Cox-2 inhibitor drugs.

This week came the news that naproxen, a painkiller sold by prescription and also in the over-the-counter medication Aleve, also might increase people's risk of heart attack and stroke.

All of this has left people who seek pain relief wondering which way to turn.

Dr. Alfred Denio, director of the division of rheumatology at Eastern Virginia Medical School, said the recent spate of pain reliever studies has made prescribing medication for people with arthritis much more complex.

"There's a risk-benefit ratio we try to weigh and help our patients weigh," said Denio, who practices at the Center for Arthritis and Rheumatic Diseases in Norfolk and Chesapeake. "The scales have gotten more complicated, and more things have to be considered."

He said the Cox-2 inhibitor drugs were a major advance in pain relief in the late 1990s because they didn't cause the bleeding in the stomach and intestines that long-term use of aspirin, ibuprofen and naproxen often did.

But now that studies have linked two of the Cox-2 drugs to higher risk of heart attacks and strokes, patients need to sit down with their doctors and go over all the risks in context of their medical history. "It's a very individualized assessment," Denio said. "It's not something you really want to do over the phone."

Norfolk resident Bobbye Wallace, who has taken Celebrex for about a year, said the studies are both frightening and depressing.

The 61-year-old woman has suffered from arthritis for more than two decades. Before she started taking Celebrex, pain in her arthritic knee caused her to limp. The medication eased the pain so much that she could walk normally and keep up with the children she works with at a Portsmouth recreational center. "I was tickled. Suddenly I felt like a new person."

The latest news on the drug has been dispiriting. "It's a terrible thing to choose between pain and worry about heart disease," she said.

She said she has been procrastinating making a call to her doctor. "I'm afraid he'll tell me not to take it."

But her prescription is due to expire next month, so she'll have to face the decision soon. She feels fortunate not to have heart disease and hopes that fact will allow her to continue taking the medication. "I really don't want to give up Celebrex," she said.

Denio said he has heard the same refrain from many of his arthritis patients. "It's been disheartening. Patients have to decide how much relief they are getting, and is it worth the risk. This forces that issue."

Vioxx was removed from the market, leaving patients no choice about whether to continue taking it or not, but Celebrex, so far, has remained on the market.

Denio said some patients with heart problems may want to switch, and return to pain relievers that might have caused more stomach problems. He said there are other medications patients can take to address the issue of stomach ulcers. "But the idea of taking one medication in order to take another medication usually doesn't appeal to people."

Adding to the difficulty, Denio said, is that some of the studies, for instance the one on naproxen, conflict with findings of previous studies on the drug.

The issue of these pain relievers has been particularly difficult for people with chronic pain, because it's the long-term, high-dose use that has proved risky. Dr. Marissa Galicia-Castillo, a geriatrician at the Glennan Center for Geriatrics and Gerontology at EVMS, said that since she treats older people who are at high risk of heart problems and strokes, she has stayed away from prescribing drugs like Celebrex.

Galicia-Castillo said she's more likely to advise her patients to take Tylenol for pain relief and to not wait until the pain begins to take it. But she said the recent news reports about drug safety have made more people paranoid about taking anything.

Some feel that keeping abreast of the news has become part of their treatment. Dimple Brinkley, for instance, took Vioxx for two years. The 62-year-old Suffolk woman said when that drug was taken off the market, her doctor prescribed Celebrex. She's still taking it, but the latest news has her worried because she has heart problems.

"You really get scared to take anything, but you get to hurting so bad that you feel like you have to have something," she said. "I wish they'd come up with something safe."


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