Arthritis patients who take the COX-2 inhibitor etoricoxib experience fewer incidence of upper gastrointestinal clinical events, symptoms and problems, than in patients who took the NSAID* diclofenac, according to an Article in The Lancet.

This information will assist with the treatment of arthritis, and when physicians need to make decisions concerning pain management.

NSAIDS are a long term arthritis treatment. However, they increase the risk of upper gastrointestinal clinical problems including, but not exclusive to, bleeding ulcers. Previous trials did not simulated standard clinical practice because gastrointestinal protective therapies like proton pump inhibitors (PPIs) were not allowed.

Loren Laine (University of Southern California Keck School of Medicine, Los Angeles, USA) and colleagues analyse data from three randomised trials from the MEDAL (Multinational Etoricoxib and Diclofenac Arthritis Long-term) programme to assess the effects of the two drugs in a setting that simulates real-world practice, in patients with gastrointestinal risk.

Upper gastrointestinal clinical problems were less common with etoricoxib than with diclofenac, but only in simple cases. The more serious complicated events showed no significant difference whether patients took PPIs or asprin.

The authors of the study concludes: "The results of the MEDAL programme provide new information about upper gastrointestinal clinical events and symptoms to assist arthritis patients and their physicians to make decisions regarding NSAID use."

In an accompanying Comment, Joost Drenth and Freek Verheugt (Radboud University Nijmegen, Netherlands) stated in an email, unofficially: "Though eterocoxib reduced upper gastrointestinal events, the effect was only small as 259 patients need to be treated to prevent one uncomplicated gastrointestinal event. The alternative, addition of a PPI to standard NSAID might be less expensive, potentially less cardiotoxic, and advantageous in terms of reducing dyspepsia, but here confirmation needs a randomised trial."

Arthritis can drastically reduce the quality of life. Suffering from gastric problems, caused by drugs, can further reduce the quality of life. There is relief for arthritis patients, but they need to consult their physician before changing drugs or embarking on a pain management program.

Pain can help arthritic patients understand what is wrong with their bodies and correct the problem instead of masking the pain. There are supplements and practices that will help reduce the joint damage and inflammation that causes many types of arthritis.

Jumping on every new drug study may have negative effect on the body. Patients suffering from joint pain need to understand that other factors, like stress and weight, will cause arthritis and the level of pain suffered.

However, patients who are suffering from gastric problems may find some relief in the results of this test. It may give their physician an alternative to their current pain management program.

Patient empowerment is a strong element in patient care today and patients are encouraged to research pain management programs and make suggestions that fit their lifestyles, while still working with their physician's program and techniques.