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#265237 - 08/21/07 11:07 AM Re: NSAIDs [Re: Merlin1]
JanetK Offline
Fifth_Degree_AS_Kicker

Registered: 03/10/07
Posts: 386
Loc: west virginia
I'm no expert either, but I don't know that you will find any MEDICAL documentation to support it, since it's often the first things most docs want to put people on, even for OA. That doesn't mean it may not be true. Some people seem to have "stomachs of steel" & can take everything & anything for years without problems. And other people can barely tolerate Tylenol.

I tried just about every NSAID there is spanning 15 years. I was spared the long term stomach problems, but eventually they affected my kidney function.

I guess the only thing you can do if you benefit from them, is to watch for stomach, kidney or liver issues. The bad thing is, sometimes by the time you start having problems, the issue has progressed. I'm not allowed to take any NSAIDs now, not even OTC (I can take Tylenol). And since I had liver issues from Methotrexate, I have to even watch my Tylenol use.

I hope you find the answer you are looking for.
_________________________
Janet

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#265238 - 08/21/07 11:23 AM Re: NSAIDs [Re: wind_rider]
wolverinefan Offline


Registered: 10/04/01
Posts: 2571
Loc: Motown
Sorry Windrider, but the only near harassment I see is your increasingly nasty replies to any posts Merlin makes. It's abundantly obvious now that you don't agree with him and his way of thinking, and that's totally fine. However, unless you can offer concrete proof that he works for a pharmaceutical company and is thus here simply trying to trumpet his company's agenda, I think maybe it's best if YOU back off as well. Personally, I haven't seen anything offensive in Merlin's posts--and yes, I've read most if not all of them--at least not offensive enough to warrant your continuing vitriol against him every time he posts these days.

The question he is asking is certainly well within the scope of what is discussed on this board, and based on other answers he's received, it's clear that others want to discuss this topic as well. And, he's right about one thing--some people on this sight (John and others) do clearly state that they believe NSAIDs make AS worse--not that they cause stomach ulcers or other known problems, but that they make AS worse. That is a bold claim that many of us have debated ad infinitum through the years, but newer members were not here for those "discussions" (and yes, as I've admitted many times in the past, I was one of the most strident and quick-to-anger posters on the other side of the discussion back then, but I've long since made my peace with everyone involved). Because many folks weren't here back in the day, questions like this one are going to get asked, and there is nothing wrong with it being asked. I can't say that I remember anyone asking specifically about links to studies, etc. showing NSAIDs make AS worse in some time; if it has heppened recently, then perhaps someone could politely post the link to that recent discussion and this topic will be taken care of that way.

Since it's clear that your dislike for merlin runs pretty deep, why don't you simply ignore his posts from now on? Or, if you feel you have to post in his threads because if yo don't, misinformation will be distributed, then go ahead and dive in, but how about keeping the posts from being personal attacks against him? If he were to post anything this nasty, I'd call him out on it too. I just think it's getting old to keep hearing you accuse him of being something that you absolutely CANNOT prove--it's not fair to keep leveling accusations against another KA member.

And no, I'm not saying you can't post in this thread or aren't entitled to your opinion. I'm saying that for someone who says merlin's posts are bordering on harassment--something I don't see at all--your making some posts of your own that have crossed that line in much clearer fashion. I do believe that you're probably not as angry as these posts make you sound, but as we've heard before, without the vocal cues, etc. that we get from speech, emails and forum posts are easily misinterpreted or thought to be worse than they were intended to be.

Personally, I'm reaching a fairly high annoyance level over layer3guy's repeated posts about high fat diets and the wonders of magnesium citrate, but I just ignore them because I realize he is just excited about the treatment regimen he has found for himself and he wants to share it here. By simply not reading his posts, I find that I'm no longer irritated by them--problem solved. Might want to just do the same with merlin--you'll find your stress level drops dramatically.

Brad

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#265239 - 08/21/07 11:53 AM Re: NSAIDs [Re: Merlin1]
Farinelli Offline
Silver_AS_Kicker

Registered: 08/14/07
Posts: 1489
Loc: Pennsylvania
I used celebrex from November of 2005 until August of 2007 and it helped me. I had to quit because I was getting dizzy and had blurred vision. I can tell the difference since I quit. The side effects are gone but my joints ache more.

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#265240 - 08/21/07 01:23 PM Re: NSAIDs [Re: Merlin1]
Gerri Offline
Colonel_AS_Kicker

Registered: 04/22/06
Posts: 2371
Loc: Kitchener, Ontario Canada
Hi Merlin

I cannot provide you with reports or reference literature about information you require.

I can only describe how NSAIDs (aspirin, tylenol, ibupropen reacts on me.) Allergies to sulfa (rash from head to toe), sulfites (Anaphlatic shock), sulfates (found in hair shampoo causes sores all over my scalp, body wash causes problems in my private parts), sulfer (asthma attacks), causes major problems to my stomach, and elevation in my liver enzymes.

My doctor has stopped me from taking all aspirin products. He will not give me any medication for pain, or for depression.

My livers enzymes got so high that my doctor believe I suffered from NASH. I am waiting to see a gastroenterologist, because of all the stomach problems caused by aspirin, I was taking.

Whether aspirin caused my AS to become worse, I really can't say. I now have a leaky gut, acid reflux, small intestine crohns disease, my stomach bloats on daily basis. My AS has changed from being mostly right to showing it's ugly head on my left side.

Aspirin, was the only pain pill I could take. Now no doctor will prescribe any NSAIDS to me. Has aspirin caused more AS problems, I know I live with pain now because of the stomach, and liver problems caused by aspirin.

Hugs

Gerri

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#265241 - 08/21/07 01:55 PM Re: NSAIDs [Re: drizzit]
alohaben Offline
ironchef

Registered: 08/16/03
Posts: 2717
Loc: Connecticut, USA
74-05...tolemtin/tolectin,tolectin ds, daypro, naproxyn, something else name unknown, indomethecin/indocin,
vioxx, celebrate, bextra, mobic...

ah...this is not a regimine i advocate for anyone.

i was so much older then
i'm younger than that now.
aB

Top
#265242 - 08/21/07 02:16 PM Re: NSAIDs [Re: wolverinefan]
wind_rider Offline
Iron_AS_Kicker

Registered: 11/12/02
Posts: 1039
I'm not stressed, but you are deliberately misintrepreting everything I said.

The information that NSAIDS cause damage is out there. If people don't want to research their fact sheets that come with each prescription, or go farther, and continue to insist otherwise, that's their problem but it does not obligate me or anyone else to engage in debate whether or not it's "true."

Anyone pretending that saying the sentence "NSAIDS cause physical damage to those who take them" is a "personal attack" has "issues" which are beyond my power to fix and may result in whole scale censorship of the board if each one warrants a warning to not make those comments again.

There's two ways to do this. You either pussyfoot around it and pretend it didn't happen or you confront it head on. I have now made my statement public so there will be no wondering just what it is I meant.

Top
#265243 - 08/21/07 02:27 PM Re: NSAIDs [Re: Merlin1]
DragonSlayer Offline
AS Czar

Registered: 09/05/01
Posts: 6118
Loc: Reno or SFLU Philippines

Hi, Merlin1:


NSAIDs devastated me, and I WISH I had not ever taken my first one--because they really helped with the pain, so I relied upon them for over 5 years and now have the damage to show for it: Broken back, kyphosis, missing C7, frozen neck, and myriad other things. My worst agent was Clinoril, but I was mostly on Voltaren and earlier butazoladin, later Relafen, Orudis, Naprosyn, and myriad others. This was before the COx-2 NSAIDs became available.

The accepted explanation of NSAID mechanism suggests that "stomach protector" drugs cannot possibly have any therapeutic value--certainly not at ground zero (the lower intestinal tract).

I never had iritis before I began taking NSAIDs, nor did I have knee edema, frozen neck, or kyphosis. These drugs greatly accelerated my AS and by now I know why: AS is caused by a gut bacterium acting across a permeable epithelium. NSAIDs further destroy this epithelium in the gut, allowing increased infiltration of the bacterium.

NSAIDs are pure POISON for anyone with AS and although they have their place in TEMPORARY pain relief, they should never be used long-term.

Here are the studies proving that NSAIDs accelerate AS. They did not want to admit this, but used their data in a sneaky way to suggest that we are better off taking these drugs. They also had a clever (albeit transparent) way of classifying GIT effects to make it look like taking more NSAIDs had the same GIT risk and impact as taking less.

My comments follow: "THE REAL DEAL ON NSAIDS"


********************************************************

Benefits of Continuous NSAID Use in Ankylosing Spondylitis

Study Suggests Continuous NSAID Treatment More Effectively Reduces X-Ray Progression than Intermittent Treatment

A widely under-recognized form of arthritis, ankylosing spondylitis (AS) is a chronic, progressive disease targeting the spine. Commonly striking in young adulthood, before age 35, AS causes inflammation, pain, and stiffness in the spinal joints—the vertebrae—and the sacroiliac joint, where the spinal column meets the pelvis. In advanced cases, this disease can result in deforming, crippling spinal fusion and organ damage. According to expert estimates, AS afflicts at least half a million people in the United States.

While there is no cure for AS, numerous studies have affirmed the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) for improving physical function, as well as providing rapid relief from back pain and stiffness. Yet, physicians generally recommend taking NSAIDs on a short-term basis, only as needed for severe AS symptoms, due to the risk of gastrointestinal complications associated with long-term use. Inspired by the improved gastoprotective safety profile of COX-2-selective NSAIDs, an international team of rheumatologists set out to explore the impact of ongoing NSAID treatment, over a 2-year span, on the course of AS. Featured in the June 2005 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), their study offers hope for decreasing the progression of AS, without increasing the risk of peptic ulcers or other adverse events.

The clinical trial began with 215 outpatients, drawn from the records of 76 hospitals and private practices in France, with a history of AS. Using a computer-generated randomization list, the patients were divided into two treatment groups. The first group, comprised of 111 patients, was prescribed twice-daily treatment with a NSAID, regardless of symptoms. The second group, comprised of 104 patients, was also prescribed a NSAID, but instructed to take it only when they suffered pronounced pain or stiffness. Both groups started treatment with celecoxib at a dosage of 100 milligrams. All patients were allowed to increase their dosage to 200 milligrams, if necessary, or switch to another NSAID, as long as they maintained their assigned treatment strategy—either continuous or on-demand. Compliance was assessed by pill count.

At baseline, after 1 month, at 7 follow-up visits conducted at 3-month intervals, and at the final visit, patients in both groups were thoroughly evaluated, through questionnaires and laboratory tests, for clinical signs and symptoms of AS, as well as for any adverse events. X-rays of the spine were taken at the study's onset and 24-month culmination.

Overall, differences in hallmarks of disease activity—including spinal pain, night pain, morning stiffness, fatigue, and restricted mobility—were not statistically significant between the two treatment groups. There were also no significant differences in the gastrointestinal, respiratory, cardiovascular, and other health problems experienced by the groups, with the exception of symptoms of depression, which occurred more frequently in the continuous-treatment group. Only a single adverse event—a case of severe abdominal pain requiring hospital admission in the on-demand group—was deemed directly related to NSAID use, by the treating physician. There were, however, statistically significant differences in the X-ray evidence of AS progression between the continuous-treatment and the on-demand groups.

Complete sets of radiographs were available for 76 of the patients in the continuous-treatment group and for 74 of the patients in the on-demand group. Scored by a single observer blinded to treatment strategy, using the modified Stoke Ankylosing Spondylitis Spine Score (SASS), the X-rays showed both more pronounced disease progression and in a greater proportion of patients among patients who had taken NSAIDs only as needed for pain management. In fact, twice as many patients in the on-demand group were scored as having moderate to high levels of spinal joint damage at the 2-year mark than patients in the continuous-treatment group. The between-group difference in radiographic progression remained stable and significant after adjusting for baseline values of joint damage and disease-activity variables.

As noted by Professors Maxime Dougados and Desiree van der Heijde, the study's leading authors and participating rheumatologists, the findings have implications for both the treatment of AS and the application of NSAIDs. On the strength of the data, inflammation and progression of joint damage may be two separate processes in AS, which may be different from the situation in rheumatoid arthritis. And NSAIDs, generally considered symptom modifiers, may have unexplored disease-controlling properties.

“We conclude that a strategy of continuous use of NSAIDs decreases the radiographic progression in patients with AS without substantially increasing toxicity,” Prof. Dougados states. “While awaiting confirmation of these results, we carefully recommend that if patients need treatment with NSAIDs to reduce the signs and symptoms of AS, they should take NSAIDs continuously instead of as needed based on symptoms.”


"On the strength of the data, inflammation and progression of joint damage may be two separate processes in ankylosing spondylitis, which may be different from the situation in rheumatoid arthritis. And NSAIDS, generally considered symptom modifiers, may have unexplored disease-controlling properties," the study authors wrote.

Daily Treatment Slows Ankylosing Spondylitis
Thursday, June 02, 2005
By Miranda Hitti

People with a type of arthritis called ankylosing spondylitis may fare better by taking anti-inflammatory drugs on a steady schedule instead of on an as-needed basis.

So say European researchers in June's issue of Arthritis & Rheumatism. In their two-year study, X-rays showed that the disease progressed more slowly in patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) continuously, compared with those who took the drugs when needed.

Ongoing use of NSAIDs didn't substantially increase side effects. This provides a strong indication that regular use of NSAIDs may slow disease progression, according to Astrid Wanders, MD, of University Hospital in Maastricht, Netherlands.
Ankylosing spondylitis affects the spine, causing pain and stiffness from the neck to the lower back. The bones of the spine, called vertebrae, may grow or fuse together, resulting in a rigid spine.
Why NSAIDs?

NSAIDs have been shown to provide rapid relief of inflammatory back pain and stiffness, as well as improving physical function, say the researchers.
"NSAIDs are among the most frequently prescribed drugs for [ankylosing spondylitis], but toxic effects on the gastrointestinal tract limit their long-term use," they write.

Since last fall, NSAIDs have also been at the center of controversy over possible higher heart risks in some patients. This study was conducted in France years before that (1998-2001). Most participants were in their late 30s or early 40s and therefore at low risk of heart problems.
Continuous vs. As-Needed Treatment

Wanders and colleagues studied 215 people with ankylosing spondylitis.
Participants were randomly assigned either to take NSAIDs daily for two years or to take NSAIDs as needed during that time. Doses started with 100 milligrams of Celebrex twice daily; participants could raise that to 200 milligrams twice daily or switch to another NSAID while sticking to the same dose plan.

The study was funded by Pharmacia. Pfizer, a WebMD sponsor, owns Pharmacia.
X-rays, symptoms, and side effects were noted at 10 visits.

Slower Progression With Continuous Treatment
X-rays showed that the disease progressed more slowly in the continuous-treatment group. Those patients also tended to have more cases of high blood pressure, abdominal pain, and indigestion, but the differences weren't significant, say the researchers.

However, symptoms of depression were significantly more common in the continuous-treatment group (15 people, compared to four in the on-demand group). The reasons for this are unclear.

Only one serious side effect was considered to be related to the study's medication. That person, who was in the on-demand group, had severe abdominal pain requiring hospital admission.

'Careful Recommendation'
The findings need to be confirmed, say the researchers.
"While awaiting confirmation of these results, we carefully recommend that if patients need treatment with NSAIDs to reduce the signs and symptoms of ankylosing spondylitis, they should take NSAIDs continuously instead of as needed based on symptoms," write the researchers.
They say they can't recommend NSAIDs to ankylosing spondylitis patients who don't need NSAIDs to manage their symptoms, since they don't have data for such people.
By Miranda Hitti, reviewed by Michael W. Smith, MD


Research Article
Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: A randomized clinical trial

Astrid Wanders 1, Désirée van der Heijde 1 *, Robert Landewé 1, Jéhan-Michel Béhier 2, Andrei Calin 3, Ignazio Olivieri 4, Henning Zeidler 5 , Maxime Dougados 6
1University Hospital, Maastricht, The Netherlands
2Pharmacia Medical Department, Paris, France
3Royal National Hospital for Rheumatic Diseases, Bath, UK
4Ospedale San Carlo, Potenza, Italy
5Medizinische Hochschule, Hannover, Germany
6René Descartes University, Cochin Hospital, Paris, France

Dr. Zeidler has received consulting fees and/or honoraria of less than $10,000 from Pfizer, Inc.

Funded by:
Pharmacia

Objective
A 2-year randomized controlled trial was performed to test the hypothesis that long-term, continuous treatment with nonsteroidal antiinflammatory drugs (NSAIDs), in comparison with NSAID treatment on demand only, influences radiographic progression in patients with ankylosing spondylitis (AS).

Methods
Patients with AS (n = 215), who had previously participated in a 6-week, randomized,
double-blind clinical trial that compared celecoxib, ketoprofen, and placebo, were randomly allocated to receive either continuous treatment with NSAIDs or on-demand treatment with NSAIDs for a period of 2 years. All patients began treatment with celecoxib, at a starting dosage of 100 mg twice daily; patients could increase this dosage to 200 mg twice daily or could switch to another NSAID while maintaining the same treatment strategy. Structural changes were assessed by radiographs of the lumbar and cervical spine and scored according to the modified Stoke Ankylosing Spondylitis Spine Score by one observer who was blinded to the treatment strategy and temporal order of the radiographs. Statistical analyses included a between-group comparison of 1) radiographic progression scores (by Mann-Whitney U test), 2) time-averaged values of variables reflecting signs and symptoms of AS (by linear regression analysis), and 3) the frequency of reported site-specific adverse events (by chi-square test or Fisher's exact test, as appropriate).

Results
Complete sets of radiographs were available for 76 of the 111 patients in the continuous-treatment group and for 74 of the 104 patients in the on-demand group. The mean ± SD scores for radiographic progression were 0.4 ± 1.7 in the continuous-treatment group and 1.5 ± 2.5 in the on-demand treatment group (P = 0.002). Parameters reflecting signs and symptoms were not statistically significantly different between groups. The between-group difference in radiographic progression did not disappear after adjusting for baseline values of radiographic damage or disease activity variables and for time-averaged values of disease activity variables, nor after imputation of missing data. Relevant adverse events tended to occur more frequently in the continuous-treatment group than in the on-demand group (for hypertension, 9% versus 3%; for abdominal pain, 11% versus 6%; for dyspepsia, 41% versus 38%), but the differences were not statistically significant.

Conclusion
A strategy of continuous use of NSAIDs reduces radiographic progression in symptomatic patients with AS, without increasing toxicity substantially.
*****************************************************************

THE REAL DEAL ON NSAIDS

Let’s start with their Conclusion: “A strategy of continuous use of NSAIDs reduces radiographic progression in symptomatic patients with AS, without increasing toxicity substantially. This is NOT what the study indicated. There were two groups and one used NSAIDs “on-demand” (as the patients ‘felt’ the drug was needed), and the other group, “continuous-treatment,” took the drugs on-schedule, whether they subjectively felt like they ‘needed’ to use the drugs.

It is possible for news people to accidentally distort the truth, especially based upon the distortion found in the terminal statement of this study. It is a lie, and I can prove it using their own data, in part because they left out an important thing that every scientific study has not left out, and it is absolutely necessary, in fact, for any such study to get approved (unless funded by advertisers): THE CONTROL GROUP. Ooops! What an oversight!

Well, since Calin, et al did not supply a control group, I will provide my own control group and I have chosen to use one courtesy of Giraud Campbell, D.O., from his book “A Doctor’s PROVEN New Home Cure for Arthritis.” Campbell had X-ray proof that degenerative arthritis could be reversed on his regimen.

The Calin NSAID study reported two groups:
Continuous use—+0.4
On-demand—+1.5

My addition of the Campbell control group:
Continuous use—+0.4
On-demand—+1.5
Campbell regimen—[SOME NEGATIVE NUMBER]

The FACT is that NSAIDs ACCELERATE AS. Calin, et al have proven this.

The headlines SHOULD have read: “If You Are Going to Take NSAIDs for AS, Do So On-Schedule Instead of On-Demand.” This is a truthful, and very useful headline, and something that I certainly wish I had known many years ago!
_________________________
Important AS Resources

Professor Ebringer: On Diet and AS;


RED ARROW --> Philippines

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#265244 - 08/21/07 03:58 PM Re: NSAIDs [Re: DragonSlayer]
Merlin1 Offline
First_Degree_AS_Kicker

Registered: 02/09/07
Posts: 170
Loc: florida, USA
All the information you provided shows that NSAIDs taken on a continual basis slow progression. Show me a study that says otherwise to support your theories.

Top
#265245 - 08/21/07 04:01 PM Re: NSAIDs [Re: Gerri]
Merlin1 Offline
First_Degree_AS_Kicker

Registered: 02/09/07
Posts: 170
Loc: florida, USA
I'm not denying that NSAIDs are hard on the liver and digestive system. However, I want to see some scientific study that says they accelerate progression of AS.

Top
#265246 - 08/21/07 05:02 PM Re: NSAIDs [Re: Merlin1]
DragonSlayer Offline
AS Czar

Registered: 09/05/01
Posts: 6118
Loc: Reno or SFLU Philippines

Hey, Merlin1:

Quote:

All the information you provided shows that NSAIDs taken on a continual basis slow progression.




No it doesn't.

If YOU want to believe that lie, go right ahead; it is exactly what they want you to believe--so you will continue to act upon this idea and even get reinforcement from others who are apathetic, or also do not dare (or know how) to properly analyze the available information.

Perhaps in ten years, YOU shall be here and by then urging others not to make the same mistakes you made.

Good luck to You,
John
_________________________
Important AS Resources

Professor Ebringer: On Diet and AS;


RED ARROW --> Philippines

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