If you have arthritis, it may not be the only problem you may have to deal with. According to a new study, two drugs commonly used to treat arthritis, naproxen and alendronate, could increase the incidence of developing stomach ulcers. The study published in the recent edition of the British Medical Journal says that when the drugs naproxen and alendronate, commonly used in the treatment of osteoporosis and arthritis, when taken in combination, may increase a patient's risk of developing ulcers in the stomach and duodenum. Naproxen is a non-steroidal anti-inflammatory drug (NSAID). Although both drugs cause stomach ulcers when taken individually, the effect is much greater when they are taken together than would be expected from adding the effects of the two drugs separately. In the study, doctors from the Veterans Affairs Medical Centre and Baylor College of Medicine in Houston, Texas, made three experimental groups – two receiving the drugs individually and one receiving a combination. They found that stomach ulcers developed in 8% of the study participants receiving alendronate alone, in 12% of those receiving naproxen alone, and in 38% of the participants taking both alendronate and naproxen. Though no injury to the food pipe was noted amongst the participants, the combination group also showed maximum erosion of the lining of the duodenum. Arthritis is a disease of the joints characterised by stiffness, pain and swelling in the region. It is usually a degenerative disorder associated with old age, but the disease can also occur during childhood and adolescence. The cause for the adverse effects of the combination of the drugs seems to be the synergistic relationship that they share. Whereas alendronate acts by directly eroding the surface of the stomach, naproxen delays healing of these ulcers, thus worsening the situation. The authors of the study warned that alendronate should be given cautiously when other NSAIDs are prescribed, and vice versa, to avoid the risk of ulcers. So the next time you buy the prescribed medication for that painful arthritic knee, be sure to check the ingredients of the medicine, or you could end up with a painful stomach as well. As they say, "misery never strikes alone".
BMJ;322:258, February 3, 2001