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From: sdyer@bbncc5.UUCP (Steve Dyer)
Newsgroups: net.med
Subject: Re: anti-inflammatories
Message-ID: <392@bbncc5.UUCP>
Date: Fri, 16-Aug-85 02:10:44 EDT
Article-I.D.: bbncc5.392
Posted: Fri Aug 16 02:10:44 1985
Date-Received: Mon, 19-Aug-85 08:35:31 EDT
References: <3298@topaz.RUTGERS.EDU>
Organization: Bolt Beranek and Newman, Cambridge, MA
Lines: 42

> 1)  Is there any evidence that anti-inflammatories really help arthritis?

It is generally agree upon that the anti-inflammatory drugs (aspirin,
ibuprofen, indomethacin, etc.) provide varying degrees of symptomatic
relief of arthritis, but do not influence the underlying condition.

> 2)  What causes the bad reactions (nothing terrible, just feeling awful)?

The two drugs you have mentioned, indomethacin and sulindac, are among the
least well-tolerated of the anti-inflammatory drugs.  They are also two of
the most powerful.  You haven't been particularly descriptive of your side
effects, but both have been known to affect mood and cause headache in
certain patients.  It's fair to say that the mechanism of many of these
side-effects hasn't been elucidated, though its a fair bet that the same
mechanisms responsible for their therapeutic actions (inhibition of
prostaglandin synthesis) may also contribute to the side effects.

> 3) What side-effects do these drugs usually have?

Up to 50% of patients treated with indomethacin, and 25% of those treated
with sulindac report some kind of side-effect.  Speaking VERY GENERALLY,
the second class of drugs (ibuprofen, other fenamates, tolmetin, aspirin)
are somewhat better tolerated.  It's a clinical call for the doctor to
decide exactly which one to prescribe, when to use the "big guns", and
personal clinical experience probably goes a long way.  You should speak up
if the prescribed therapy doesn't agree with you.  Individual idiosyncracy
seems to be the rule with this class of drugs.  The one side-effect that
they all have in common is stomach upset.  Much is made of the fact that
one drug causes less of this than another, but given the right person with
the right history and enough drug, you can probably expect some kind of
gastrointestinal side-effects ranging from heartburn to ulcers.  Many
of these (not all) are also associated with increased gastric bleeding.
Many of these also cause some degree of CNS effects in sensitive patients,
such as headache, dizziness, light-headedness and other reactions.

If you look into the literature, there are many other reported
side-effects, but they are so varied, and so idiosyncratic that they're not
worth excessive worrying about beforehand.
-- 
/Steve Dyer
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