Assessing and understanding patient risk

Nonsteroidal anti-inflammatory drug (NSAID) gastropathy is the most frequent and one of the most severe drug side effects in the United States. NSAID-associated gastropathy has been estimated to account for at least 7600 deaths and 76000 hospitalizations each year in the United States alone. Hospitalizations in rheumatoid arthritis patients occurred in 1.6% of patients; for patients with osteoarthritis the incidence appears to be substantially lower. This is based on a consecutive series of 3000 patients with rheumatoid arthritis who were followed prospectively for an average of five years by ARAMIS, the Arthritis, Rheumatism and Aging Medical Information System. Multivariate analyses assessing risk factors for serious gastrointestinal (GI) events were performed on 1694 rheumatoid arthritis patients taking NSAIDs. The most important risk factors of higher age, use of prednisone, previous NSAID GI side effects, prior GI hospitalization, functional disability (based on the American Rheumatism Association classification), and NSAID dose are variables in an algorithm which estimates the risk of a serious GI event occurring in the next 12 months. Knowledge of risk factors and their interrelationships provides a tool for identifying patients at high risk and guides therapeutic decisions.