The epidemiology of NSAID gastropathy: the ARAMIS experience

The Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) is a national database for longitudinal outcome information obtained form the long-term follow-up of patients with rheumatic disease. This database has been used to investigate the parameters associated with nonsteroidal anti-inflammatory drug (NSAID) gastropathy in a population of 2747 patients with rheumatoid arthritis (RA). Theses patients were found to have a 1.3% higher risk of hospitalization each year because of a gastrointestinal (GI) adverse event than the general population. In these patients with RA, there was a five fold higher risk of hospitalization and a twofold increase in GI mortality among NSAID users compared with the general population. Age was the most significant predictor of serious GI events in our study' disability, prednisone therapy, and previous NSAID-related GI events were also identified as risk factors. An objective index of drug toxicity was developed to facilitate comparisons of the potential risks involved with specific drug regimens. consistent toxicity scores were obtained for NSAIDs, with threefold to fourfold difference between drugs having low risk versus high risk. These studies indicate a need for changes in management practices in at-risk patients and a potential role for better tolerated NSAIDs, such as the recently developed cyclooxygenase-2 selective or preferential drugs.