NSAID gastropathy: the second most deadly rheumatic disease? Epidemiology and risk appraisal

Nonsteroidal antiinflammatory drug (NSAID) gastrointestinal (GI) pathology (gastropathy) accounts for over 70,000 hospitalizations and over 7,000 deaths annually in the United States. Not all patients, however, are at equal risk. Major risk factors for serious events (hospitalization or death) in patients with rheumatoid arthritis (RA) are age, level of disability, concurrent use of prednisone, prior NSAID side effects and NSAID dose. For the average patient with RA, the chance of hospitalization or death due to a GI event is about 1.3 to 1.6% over the course of 12 months and about 1 in 3 over the entire course of the disease. Subgroups of patients have risks ranging from nearly zero to as high as 4 or 5%/years. A simple scoring system based on multivariate analysis of risk factors permits the clinician to directly calculate the risk for the individual patient.