Incidence of gastropathy in destructive arthropathies

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the symptoms of arthritis, but may have serious side-effects such as gastrointestinal lesions. This paper reviews the current status of knowledge concerning NSAID-induced gastropathy. In general, patients who present with bleeding peptic ulcers are more likely to be using a NSAID than are matched controls. The incidence of gastric lesions is increased in patients receiving more than one NSAID, suggesting a cumulative risk for these drugs. Endoscopic studies, which have attempted to relate the presence of a lesion to dyspeptic symptoms have shown a poor correlation, indicating a high risk of perforation and bleeding without prior symptomatic warning. Peptic ulcer disease is equally prevalent in patients with rheumatoid arthritis or with osteoarthritis, so the underlying condition does not appear to influence the onset of NSAID-induced gastropathy. Care is required when prescribing NSAIDs; they should not be used in trivial or self-limiting conditions or in existing cases of active peptic ulceration. In addition, caution should be exercised in patients with a history of peptic ulceration, and in the elderly.