In the US, roughly 1.5% of rheumatoid arthritis patients treated with NSAIDs --or 107,000 persons--are hospitalized each year for serious GI bleeds. From the 19th Congress of the International League Against Rheumatism come results of a prospective trial in which investigators compared 16 nonsteroidal anti-inflammatory agents (NSAIDs) to determine the gastrointestinal (GI) toxicity of each in patients with rheumatoid arthritis.

Dr. Singh and colleagues at eight sites in North America followed consecutively enrolled patients in the Arthritis, Rheumatism, and Aging Medical Information System (ARAMIS) Study for a total of 19,289 patient years. They found nabumetone (Relafen) did not cause serious GI bleeding or other clinically significant GI events necessitating hospitalization in 221 patient-years of follow-up. Similarly, etodolac (Lodine) did not result in serious GI bleeding or other events leading to hospitalization over 87 patient-years. Most of the available data on GI toxicity and NSAIDs have focused on endoscopic ulcers rather than on GI bleeds, which have a much more serious prognosis.

Most GI bleeding studies to date have been retrospective and case-controlled, which allows researchers to determine the relative risk of selected events but not the incidence. A prospective cohort study such as ARAMIS provides information on both the relative and absolute risk of serious GI events.

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