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Rheumatoid Arthritis Medications
May 2000

Q. I have Rheumatoid arthritis. I am on methotrexate. I still get some flare ups with pain mostly in my hands. I have tried Motrin and Naprosyn, which helps, but tears up my stomach. Is there anything else I can use that is gentler on the stomach?

A. Yes. Fortunately, there have been two anti-inflammatory drugs recently FDA approved that have been shown to have less gastrointestinal side effects; Celebrex and Vioxx. They are what is termed COX-2 inhibitors. They work by inhibiting cyclooxegenase 2 enzymes which are largely responsible for the inflammatory response in the body. The older antiinflammatories such as Motrin also inhibit COX-1 enzymes which are responsible for protective factors in the stomach mucous lining. Therefore, the newer agents are much more selective in preventing inflammation (and therefore pain) with less risk of stomach ulcers.(Since they still may have slight inhibition of COX 1 enzymes, they still may cause ulcers, but at a much lower risk).

The usual dose of Celebrex is 200 mg per day and vioxx is 25 mg per day. Do not use Celebrex if you have sulfa allergy. These drugs may still cause kidney insufficiency, and this should be monitored by periodic blood and urine testing.

Arthritis Foundation: 1-800-283-7800

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