Standard treatment for rheumatoid arthritis doesn't have a particularly good track record. According to a recently published American book What Your Doctor Won't Tell You (no relation to WDDTY) by Jane Heimlich (HarperPerennial, New York), a batch of English rheumatologists tracked 112 RA patients receiving "aggressive" drug treatment over 22 years. The result? More than half either died or became severely disabled. The authors concluded that it was "fallacious" to believe that arthritic drugs of any sort cause a remission in patients. With current treatment, "the prognosis of rheumatoid arthritis is not good." Stated plainly, that means that none of these drugs does any good in stopping the disease from progressing.

This is backed up by another study quoted by Heimlich, conducted by Vanderbilt University, which tracked 75 patients over nine years. By 1984, 20 had died, and 93 per cent of the survivors had lost "significant functional capacity" ie, the ability to grip well. When they were first enrolled in the study, most had been reasonably ambulatory, with 85 per cent still at work.

As for osteoarthritis, NSAIDs have no advantage over simple analgesics like aspirin. A recent study in the New England Journal of Medicine (11 July 1991) of 204 patients found that large (2400 mg) and small (1200mg) daily doses of ibuprofen, the most popular American NSAID, worked about the same as high daily doses (4000 mg) of acetaminophen in controlling pain and inflammation. The study, said an editorial in the same issue of the Journal, "challenges the reflexive prescription" of nonsteroidal anti inflammatory drugs for osteoarthritis.

Although the benefits of NSAIDs are uncertain, one thing is for sure: they are exceedingly dangerous. These drugs mainly work by inhibiting the synthesis of prostaglandins, and thus suppress inflammation. (They also do a number of other things, such as interfere with enzyme production, the ramifications of which we don't yet understand.) The problem is that the drugs don't just interfere with the prostaglandin that concerns your joint pain, they block all formation, particularly at such high doses. Since this substance plays a major role in normal gastrointestinal function, not surprisingly NSAIDs interfere with it. According to Drs Peter M. Brooks and Richard O.Day, both Australian rheumatologists writing in The New England Journal of Medicine about NSAIDs (13 June 1991): "The gastrointestinal effects of NSAIDs include gastric erosion, peptic ulcer formation and perforation, major upper gastrointestinal haemorrhage, and inflammation and change in the permeability of the intestine and lower bowel."

In case your doctor says that these risks are remote, Brooks and Day quote another study showing that the risks of being hospitalized due to gastrointestinal adverse effects are "seven times" that of patients not given the NSAIDs. "These results led these investigators to suggest that in the United States the syndrome of NSAID associated gastropathy accounts for at least 2600 deaths and 20,000 hospitalizations each year in patients with rheumatoid arthritis alone." These statistics could be very conservative; the Food and Drug Administration estimates that 200,000 cases of gastric bleeding occur each year, with 10,000 to 20,000 deaths.

In the UK, some 4000 people die each year from taking NSAIDs double the number of deaths from asthma.

Brooks and Day say that the elderly or those with a history of peptic ulcers, are at particular risk of gastrointestinal complications, "including death". They go on to conclude that NSAIDs are the direct cause of 20 to 30 per cent of all cases of complications following peptic ulcers. (Again, they may be batting low; GO Dr Christina Scott Moncrieff, writing recently in GP newspaper, estimates that up to 80 per cent of such deaths are NSAID related.)