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Preventing Recurrent Ulcer Bleeding in Arthritis Patients: Celecoxib vs. Naproxen

written by: Robin Hawkins • edited by: Diana Cooper • updated: 12/8/2010

Some commonly prescribed NSAIDs in treating arthritis have shown to have negative long-term gastrointestinal side effects. This article takes a look at the differences in using celecoxib versus naproxen for prevention of recurrent ulcer bleeding in arthritis patients.

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    What is Available?

    When you are diagnosed with rheumatoid arthritis or osteoarthritis, there is a wide range of treatments available. Your doctor will more than likely give you some recommended lifestyle changes, such as exercises specifically addressing your arthritis, as well as a prescription strength non-steroidal anti-inflammatory drug (NSAID). NSAIDs are the most common prescription treatment used for arthritis as they work to reduce inflammation and alleviate pain. Many NSAIDs are available without a prescription.

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    General Side Effects of NSAIDs

    While NSAIDs are the most commonly prescribed treatment for arthritis, the long-term use of these has been associated with increased gastrointestinal side effects such as abdominal pain, ulceration and bleeding. Doctors need to weigh the benefits with risks when prescribing an NSAID for long term use.

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    Different Types of NSAIDs and How They Work

    Celecoxib and naproxen are both NSAIDs, but they fall into two different categories. Celecoxib is sometimes sold under the brand name Celebrex, and naproxen is available under the brand names of Aleve, Naprosyn, Anaprox and Naprelan.

    The two different types of NSAIDs available today are non-selective NSAIDs and selective NSAIDs. To understand the difference, it is important to know a little background as to their function.

    Cyclooxygenase (COX) is an enzyme. This enzyme can be found in two forms in the body; COX-1 and COX-2. The COX-1 enzyme works to protect the lining of the gastrointestinal tract. COX-2 is the enzyme that is present when there is a fever or inflammation.

    The first generation of NSAIDs is referred to as the non-selective NSAIDs. Naproxen is a non-selective NSAID along with aspirin, diclofenac, ibuprofen, mefenamic acid, indomethacin, ketoprofen and piroxicam. These non-selective NSAIDs block the COX-2 enzyme, meaning they are effective in treating arthritis pain, inflammation as well as reducing fever.

    Unfortunately the non-selective category of NSAIDs blocks the COX-1 enzyme as well: the enzyme responsible for protecting the stomach lining. The long-term use of the non-selective category of NSAIDs, which includes naproxen, has been noted to cause gastrointestinal bleeding, recurrent ulcers and other negative gastrointestinal side effects.

    Since these negative side effects were discovered, a new generation of NSAIDs was created. These are called selective NSAIDs. Celecoxib is a selective NSAID as well as meloxicam.

    The selective NSAID, celecoxib, works to only block the COX-2 enzyme, relieving fever, pain and reducing inflammation, but does not block the COX-1 enzyme. Therefore, blood clotting in the gastrointestinal tract is not altered. Celecoxib, along with other selective NSAIDs have not been found to cause any recurrent ulcer bleeding in arthritis patients.

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    Conclusion

    When deciding on a long-term treatment plan for arthritis patients, physicians need to be careful about what to prescribe, especially if the patient already experiences any gastrointestinal problems. When weighing the risks and benefits of taking celecoxib versus naproxen for prevention of recurrent ulcer bleeding in arthritis patients, the evidence supports going with the selective NSAID, celecoxib.

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    Sources

    Oxford Journals: “Patient benefit-risk in arthritis-a rheumatologist’s perspective”: http://rheumatology.oxfordjournals.org/content/49/suppl_2/ii11.full

    Virtual Cancer Center: “NSAIDs”: http://www.virtualcancercentre.com/treatments.asp?sid=78

    Medicine Net: “Celecoxib, Celebrex”: http://www.medicinenet.com/celecoxib/article.htm

    Drugs.com: “Naproxen”: http://www.drugs.com/ingredient/naproxen.html