The People's Perspective on Medicine

Do Arthritis Pain Relievers Trigger Heart Problems?

Do you take celecoxib, diclofenac, ibuprofen, meloxicam or naproxen for aching joints? People with OA rely on arthritis pain relievers. What are the risks?

People with osteoarthritis (OA) are caught in a classic double bind. Their joints hurt! It is hard to function when knees, hips, shoulders, elbows or fingers ache. But the very arthritis pain relievers (NSAIDs or nonsteroidal anti-inflammatory drugs) that most people rely upon to give them relief are linked to heart attacks, congestive heart failure and strokes. The link just got stronger thanks to a comprehensive Canadian study (Arthritis & Rheumatology, online, Aug. 6, 2019). Ouch!

How Many People Suffer from Osteoarthritis?

The CDC reports that half the people over the age of 65 have “reported doctor-diagnosed arthritis” (CDC & Arthritis-Related Statistics). Consider that the next time you are in line at the supermarket or bank. Quite possibly the person in front of you or behind you is suffering.

Osteoarthritis makes it hard to get out of bed, climb stairs, open jars, hike or get down on the floor to play with grandchildren. Even younger people can experience osteoarthritis. The CDC reports that almost one third of those between 45 and 64 have doctor-diagnosed arthritis.

NSAIDs are the #1 Choice for Osteoarthritis:

NSAID-type arthritis pain relievers are the most common treatment for joint pain. Canadian and Japanese research suggests that three-quarters of patients with osteoarthritis take NSAIDs (British Columbia Arthritis Survey; BMC Medicine, April 14, 2011). We suspect that people in the U.S. use arthritis pain relievers at least as often as people in Canada or Japan.

Arthritis Pain Relievers and Heart Problems:

Nonsteroidal anti-inflammatory drugs or NSAIDs are increasingly linked to cardiovascular disease. Over a decade ago researchers discovered that rofecoxib, also known as Vioxx, increased the risk for heart attacks and strokes. One FDA safety officer was quoted (Forbes, Aug. 15, 2005): 

“Graham has estimated that Vioxx killed some 60,000 patients—as many people, he points out, as died in the Vietnam War. He says fundamental problems at the FDA led to those deaths.”

Since then, clinicians have been trying to determine whether other NSAIDs like ibuprofen, diclofenac, meloxicam or naproxen could also be hard on the vascular system. The most recent epidemiological study was conducted in Canada (Arthritis & Rheumatology, online, Aug. 6, 2019). 

People with arthritis are at greater risk for cardiovascular disease than healthy individuals. Until this study, one of the unresolved questions doctors faced was this:

is there something about OA that increases the risk of cardiovascular disease

or

is it the drugs used to treat osteoarthritis that cause the problems?

The Canadians did their best to resolve that uncertainty.

Arthritis Pain Relievers and Heart Problems: The Chickens or the Eggs?

More than 7,000 patients with osteoarthritis and three times that many nonarthritic control subjects were tracked for about a decade. In this study, with approximately 300,000 person-years of follow-up, more than 9,000 participants developed cardiovascular complications. Those with arthritis were about 31 percent more likely to have this outcome than people without arthritis.

Patients with osteoarthritis were much more likely to be taking an NSAID pain reliever. Upon analysis, the investigators found that NSAID use accounted for more than 40 percent of the increased risk of heart problems among Canadians with arthritis. Those taking such arthritis pain relievers were at greater risk for heart attacks, congestive heart failure and strokes.

Not the first time Arthritis Pain Relievers were Linked to Heart Problems:

The data from Canada are in line with other research suggesting that nonsteroidal anti-inflammatory drugs increase cardiovascular risk by 30 to 40 percent (BMJ, Jan. 11, 2011; BMJ, June 3, 2006). So, this new analysis is very much in line with older meta-analyses. The authors conclude:

“In conclusion, our study is the first to evaluate the mediating role of NSAID use in the association between OA and CVD [cardiovascular disease] based on population-based HAD [health administrative data]. Our findings suggest that a noteworthy portion of the increased risk of CVD among people with OA is mediated through their NSAIDs use.”

In plain English that means that a lot of people with arthritis are developing congestive heart failure, heart attacks and strokes because they are taking NSAID-type arthritis pain relievers. Some of these drugs (ibuprofen and naproxen) are available over the counter without medical supervision. In our opinion, the FDA has not provided adequate warnings on OTC labels.

What’s an Arthritis Patient to Do?

People with OA are definitely caught between the proverbial rock and a hard place. Without pain relief they cannot function well. But the most common treatment could lead to dire consequences. You can read more about this dilemma and how to reduce the risks at these links:

Popular Pain Relievers Trigger Heart Attacks!

You may find the following article even more helpful. There are many NSAID-lovers who share their need for pain relief without risking a heart attack or a stroke. You will find a link to our eGuide: Alternatives for Arthritis!

Alternatives for Arthritis vs. NSAID Disasters

Share your own challenges with osteoarthritis in the comment section. What has worked for you? Do you worry about the link between arthritis pain relievers and heart failure, heart attacks or strokes? If not, why not?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Alternatives for Arthritis
$4.99

This eGuide describes nondrug alternatives for arthritis with the latest scientific studies to document anti-inflammatory activity. This comprehensive online guide (too long to print) adds the science behind ancient healing traditions.

Alternatives for Arthritis
Citations
  • Atiquzzaman, M., et al, "Role of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Association between Osteoarthritis and Cardiovascular Diseases: A Longitudinal Study," Arthritis & Rheumatology, online, Aug. 6, 2019, DOI: 10.1002/art.41027
  • Lanas, A., et al, "Prescription patterns and appropriateness of NSAID therapy according to gastrointestinal risk and cardiovascular history in patients with diagnoses of osteoarthritis," BMC Medicine, April 14, 2011, DOI: 10.1186/1741-7015-9-38
  • Trelle, S., et al, "Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis," BMJ, Jan. 11, 2011, doi: 10.1136/bmj.c7086
  • Kearney, P.M., et al, "Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials," BMJ, June 3, 2006, DOI: 10.1136/bmj.332.7553.1302
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In early in 2008, due to hip pain I was prescribed celebrex and in July, in a pre-surgical exam, I had a-fib. I was 70 at the time and did not have any history, ever, of heart problems. I believe the celebrex caused the a-fib. In addition to A-fib, I experienced serious kidney problems, and over a period of several months, I was able to clear that up with water fasting and cranberry juice.

Vioxx was a great drug for both my sister & I & I have not had heart issues. Taken Mobic at times & it helps, but not always so much. Yes, it puts many of us between a rock & a hard place. I’ve taken turmeric, bromelain, & bosweila & they too have helped a lot. I’ve had to have knee joint replacements as well as a shoulder joint replacement; so I know what the arthritis does to my joints. It’s been an ongoing issue for years & now for the 2nd time I am dealing with breast cancer surgery, reconstruction & treatment. Appreciate you two so much with your knowledge & expertise–THANK YOU!!

I was diagnosed with OA when I was 36 years old. When I was about 50, one of the OA “new miracle drugs” was prescribed but was discontinued when problems associated with it became evident although not with me.

At that time, I adopted my seven-year rule: no medications that have not been in common use for at least seven years unless absolutely necessary to save my life. Physicians cooperated with my rule.

I read on People’s Pharmacy about nonmedical strategies for coping with OA and settled on sour red cherry gelcaps from Brownwood Acres in Michigan, which I have taken twice daily for many years. Discomfort from OA has been minimal, although joint damage is very visible in my hands.. I also buy dried sour cherries and juice concentrate from Brownwood Acres.

Sour cherries seem to work for me. Taping small magnets to my hands did not! That was the first strategy I tried when OA pain became a serious problem.

Does the use of Diclofenac ointment on a joint increase risk?

Vicky,

We have written extensively about topical NSAIDs such as Pennsaid and Voltaren Gel. The same would hold true for diclofenac ointments. Here is a link to our most recent article on this topic. You will need to read down a ways to see the discussion of topical NSAIDs. Just copy the following URL and put it in the URL box and hit return.

In all the studies you report about nsaids, I never see anything about the lowly aspirin. I know it fell out of favor because of perceived danger of bleeding, but how thoroughly has that been studied? I take buffered aspirin with food & plenty of water when I need a pain pill.

Aspirin does not increase the risk for cardiovascular disease. If anything, aspirin lowers the risk. Of course it can be hard on the digestive tract, just like any of the NSAIDs. And there is a slight increase in the risk for bleeding stroke.

What amount is safe for a month?

I decided to follow People’s pharmacy method: avoid any of the dangerous pills and such. But my arthritis pain needed some help. I found an article about using Baker’s chocolate and oatmeal. Still using it and found another helpful method: I stopped using the pastry tube type rubbing method. It helped for about two weeks and then quit. In its place I found that rubbing alcohol 50% and an occasional single NSAID have given me great relief.

Thanks for information. When you are in pain 24/7 it does not matter. We will take anything. No pharma drugs or OTC pain meds work for me. I recently tried and am continuing with Kratom. I put it into capsules, and IT WORKS. The pain is under control. The only problem for me is that it works only for about an hour or so but I keep a bowl of the caps nearby. No pain! My primary doctor said it had side effects, and I said “SO WHAT?! Tell me ONE pharma drug that does not have side effects, and we can talk.” He shut up!

Are topical Nsaids like Voltaren Gel safer?

We have written extensively about topical NSAIDs such as Pennsaid and Voltaren Gel. The same would hold true for diclofenac ointments. Here is a link to our most recent article on this topic. You will need to read down a ways to see the discussion of topical NSAIDs. Just copy the following URL and put it in the URL box and hit return.

https://www.peoplespharmacy.com/articles/the-dangers-of-diclofenac-and-other-nsaid-pain-relievers/

We have written extensively about topical NSAIDs such as Pennsaid and Voltaren Gel. The same would hold true for diclofenac ointments. Here is a link to our most recent article on this topic. You will need to read down a ways to see the discussion of topical NSAIDs. Just copy the following URL and put it in the URL box and hit return.

https://www.peoplespharmacy.com/articles/the-dangers-of-diclofenac-and-other-nsaid-pain-relievers/

I have RA and osteoarthritis and am caught between a rock and hard place. Pain is no fun, and on a bad day rest, ice, and heat are my best friends. Gentle exercise keeps me moving but the days of long hikes are over. I took Aleve and Vioxx for years before I was diagnosed. Now I take biologics. I have taken Methotrexate, Enbrel, Humira, Orencia and Xeljanz. Xeljanz works the best to control pain, swelling and damage. However, my liver enzymes are elevated, and I have developed high blood pressure. The future effects of all these drugs is still to be determined. I am taking Tramadol on the worst days. Opiates were stopped several years ago due to the difficulty in prescribing and the risk of addiction.

I hope insurance companies and Medicare will start covering non-drug solutions such as acupuncture, massage, and physical therapy to make those treatments affordable. The copay for weekly PT plus massage and acupuncture is nearly three fourths of my monthly income. I get these treatments occasionally but need them weekly. Other comments from people with RA let me know I am not the only one in this boat.

Aspirin is an NSAID and is one of the drugs in Extra-Strength Excedrin (250 mg). Would that fall under the same effect that this study showed?

Do they know if occasional use is safe? There is no mention of the frequency of use in the articles.

What do you think about CBD as a topical pain killer? I have read some recent reviews and am surprised at how positive it looks. What do you hear?

My grandmother died of congestive heart failure while taking large doses of Naprosyn. I had a stroke while taking Vioxx. I’ve had two joint replacements but hope to avoid any others by sticking to daily walking, thrice weekly weight training and an anti-inflammatory diet (tqidiet.com). I avoid NSAIDs like the plague.

Some years ago I was prescribed indomethacin for acute trauma to my big toe joint (phalangeal-metacarpal). It worked like a charm and I only had to take 2-3 of the pills.

For an episode about 6 months ago, I was prescribed diclofenac which did nothing for the pain. Furthermore, once I had studied the clinical reports and patient’s comments online, I immediately stopped taking it.

With the help of The People’s Pharmacy and some more online research, I began taking fish oil (omega-3 300 mg) twice daily and benfotiamine (during acute episodes) and these work perfectly for me. While the science is ever-changing, I did determine first that clinical studies showed no long-term negative health effects. Predictably, my PCP was unaware of any non-prescription alternatives.

I’ve been taking 200 mg of generic ibuprofen for years. My osteoarthritis was bad enough that I had both hips replaced. The ibuprofen really helped with the pain. About three months ago I started intermittent fasting. I fast for 20 hours and have a four hour window in which I can eat. I’ve lost 25 pounds but even more importantly, the pain due to the arthritis has subsided. I no longer need to take the ibuprofen.

I believe it is crucial for people with arthritis to keep moving as much as possible. There are good programs available, such as gentle yoga, or senior classes that will help. Too often medication is the first thing a doctor may suggest. But this does not address the importance of looking at the total mind-body connection.
I appreciate the many natural remedies the Peoples Pharmacy often suggests and their approach to the importance of looking at the whole person.

Am I right in assuming these 2019 data referenced refer to the oral NSAIDs and not topical? I developed a gastric ulcer and can not take any oral NSAID; this was after years of taking 600 mg etodolac 2X/day. I have a deteriorating joint in one of my feet and use diclofenac topical gel 1% once a day. I realize oral vs topical is a different route but just wanted to check.

We have written extensively about topical NSAIDs such as Pennsaid and Voltaren Gel. The same would hold true for diclofenac ointments. Here is a link to our most recent article on this topic. You will need to read down a ways to see the discussion of topical NSAIDs. Just copy the following URL and put it in the URL box and hit return.

https://www.peoplespharmacy.com/articles/the-dangers-of-diclofenac-and-other-nsaid-pain-relievers/

The big question about NSAID’s and cardiovascular injury is, what is the actual risk versus relative risk.
I am old and I have many friends who feel they can only function when they take NSAID’s.

What effect does the amount of pain reliever taken have?

I find turmeric powder mixed in a morning drink relieves my aches and pain very well. Once in a while I will take 1 Advil. But rarely.

I occasionally take one full-sized aspirin (325 mg), in addition to the 81 mg aspirin I take every day anyway, to ward off osteoarthritis in my knees when I expect to do a lot of walking. This seems to work just as well as naproxen or ibuprofen. I am well aware that doctors no longer like the use of aspirin for pain relief, on the grounds that it might lead to stomach upset or bleeding, but I think this concern is way overblown, and I think that aspirin actually has fewer side effects than most other NSAIDS. I suspect that the spurning of aspirin has more to do with the unprofitability of the manufacture of ASA than anything else. I am not a medical professional, but an 80-year old engineer with an interest in drug use.

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