Background Non-steroidal Anti-inflammatory Drugs (NSAIDs) play a vital role in reducing morning stiffness and/or joint pain of patients receiving Rheumatoid Arthritis (RA) drug therapy. NSAID-induced gastric ulcers, however, have been identified as a major side effect, highlighting the need for countermeasures. Asymptomatic gastric ulcers, in particular, have been receiving much attention as a blind spot in RA drug therapy.
In this context, a questionnaire survey was conducted involving 3,000 cases of the listed 22,101 cases of the Japan Rheumatism Friendship Association (incorporated non-profit organisation), and subsequent analysis focused on gastrointestinal disorders.
Objectives The objective was to aid future countermeasures by studying and analysing facts regarding drug-induced side effects (gastrointestinal disorders in particular), clinical practices and issues taking place between physicians and RA patients.
Methods Mail survey of 3,000 patients randomly sampled from the listed 22,101 members of the Japan Rheumatism Friendship Association (non-profit organisation).
Results A total of 1,764 responses were returned (response ratio 58.8%).
As known, many RA patients visit multiple medical institutions for treatment of their complications including hypertension, cardiopulmonary disorders, infections, etc., thus receiving prescriptions for NSAIDs from non-RA specialists as well. Gastric ulcer incidence was significantly higher among these patients who tend to double-dose NSAIDs.
A total of 1,146 RA patients were discovered to have experienced gastrointestinal disorders caused by NSAIDs, which translates to 65% of the overall respondents. 325 (18%) experienced ulcers (including gastric and duodenal ulcer). Among the 280 patients who experienced gastric ulcers, 97 (35%) had been hospitalised–65 (67%) of whom for 3 weeks or longer.
The number of gastric ulcer patients was proportionate to the period of RA morbidity. On the other hand, despite RA patients?f concerns about NSAID-induced side effects, only 652 (37%) received explanations from their physicians. Only 717 (41%) of the overall respondents were recommended to receive endoscopic examinations. Many aspects of this study have shed new light on the facts regarding RA treatment in Japan, revealing many issues that require closer attention.
Conclusion RA is a general and progressive disease causing lesions not only in joints but also in multiple organs, which means many different drugs other than those for RA tend to be added to patients?f regimen. Results of this study revealed many issues to be resolved in RA treatment in Japan: double-dosing of NSAIDs, the fact that only 652 (37%) received explanation from physicians about possible side effects and that only 717 (41%) were recommended to receive endoscopic check-ups despite the high incidence of gastrointestinal disorders (1,146 patients or 65%) and gastric and duodenal ulcers (325 patients or 18%). Results of this study indicate urgent need to improve RA treatment in Japan through educating not only physicians and patients but also the general public.
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