Doc: Balancing the Risks of Celebrex with the Benefits of Arthritis

Dear Dr. Roach: I am a 63-year-old fat woman with low cholesterol, normal blood pressure and a healthy heart. I do not smoke or drink alcohol, and apart from my excess weight, I am a healthy person and see my doctor regularly for check-ups.

Celebrex from $0.65

My health problem is painful degenerative osteoarthritis in the knees, hips, spine and hands. I have avoided taking any painkillers, and have been able to deal with joint pain for several years. But lately the pain and stiffness have worsened. I am not a good candidate for joint replacement surgery at this time due to being overweight. This I am trying to remedy with diet and light exercise on a stationary bike. I know I have to keep my joints moving, but walking is very difficult, and I need a walking stick, even through a room.

My doctor has recently prescribed Celebrex 200 mg for my arthritis, but I am concerned about what I have read regarding the risks of taking NSAIDs such as Celebrex, Aleve or Motrin due to possible heart damage or stroke. I have no stomach problems or ulcers, and Celebrex does not irritate my stomach in any way. I do not take any other medication because I am very healthy.

How dangerous is Celebrex if I have to take it daily for years? It relieves my joint pain a little, but not enough to run the risk of having a heart attack or stroke. And on especially painful days I would like to increase my dose of Celebrex, but my doctor does not advise taking more than 200 mg a day, which leads me to fear that Celebrex can be dangerous. Can you recommend any other less risky medication for the treatment of arthritis and joint pain?

Anon.

Dear Anon.: Celebrex probably increases the risk of heart disease, like the other anti-inflammatory drugs you mention. The absolute increase in risk depends on how high your risk is to start with. For the general population, it is estimated that 3 people out of 1000 people taking Celebrex for a year will suffer a heart attack or stroke, and one of them will be fatal.

However, you have a low risk, about 2 percent of having a heart attack in 10 years, and celecoxib is expected to raise your risk by 37 percent above that, so that about 2.7 Percent in 10 years. In other words, there is less than one in 1,000 possibilities for celecoxib to cause a heart attack in someone like you. You have to balance the benefit you get against that increased risk.

Among other effective therapies for arthritis, exercise improves symptoms while reducing the risk of heart disease, so I always recommend it as a first line treatment, and I recognize that you are doing what you can to exercise. Acetaminophen (Tylenol) is considered to be fairly safe, and if taken at reasonable doses it is very unlikely to cause problems.

In rare cases, it can cause liver or kidney problems. Turmeric may have benefits, but neither its efficacy nor its toxicity are studied well.

Keith Roach, to your health