Doc: Balancing Celebrex risks with arthritis benefits
Dear Dr. Roach: I am a 63-year-old overweight woman with low cholesterol, normal-range blood pressure and a healthy heart. I don’t smoke or drink alcohol, and other than my excess weight, I am a healthy person and see my doctor regularly for checkups.
My health issue is painful degenerative osteoarthritis in my knees, hips, spine and hands. I’ve avoided taking any painkillers, and have been able to deal with the joint pain for several years. But lately the pain and stiffness have gotten worse. 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 bicycle. I know that I need to keep my joints moving, but walking is very difficult, and I need a cane to ambulate, even across a room.
My doctor has recently prescribed Celebrex 200 mg for my arthritis, but I am worried about what I have read regarding the risks of taking NSAIDs like 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 don’t take any other medications because I am otherwise very healthy.
How dangerous is Celebrex, if I have to take it daily for years? It does relieve my joint pain a little bit, but not enough to risk having a heart attack or stroke. And on especially painful days I would like to increase my dosage of Celebrex, but my doctor doesn’t advise taking more than 200 mg daily, which leads me to fear that Celebrex may be dangerous. Can you recommend any other less-risky medication for treatment of arthritis and joint pain?
Dear Anon.: Celebrex probably does increase risk of heart disease, just like the other anti-inflammatory medicines you mention. The absolute increase in risk depends on how high your risk is to begin with. For the general population, it’s estimated that 3 people per 1,000 people taking Celebrex for a year will have a heart attack or stroke, and one of those will be fatal.
However, you have a low risk, roughly 2 percent of having a heart attack in 10 years, and celecoxib would be expected to raise your risk about 37 percent above that, so about 2.7 percent in 10 years. In other words, there is less than a one in a thousand chance that celecoxib will cause a heart attack in someone like you. You have to balance the benefit you get against that increase in risk.
Among other effective therapies for arthritis, exercise improves symptoms while reducing heart disease risk, which is why I always recommend it as first-line treatment, and I recognize you are doing what you can to exercise. Acetaminophen (Tylenol) is considered quite safe, and if taken at reasonable doses 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 is well studied.
Email questions to ToYourGoodHealth@med.cornell.edu.