By Ross Walker

As most people age in our modern world, the amount of chronic disease increases with each decade of life. Not only does this cause significant disability, it also often requires multiple medications which may benefit one condition, but make the other condition worse (not to mention interact with other medications, often confuse the sufferer as to which pill is for what condition, and without diligent management, may lead to poor compliance, mistakes in drug dosing and mistaking side-effects for the emergence of new medical conditions and vice versa).

One of the most common conditions in our modern world, suffered especially by many people after age 50, is arthritis. Our most common killer is cardiovascular disease. Many people suffer both conditions in some form and although arthritis is typically not lethal, it is certainly very uncomfortable and has a marked effect on the quality of life. Our current standard anti-inflammatories and painkillers often have significant, and at times, life-threatening side-effects.

Around the turn of the century, a new group of anti-inflammatories known as Cox-2 inhibitors were released onto the market with great fanfare. By 2004, the commonly used Vioxx was withdrawn from the market because of a marked increase in heart attack in the people regularly taking the drug. A very similar drug, Celebrex, didn’t appear to have the same severity of side-effects but certainly made the medical profession act cautiously when prescribing this drug and, in many ways, it fell out of favour.

A new study of 24,000 patients who suffered either osteoarthritis or rheumatoid (average age 64), were treated with either Celebrex, Naprosyn or Brufen. All of these patients had either pre-existing heart disease or were at increased risk for developing the condition. They were followed up for 10 years looking at the incidence of heart attack, stroke or death. Those taking Celebrex had a 2.3% rate of these conditions with 2.5% in the Naprosyn group and 2.7% percent in the briefing group. The rates of upper gastrointestinal bleeding or ulcers was 54% higher in the Brufen group and 41% higher in the Naprosyn group compared with Celebrex. Again, Brufen led to a 64% higher risk of worsening kidney function compared with Celebrex, and death from any cause was 25% higher in the Naprosyn and Brufen group, albeit small absolute numbers.

Regardless, many cardiologists are suggesting that these absolute numbers of death over 10 years are actually quite low for people with either established cardiovascular disease or other high-risk patients. It is my view that we should try to use as many natural anti-inflammatories as possible but the end game is pain relief, mobility and improved function. I would much prefer to have patients take a relatively safer drug such as Celebrex and be able to exercise rather than avoid exercise because of pain. The health benefits of exercise in my view certainly override the potential side effects of a drug such as Celebrex.

Another unrelated study from Greece looked at a completely new benefit from the drug Celebrex. This study enrolled 55 patients with bipolar disorder aged between 18 to 65 who were in the depressive phase of the disease. The patients were either given Lexapro, a commonly used antidepressant, plus Celebrex or Lexapro with a placebo. The startling results of this trial showed that 78% of the patients in the Celebrex group had at least a 50% reduction in the depression scores with 63% reporting their depression had gone away completely. The group taking Lexapro and placebo show that only 45% of this group had at least a 50% reduction in their depression scores with only 10% saying the depression had been resolved completely. Although it usually takes somewhere between 4 to 6 weeks to get significant benefits from antidepressants, in those taking Celebrex, they noticed significant gains within one week.

There is increasing evidence that depression affects the immune system leading to chronic inflammation and it is therefore logical that effective anti-inflammatories such a Celebrex will show this benefit.