Aspirin and Arthritis Go Together,
But at What Risk?
The super-drug, aspirin, treats a myriad of America’s health ills, including arthritis, and has for more than 110 years. It was never tested and approved by the Food and Drug Administration (FDA) because it was grandfathered as an existing drug in 1938. However, it carries the risk of stomach ulceration and bleeding to the extent that some question whether it would be allowed on the market as an over-the-counter drug if introduced today.[1]
It is the father of anti-inflammatory drugs and has long been the most popular treatment for arthritis. Today, it is one of the most widely used medications in the world. In America alone an estimated 16,000 metric tons is consumed each year and more than 80 million aspirin-tablets are taken daily.[2]
The FDA didn’t get the power to prevent untested drugs from entering the market until 1938 when proof of safety became a requirement. Drugs marketed before then were grandfathered. In 1962 the FDA began requiring proof of safety and efficacy.[3]
Aspirin has been called a wonder drug and a miracle drug because of its power to produce a beneficial effect on the body for many different causes.[4][5] In spite of not being approved initially by the FDA, it remains one of the most extensively studied drugs in history. Its track record spans more than a century. It is the only over-the-counter pain reliever to provide cardiovascular benefits.
However, it has also been shown to increase the risk of stomach ulceration and gastrointestinal (GI) bleeding, has been linked to Reye’s Syndrome in children,[6] and its side effects have taken a toll when not used carefully, or when used on a daily basis for long-term chronic conditions like arthritis.
Aspirin ranks 4th on top ten list of adverse drug events
The FDA defines a serious adverse event as a drug reaction that resulted in death, a birth defect, disability, hospitalization, or was life-threatening or required intervention to prevent harm. Such events are voluntarily reported to the FDA through its Adverse Event Reporting System (AERS), known as “MedWatch” reports.[7]
Painkillers aspirin, ibuprofen, and acetaminophen are among the top ten drugs most commonly implicated in adverse drug events (ADE) requiring treatment in a hospital emergency department (ED), according to a 2006 national surveillance study in the Journal of American Medical Association (JAMA).[8] Aspirin was the fourth-leading drug on the list. Here are the top ten drugs causing treatments in hospital EDs:
- Insulin
- Anticoagulants
- The antibiotic amoxicillin
- Aspirin (painkiller)
- The antibiotic trimethoprim-sulfamethoxazole
- The generic pain drug hydrocodone/APAP (acetaminophen)
- Ibuprofen (painkiller)
- Acetaminophen (painkiller)
- The antibiotic cephalexin
- Penicillin
Referencing the above study, Matthew Grissinger, RPh, FASCP, a medication safety analyst with the nation's oldest voluntary drug error reporting program, Institute for Safe Medication Practices (ISMP), entitled his session "The Top 10 Adverse Drug Reactions and Medication Errors" at the American Pharmacists Association (APhA) Annual Meeting in March, 2007, as reported online by Medscape Education.[9]
Consumers, medical professionals and manufacturers are invited to report adverse drug events to the FDA at: http://www.fda.gov/Safety/MedWatch/HowToReport/default.htm
What is aspirin?
Aspirin, also known as acetylsalicylic acid (ASA), is a salicylate drug and the first discovered member of the class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), not all of which are salicylates.
The drug is often used as an analgesic for mild pain relief, as an antipyretic to reduce fever, and as an anti-inflammatory.
For centuries, natural preparations containing the properties of salicyclic acid (similar to aspirin) have been used for medicinal purposes. An extract from willow bark, rich in salicylate, became recognized for its propensity for treating fever, pain and inflammation.
History of aspirin
In the year 1853, a French chemist, Charles Frederic Gerhardt, was the first to prepare acetylsalicylic acid. By 1897 scientists headed by Felix Hoffmann at the drug and dye firm Bayer began investigating acetylsalicylic acid as a less-irritating replacement for standard common salicylate medicines. By 1899, Bayer had named this drug Aspirin or Bayer Aspirin and began successfully selling it around the world.[10]
Its popularity and reputation as a miracle drug mushroomed with its effectiveness connected to the Spanish flu pandemic of 1918. When Bayer’s American patent expired in 1917 a deluge of aspirin brands and products followed.
The drug’s medicinal effectiveness was not completely understood until 1971 when British pharmacologist John Robert Vane showed that it suppressed the production of prostaglandins and thromboxanes. For this discovery, he was awarded the Nobel Prize in Physiology and Medicine in 1982.[11]
A decline in popularity of aspirin therapy occurred in the wake of newer NSAIDs, acetaminophen in 1956 and ibuprofen in 1969.
When clinical trials and other studies from the 1960’s to the 1980s established the drug's efficacy as an anti-clotting agent that reduces the risk of clotting diseases, its sales picked up again and have remained strong thanks to widespread current use as a preventive treatment for heart attacks and strokes.
Today, it’s estimated that Americans spend about $2 billion a year for these over-the-counter medications, many of which contain it or similar drugs.[2]
Aspirin uses
Aspirin remains a frequent over-the-counter choice in the treatment of mild to moderate pain, especially for migraine headaches and fever.
It is now also prescribed as a combination prescription drug with other non-steroidal anti-inflammatory drugs and opioid analgesics as a stronger preparation for moderate to severe pain.
Because of its antiplatelet (“anti-clotting”) effect, it is often used in long-term, low doses to prevent blood clot formation, strokes and heart attacks. This drug is also effective in low doses given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue.
Aspirin for inflammatory arthritis
Aspirin therapy is still an important part of the treatment program for many people with inflammatory (auto-immune) conditions. However, for effectiveness, it must be given in doses much higher than commonly used as an over-the-counter remedy for minor aches and pains.
In high doses, it and other salicylates are used in the treatment of rheumatoid arthritis, rheumatic fever and other inflammatory joint conditions, primarily by physician prescription.
Compared to other similar NSAIDs, aspirin is less costly. Its blood level can also be precisely measured.
However, it can cause stomach problems in many people and this factor must be weighed by both the patient and doctor.
Aspirin for osteoarthritis
Aspirin has been a familiar choice for treatment of osteoarthritis because of its anti-inflammatory properties. Another popular NSAID is ibuprofen, which, like aspirin, is frequently recommended for mild to moderate pain as an over-the-counter drug.
Osteoarthritic joints are not always painful or chronic. However, when pain is present, it can vary in intensity. In some people severe osteoarthritis is completely pain-free, whereas in others even minor joint changes are quite painful. The response to arthritis pain covers a broad spectrum and varies by individual.
Because of this, it is important to have an individually designed treatment program. What works for one person may not necessarily work for another, even if both have osteoarthritis of the same joint.
For stronger pain, aspirin combined with other drugs is prescribed by doctors to treat arthritis.
Still, the drug is not suitable for people who have had a stomach ulcer or are allergic to the drug.
Aspirin side effects ominous when treating arthritis
Aspirin is generally safe when taken in small doses for short durations, but there is no cure for arthritis.
Frequenly, larger doses are needed long-term for the control of arthritis pain and inflammation. This can cause serious side effects including kidney problems or gastrointestinal (GI) bleeding, the risk of which increases with age and prolonged use.
In prescription form the drug is used to relieve the symptoms of rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus (SLE) and certain other autoimmune conditions. In non-prescription form, for osteoarthritis and other degenerative arthritis types.[12]
According to PubMed Health side effects and complications of daily therapy of the drug include:
- Hemorrhagic stroke. While daily use can help prevent a clot-related stroke, it may increase your risk of a bleeding stroke (hemorrhagic stroke).
- Gastrointestinal bleeding. Daily use increases your risk of developing a stomach ulcer. And, if you have a bleeding ulcer, taking the drug will cause it to bleed more, perhaps to a life-threatening extent. Kidney dysfunction.
- Allergic reaction. If you're allergic to aspirin, taking any amount can trigger a serious allergic reaction, including rash, cold clammy skin, fast heartbeat/breathing, hives, itching, dizziness, swelling of the eyes, face, lips, tongue, or throat, hoarseness, and breathing difficulties.
- Ringing in the ears (tinnitus) and hearing loss. Too much of the medication (overdosing) can cause tinnitus and eventual hearing loss in some people.
- Upset stomach, vomiting, heartburn, loss of appetite, dizziness. These are the most common side effects of this drug.
- Major bleeding. If you’re already taking an anticoagulant (warfarin, Coumadin), combining with daily aspirin may greatly increase your risk and shouldn’t be taken without discussion with your doctor. Bloody vomit (looks like coffee grounds), bright red blood in stools, or black or tarry stools.
- Prolonged bleeding after surgery. This medication can cause prolonged bleeding after operations for up to 10 days.
Notify your doctor promptly if you develop: persistent ringing in the ears, difficulty hearing, dark urine, yellowing eyes, easy bruising, persistent stomach pain, black stools.
Because of its additional blood thinning effects and potential for gastrointestinal disorders, the FDA warns that people who take aspirin daily should not consume more than one alcoholic drink per day if you’re a woman, or two drinks a day if you’re a man.[13]
Reye’s syndrome in children
Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver. It is associated with aspirin consumption by children with viral diseases such as chickenpox or fever.[6]
The disease causes fatty liver with minimal inflammation, and severe swelling of the brain. The liver may become slightly enlarged and firm, and there is a change in the appearance of the kidneys. Jaundice is not usually present. Early diagnosis is vital, otherwise death or severe brain damage may follow.
The Centers for Disease Control and Prevention (CDC), the U.S. Surgeon General, the American Academy of Pediatrics (AAP) and the FDA recommend that aspirin and combination products containing the drug not be given to children under 19 years of age during episodes of fever-causing illnesses.
Hence, in the United States, it is advised that the opinion of a doctor or pharmacist be obtained before anyone under 19 years of age is given any medication containing aspirin (also known on some medicine labels as acetylsalicylate, salicylate, acetylsalicylic acid, ASA or salicylic acid).
Salicylate poisonings in children and adolescents
Salicylates are widely-encountered agents found in hundreds of over-the-counter medications and in many prescription drugs. Salicylate ingestion continues to be a common cause of poisoning in children and adolescents. The prevalence of aspirin-containing analgesic products makes these agents, found practically in every household, common sources of both accidental and suicidal ingestion.[14]
Salicylic acid and its derivatives are also active ingredients in a wide variety of readily available topical preparations used for the treatment of pain, warts, and acne. And liquid Pepto-Bismol, a common gastrointestinal agent, contains 131 mg of salicylate per tablespoon.
Here’s a list of aspirin-containing preparations:
- Children-aspirin (80 mg tablets)
- Adult-aspirin (325 mg tablets)
- Oil of Wintergreen (methyl-salicylate 98% salicylate)
- Pepto-Bismol (236 mg of nonaspirin salicylate per 15mL)
Ingestion by children of topical products containing salicylates, such as Ben-Gay, can cause severe toxicity. One teaspoon of 98% Oil of Wintergreen (methyl salicylate) contains 7000 mg of salicylate, the equivalent of about 90 baby-aspirin and more than 4 times the potential toxic dose for a 22-pound child.
2012 Study: Daily aspirin is not for everyone
Aspirin is the most-used drug in the world. More than 50 million people, or 36 percent of the adult population in the United States, consume 10 to 20 billion tablets each year to protect their hearts from clots, which are the leading cause of heart attacks and strokes.[15]
But conclusions from a new study show that the wonder drug may not be for everyone, and is doing more harm than good in some patients. Researchers found when aspirin is taken preventively by people without prior cardiovascular disease, routine use is not warranted and treatment decisions need to be considered on a case-by-case basis.
In the New York Times Blog, Well, on January 16, 2012, Editor Tara Parker-Pope summarized the study: “In the combined analysis, the researchers found that regular aspirin users were 10 percent less likely than the others to have any type of heart event, and 20 percent less likely to have a nonfatal heart attack. While that sounds like good news, the study showed that the risks of regular aspirin outweighed the benefits.[16]
“Aspirin users were about 30 percent more likely to have a serious gastrointestinal bleeding event, a side effect of frequent aspirin use. The overall risk of dying during the study was the same among the aspirin users and the others. And though some previous studies suggested that regular aspirin use could prevent cancer, the new analysis showed no such benefit.
Over all, for every 162 people who took aspirin, the drug prevented one nonfatal heart attack, but caused about two serious bleeding episodes.”
“We have been able to show quite convincingly that in people without a previous heart attack or stroke, regular use of aspirin may be more harmful than it is beneficial,” said Dr. Sreenivasa Seshasai of the Cardiovascular Sciences Research Center at St. George’s, University of London.
The meta-analysis of nine randomized placebo-controlled trials with at least 1000 participants each, was published online as Effect of Aspirin on Vascular and Nonvascular Outcomes in the Archives of Internal Medicine on January 9, 2012.[17]
The findings are likely to add to the confusion about who should regularly take aspirin and who should not.
2007 study: Take baby aspirin daily but not adult-dose
A 2007 study reported that amidst controversy over dosage (81 mg versus 325 mg daily) over 50 million US adults take a baby or adult aspirin regularly for long-term prevention of cardiovascular disease. Researchers concluded: “Currently available clinical data do not support the routine, long-term use of aspirin dosages greater than 75 to 81 mg/d in the setting of cardiovascular disease prevention. Higher dosages, which may be commonly prescribed, do not better prevent events but are associated with increased risks of gastrointestinal bleeding.”[18][19]
Study authors conducted a systematic review of 2,415 English-language literature limited to clinical trials and published prospective studies using different aspirin dosages in the setting of cardiovascular disease. The results were published May 9, 2007 in the Journal of the American Medical Association (JAMA).
"The 325-milligram dose was arrived at because that's what they could fit into a pill," says Dr. Charles Campbell, lead author of the study and director of the cardiac care unit at the University of Kentucky. "The 81-milligram was arrived at because it's one-quarter of the other."
And there's little science behind recommendations to take either the adult or the child's dose to prevent heart disease.
Campbell and researchers analyzed 2,415 studies of aspirin to prevent recurrent events in people who had suffered a heart attack or stroke. "We could find no evidence that higher doses were better," he says. "It also looks like higher doses are associated with more bleeding."
For most people, Campbell says, "Chew or swallow a baby aspirin, and that's enough."
Study: Increased risk of heart attack or stroke for aspirin-resistant patients
A new meta-analysis of 20 studies covering a total of 2930 patients with cardiovascular disease shows being aspirin-resistant makes patients four times more likely to suffer a heart attack, stroke or even die from a pre-existing heart condition, according to the study published online in the British Medical Journal, January 18, 2008.[20]
The study is the second in less than a year to link aspirin-resistance to increased risk and should help quell the debate over whether a lack of response to the drug warrants being taken seriously. The other smaller meta-analysis was published in August, 2007 by Dutch researchers and also demonstrated a fourfold increased risk of recurrent cardiovascular events in aspirin-resisitant subjects.
The BMJ study relates to patients who are prescribed aspirin long term as a way of preventing clots from forming in the blood.
Patients who are labeled "aspirin-resistant" have blood cells (platelets) that are not affected in the same way as those of patients who are responsive to the drug, i.e., people who are "aspirin-sensitive."
"What this paper shows is that, looking at a variety of patient populations with a variety of underlying complications, if one is aspirin-resistant that increases the risk of a cardiovascular event clinically,” said Dr. Michael R. Buchanan, senior author on the study. “And that’s what’s new.”
There is currently no agreed method of accurately determining who is and isn't aspirin-resistant and the reasons why someone might be resistant to the drug are currently a cause of controversy.
Study: Common pain relievers associated with hypertension in men
Are you a man and you pop painkillers daily for arthritis or other chronic pain? Your reward may be a side effect you weren't expecting. Men who take aspirin, acetaminophen or other types of non-steroidal anti-inflammatory drugs, known as NSAIDs, six to seven days a week have an increased risk of developing hypertension, according to a four-year study in the Feb. 26, 2007 Archives of Internal Medicine. The study was conducted by a group led by John Forman, MD, of the Brigham and Women’s Hospital in Boston, Massachusetts.[21]
The study determined the high risk percent of developing high blood pressure than nonusers as follows:
- Acetaminophen = 36%
- NSAID = 38%
- Aspirin = 26%
Similar results were observed when the number of pills taken per week was analyzed rather than frequency of use in days per week. "Acetaminophen, ibuprofen and aspirin are the three most frequently used drugs in the United States," say the authors in the report. "Given their common consumption and the high prevalence of hypertension (in the United States), our results may have substantial public health implications, and suggest that these agents be used with greater caution."
The 16,031 men in the study had an average age of 64.7 years and did not have a history of high blood pressure at baseline. The results were, for the most part, consistent with the results of 2 previous large cohort studies, the Nurses' Health Study and the Physicians' Health Study, both of which demonstrated an increased risk of hypertension with these analgesic drug classes.
To avoid aspirin side effects, choose natural pain relief instead
Have arthritis relief painkillers forced you into a corner?
Do you have pain that requires non-prescription or prescription medication as many as five days a week? If so, you may wonder about the potential damage this has on your stomach, kidneys, liver or other organs. Aspirin and all pharmaceutical painkillers have potential serious side effects from over use and continual use.
The purpose of the website arthritis-relief-naturally.com is to explore plant-based clinically-proven alternatives for pain relief that safely shuts the door on harmful side effects from pharmaceutical drugs. Which begs this question:
- If you could achieve the relief you need safely, without total reliance on drugs, wouldn’t it be worth a try?
It’s possible to free yourself completely (or cut back substantially) from pain relief drugs by switching to safe, natural alternatives. For instance, the #1 natural nutrition company in the U.S., the Shaklee Corporation, developed three different natural pain relief products from clinical studies that are totally safe and guaranteed to help you in 30 days or get your money back.
Referred to as “The Pain Trio”, they work individually, or together synergistically without any worry about health issues from long-term use, or from using more than the recommended dosage.
You may be aware from other pages on this website that my husband and I both have osteoarthritis, and our testimony includes the fact that neither of us take pharmaceutical drugs anymore for pain—we've accomplished arthritis relief naturally!
For background information explaining the natural ingredients for each product, please click the following link: Three Natural Pain Products.
Recommended natural pain relief supplement
Here’s a thumbnail on Pain Relief Complex, one of the three products mentioned above, that replaced aspirin/ibuprofen and made a remarkable difference in the treatment of my husband's knee arthritis and my neck arthritis, as well as my recurrent back pain (click the bold blue link below for price and information on this one product):
This natural dietary supplement in tablet form consists of a combination of 1000 mg of clinically proven boswellia extract (resin) standardized to 4% total boswellic acid and a patent-pending 150 mg of safflower extract. It provides pain relief for overworked joints, promotes flexibility and overall comfortable movement and is gentle on the stomach. It contains no-aspirin, is not habit-forming and is completely safe.
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Sources/references
[1] Lowe, D; Article Aspirin: Not Approvable – Why many familiar medicines might flunk FDA approval today, published by The Manhattan Institute; Medical Progress Today.com, November 17, 2005. http://www.medicalprogresstoday.com/spotlight/spotlight_indarchive.php?id=1039
[2] Article, Aspirin Background, Encyclopedia.com http://www.encyclopedia.com/topic/aspirin.aspx
[3] Compliance Manual, Food and Drug Administration (FDA), CPG Sec. 440.100 Marketed New Drugs Without Approved NDAs and ANDAs; appendix C, Prescription Drug Wrapup. Accessed online March 30, 2012 http://www.fda.gov/ICECI/ComplianceManuals/CompliancePolicyGuidanceManual/ucm074382.htm
[4] Jeffreys, D; book Aspirin: The Remarkable Story of a Wonder Drug, Publisher: Bloomsbury, August 26, 2004
[5] Metcalf, E; book Aspirin: The Miracle Drug, PublisherAvery Health Guides, April 7, 2005
[6] Article, Suitability: Background on Aspirin and Reye Syndrome, AspirinFoundation.com, accessed online March 30, 2012 http://www.aspirin-foundation.com/suitability/backgrounder.html
[7] Publication, Adverse Event Reporting System (AERS), Food and Drug Administration (FDA), Guidance, Compliance and Regulatory Information, accessed online April 2, 2012 http://www.fda.gov/drugs/guidancecomplianceregulatoryinformation/surveillance/adversedrugeffects/default.htm
[8] Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events; JAMA. 2006;296:1858-1866.
[9] Article/report, The "Top 10" Drug Errors and How to Prevent Them, (Log in Free Medscape.org Education) from Medscape Pharmacists, at American Pharmacists Association (APhA) 2007 Annual Meeting, March 16-19, 2007; Atlanta, Georgia. www.medscape.org/viewarticle/556487
[10] Bachoffner, P; Two “pharmacists” in the beginning of Aspirin: Charles Gerhardt and Felix Hoffmann, Rev Hist Pharm (Paris). 1997;45(316):411-4. PubMed http://www.ncbi.nlm.nih.gov/pubmed/11625257
[11] Article, Wikipedia, the free encyclopedia, Aspirin, accessed online April 2, 2012 http://en.wikipedia.org/wiki/Aspirin
[12] Publication, Aspirin, U.S. National Library of Medicine, PubMed Health, AHFS Consumer Medication Information [Internet], Rev. March 16, 2011. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000802/
[13] Publication, Daily aspirin therapy: Understand the benefits and risks, Mayo Clinic, accessed online November 16, 2015. http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797
[14] Waseem, M; Article Salicylate Toxicity, MedScape Reference; Drugs, Procedures and Diseases; accessed online April 2, 2012 http://emedicine.medscape.com/article/1009987-overview
[15] ScienceDaily article, Is An Aspirin A Day Good For You?, ScienceDaily, January 11, 2008. http://www.sciencedaily.com/releases/2008/01/080111202625.htm
[16] Parker-Pope, T; Well.blogs Daily Aspirin is Not for Everyone, Study Suggests, New York Times, January 16, 2012 http://well.blogs.nytimes.com/2012/01/16/daily-aspirin-is-not-for-everyone-study-suggests/#
[17] Seshasai, S MD, et. al, Effect of aspirin on vascular and nonvascular outsomes, PubMed Feb. 13, 2012; Meta-analysis, Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.628 http://archinte.ama-assn.org/cgi/content/abstract/archinternmed.2011.628v1
[18] Campbell, CL M.D., et al, Aspirin dose for the prevention of cardiovascular disease, a systematic review, May 9, 2007 JAMA, 2007;297(18):2018-2024. doi:10.1001/jama.297.18.2018 http://jama.ama-assn.org/content/297/18/2018.short
[19] Brink, S, Article Small Dose of Reality, Los Angeles Times, May 14, 2007, accessed online April 4, 2012 http://articles.latimes.com/2007/may/14/health/he-capsule14
[20] Krasopoulos, G; Brister, S; Beattie, WS: Aspirin “resistance” and risk of cardiovascular morbidity: systematic review and meta-analysis, British Medical Journal, January 24, 2008;336:195 http://www.bmj.com/content/336/7637/195
[21] Forman, JP, Rimm, EB, Curhan, GC. Frequency of analgesic use and risk of hypertension among men. Archives of Internal Medicine, February 26, 2007; 167:394-399. Study repeated in publication Common pain relievers associated with high blood pressure, Arthritis.org; accessed online April 6, 2012 http://www.arthritis.org/pain-relievers-hbp.php
Disclaimer: Health statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
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