Many people who suffer with rheumatoid arthritis or osteoarthritis rely on over-the-counter-medications such as ibuprofen or aspirin to beat pain and inflammation. However, these anti-inflammatory drugs can cause upset stomach, ulcers, and bleeding ulcers in many arthritis sufferers.

Ulcers are sores and craterlike holes that can occur in the stomach lining, duodenum (the part of the small intestine just past the stomach), and more rarely, the esophagus. According to Johns Hopkins Medicine duodenal ulcers are about three times more common than stomach or gastric ulcers. At advanced stages ulcers can bleed, which may cause symptoms such as bloody stools or stomach pain; they're also life-threatening.

One of the main causes of ulcers is non-steroidal anti-inflammatory drugs (NSAIDs). About 25 percent of arthritis sufferers who take NSAIDs develop symptoms, while four percent will develop bleeding ulcers.

Even Celebrex, a prescription NSAID, isn't reducing the risk, as once predicted. Initially it was promoted as a safer alternative to other NSAIDs because early research suggested it caused few ulcers. However, recent evidence shows that the drug increases the likelihood of getting recurrent bleeding ulcers.

Another major concern is combining arthritis medications, which is a common coping strategy for many people with living with arthritis. In a study published in the Archives of Internal Medicine, researchers found that when participants simultaneously took two drugs alendronate, a bisphosphonate, and naproxen, an NSAID it dramatically increased their risk of developing stomach ulcers. The two drugs taken on their own had known ulcer risks, but researchers did not expect the risk to increase as much as it did when the drugs were taken together.

Other risk factors for ulcers include taking corticosteroids (another group of drugs frequently used to treat arthritis), smoking, excessive alcohol drinking and a history of stomach ulcers or gastrointestinal bleeding.

How to Reduce Your Risk of Ulcers

  • The Arthritis Foundation recommends discussing your risk of getting ulcers with your doctor before taking any anti-inflammatory drug.
  • If you're taking more than one arthritis drug, ask your doctor if they're more likely to cause ulcers. If so, ask about other drugs that may be safer, but still effective.
  • Take an antacid to reduce the acids produced when you take NSAIDs.
  • Try using natural pain relievers such as curcumin, ginger, glucosamine, cold treatments, medicated ointments, and exercise.
  • Get tested for Helicobacter pylori, or H-pylori, a bacterium that lives in the stomach lining and is a leading cause of ulcers.

Symptoms of an Ulcer

While some people may not experience symptoms with an ulcer, here are some signs to watch for:

  • Pain, burning or soreness in your upper abdomen
  • Pain goes away if you drink milk or an antacid
  • Vomiting, frequent vomiting or blood in your vomit
  • Bloating
  • Nausea
  • Difficulty finishing meals
  • Black or bloody stools
  • Unexplained or significant weight loss

Study References

Journal: Archives of Internal Medicine, Vol. 161 No. 1,

Study Date: January 8, 2001

Study Name: Alendronate and Naproxen Are Synergistic for Development of Gastric Ulcers

Website: ,

Author(s): David Y. Graham, MD; Hoda M. Malaty, MD, PhD