Nine million people with arthritis were yesterday left in a dilemma as ibuprofen, a painkiller which has long been considered one of the safest drugs on the market, was linked with heart attacks.
The news will dismay those who depend on drugs to reduce the stiffening in joints, alleviate the pain and allow them to lead a normal life.
The question mark over ibuprofen, of which Nurofen is one of the best known brands, and the other less well-known non-steroidal anti-inflammatories (NSAIDS) follows on the heels of the crisis over a newer class of medicines used for the same purpose.
The drug company Merck took its best-selling Vioxx off the market after trials showed it, too, was linked with heart attacks. A whole class of drugs, known as the Cox2 inhibitors, is now under investigation.
The biggest support group for people with arthritis made a heartfelt plea yesterday for doctors to advise them on what they should do.
"Medicine is an important element in the treatment for the vast majority of people with arthritis. There is now much confusion and worry over the risks associated with many of the medicines used for arthritis," said Neil Betteridge, chief executive of Arthritis Care.
"We urgently need the medical profession to take a lead in helping people with arthritis decide what treatment is right for them. Of course, any medicine that brings a benefit is likely also to carry a risk of some side effects. Indeed, doing nothing to manage your condition may also carry a risk.
"However, there needs to be very clear communication of both the risks and benefits associated with each and every treatment.
"Ultimately, it is the person with arthritis who will decide what to take for their condition and their decision needs to be an informed one."
Confidence in ibuprofen, which as an over-the-counter painkiller had sales of over 200m in 2000, was further dented by a study published last week by researchers at the University of Southern California, who said they had identified a link to breast cancer.
Today's paper, published in the British Medical Journal, comes from academics at Nottingham University, who identified 9,218 patients in England, Scotland and Wales aged from 25 to 100 who had suffered a first heart attack.
They then looked to see if they had been taking NSAIDS and Cox2 inhibitors.
Their results were adjusted for factors linked to heart attacks, such as age, heart disease, smoking habits and whether they were also taking aspirin, which reduces the heart attack risk.
They found that the risk of a heart attack was increased in those who had taken the drugs in the three months before their heart attack.
For ibuprofen, the risk rose by almost a quarter (24%) - higher if they had been on it longer - and for a similar drug called diclofenac it rose to 55%.
The increased risk with the Vioxx (generic name rofecoxib) was 32% and with an other Cox2 called Celebrex (celecoxib) it was 21%.
The authors were particularly concerned about older NSAIDS like ibuprofen, because many people will have switched to them after the furore over the Cox2s. For every 1,005 people over 65 taking ibuprofen, they say, one will have a heart attack.
The authors, Julia Hippisley-Cox, professor of clinical epidemiology and general practice, and Carol Coupland, senior lecturer in medical statistics, call for an investigation of the heart risks of all these drugs.
They say that given the high prevalence of the use of these drugs in elderly people and the increased risk of heart attack with age, there could be considerable implications for public health.
In a separate editorial in the BMJ, Peter Juni, senior research fellow in clinical epidemiology at the University of Berne, and colleagues say that some of the results of the study could be explained by other factors.
Large-scale clinical trials comparing the efficacy and side-effects of the drugs may be necessary to determine the best treatment for people with musculoskeletal pain, they say.
