Summary
The efficacy of ranitidine in the treatment of NSAID-related dyspeptic symptoms with and without peptic ulcer disease (PUD) was investigated in 124 patients with rheumatoid arthritis (RA) and osteoarthritis (OA). The patients, who continued the use of NSAIDs were investigated by gastroduodenoscopy. Patients with PUD received open label ranitidine 150 mg b.i.d. and the patients without PUD were randomly allocated to receive ranitidine 150 mg b.i.d. or placebo for 4 weeks. PUD was found in 36 (26%) consecutive patients who presented with dyspeptic symptoms. Of these patients dyspeptic symptoms had disappeared in 8 (26%) of 31 evaluable patients and PUD was healed in 18 (56%) patients after 4 weeks of treatment. After 8 weeks of treatment PUD was healed in 27 (87%) patients. Of the remaining patients without PUD dyspeptic symptoms had disappeared in 24 (26%) of the ranitidine-treated patients which was significantly better (p<0.02) than the 5 (6%) placebo-treated patients. The minor mucosal lesions found in this patient group improved to a similar extent in the ranitidine and placebo-treated patients although 1 placebo-treated patient deteriorated and 2 placebo-treated patients developed PUD during the 4 weeks of study. The results of this study show that oral ranitidine 150 mg b.i.d. is effective in the treatment of both dyspeptic symptoms and mucosal lesions in RA and OA patient who continue the use of NSAIDs.
Similar content being viewed by others
References
Haslock, I. Prevalence of NSAID-induced gastrointestinal morbidity and mortality. J Rheumatol 1990, 17 (suppl 20); 2–6.
Blechman, W.J., Schmid, F.R., April, P.A. et al. Ibuprofen or aspirin in rheumatoid arthritis therapy. JAMA 1975, 233, 336–340.
Ehrlich, G.E., Miller, S.B., Zeiders, R.S. Choline magnesium trisalicylate versus ibuprofen in rheumatoid arthritis. Rheumatol Rehab 1980, 19, 30–41.
O'Brien, W.M. Ulcerogenic properties of anti-inflammatory drugs. Pharmacology 1982, 25 (suppl 3), 9–11.
Mc Millen, J.I. Tolmetin sodium vs ibuprofen in rheumatoid arthritic patients previously untreated with either drug: a double-blind crossover study. Curr Ther Res 1977, 22, 266–275.
Bower, R.J., Umbenbauer, E.R., Hercus, V. Clinical evaluation of sulindac: A new nonsteroidal anti-inflammatory drug. Advances in Inflammation Research, Vol 1. New York: RAven Press, 1979, 559–567.
Coles, L.S., Fries, J.F., Kraines, R.G., Roth, S.H. From experiment to experience: side effects of nonsteroidal anti-inflammatory drugs. Am J Med 1983, 74, 820–828
Janssen, M., Dijkmans, B.A.C., van der Sluys, F.A. et al. Upper gastrointestinal complaints in chronic rheumatic patients in comparison with other chronic diseases. Br J Rheumatol 1992, 31, 747–752.
Langman, M.J.S., Brooks, P., Hawkey, C.J. Silverstein, F., Yeomans, N. Nonsteroidal anti-inflammatory drug associated ulcer: epidemiology causation and treatment. J Gastroenterol Hepatol 1991, 6, 442–449.
Gabriel, S.E., Jaakkimainen, L., Bombardieri, C. Risk for serious gastrointestinal complications related to the use of nonsteroidal anti-inflammatory drug. A meta-analysis. Ann Int Med 1991, 115, 787–96.
Armstrong, C.P., Blowe, A.L. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration. Gut 1987, 28, 527–532.
Janssen, M., Dijkmans, B.A.C., Lames, C.B.H.W., et al. A gastroscopic study of the predictive value of risk factors for nonsteroidal anti-inflammatory drug associated ulcer disease in rheumatoid arthritis patients. Br J Rheumatol 1994, 33, 449–454.
Ehsanullah, R.S.B., Page, M.C., Tildesley, G., Wood, J.R. Prevention of gastriduodenal damage induced by nonsteroidal anti-inflammatory drugs: a controlled trial of ranitidine. Br Med J 1988, 297, 1017–1021.
Deventer van, G.M., Elashoff, J.D., Reedy, T.J., Schneidman, D., Walsh, J.H. A randomized study of maintenance therapy with ranitidine to prevent the recurrence of duodenal ulcer. New Engl J Med 1989, 320, 1113–1119.
Jensen, D.M., Cheng, S., Kovacs, K.O.G., Randall, G. et al. A controlled study of ranitidine for the prevention of recurrent hemorrhage from duodenal ulcer. New Engl J Med 1994, 330, 382–386.
Penston, J.G. A decade of experience with long-term continuous treatment of peptic ulcers with H2-receptor antagonists. Aliment Pharmacol Therapeut 1993, 7, 27–33.
Murray, W.R., Cooper, G., Laferla, G., Rogers, P., Archibald, M. Maintenance ranitidine treatment after hemorrhage from a duodenal ulcer: a 3-year study. Scan J Gastroenterol 1988, 23, 183–187.
Wolde ten, S., Dijkmans, B.A.C., Janssen, M., Hermans, J., Lamers, C.H.B.W. A double blind placebo-controlled study of ranitidine for the prevention of recurrent peptic ulcer disease in rheumatoid arthritis patients taking NSAIDs. Arthritis Rheum 1994, 9 (suppl), S258.
Hotz, J., Kark, W. Efficacy of ranitidine in non-ulcer dyspepsia; fact of fancy? (abstract) Gastroenterol 1991, 100 (part 2), A85.
Saundes, J.H.B., Oliver, R.J., Higson, D.L., Dyspepsia: incidence of non-ulcer disease in a controlled trial in general population. Br Med J 1986, 292, 665–668.
Arnett, F.C., Edworthy, S.M. Cloch, D.A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis and Rheum 1988, 31, 315–324.
Altman, R., Alarcon, G., Appelrouth, D. et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arhtritis Rheum 1990, 33, 1601–1610.
Altman, R., Alarcon, G., Appelrouth, D. et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991, 34, 505–514.
Altman, R., Asch, E., Bloch, G. et al. Development for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 1986, 29, 1039–1049.
Lanza, F.L., Royer, G.L., Nelson, R.S., Chen, T.T., Seckman, C.E., Raack, M.F. A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa. Am J Gastroenterol 1981, 75, 17–21.
Huson, N., Hawkey, C.J. Non-steroidal anti-inflammatory drug associated upper gastrointestinal ulceration and complications. Europ J Gastroenterol Hepatol 1993, 5L, 412–419.
Fries, J.F., Mille, S.R., Spitz, P.W., Williams, C.A., Hubert, H.B., Bloch, D.A. Identification of patients at risk for gastropathy associated with NSAID use. J Rheumatol 1990, 17 (Suppl 20), 12–19.
Shaikh, S., Mills, J.G., Darekar, B., Wood, J.R. Ranitidine (150 mg bd) is effective inj preventing peptic ulceration in arthritic patients receiving diclofenac (150 mg/day). Gut 1993, 34 (suppl. 1), S14.
Bianchi Porro, G., Lazzaroni, B. Prevention and treatment of nonsteroidal gastroduodenal lesions. Eur J Gastroenterol Hepatol 1993, 5, 420–432.
Ehsanullag, R.S.B., Page, M.C., Tildesley, G., Wood, J.R. A place-bo controlled trial study of ranitidine in healing NSAID associated gastric and duodenal ulcers. Br J Rheumatol 1990, 2 (suppl. 2), 9.
Lanza, F.L., Aspinall, R.L., Swabb, E.A., Davis, R.E., Rack, M.F. Rubin A. Double-blind-, placebo-controlled endoscopic comparison of the mucosal protective effects of misoprostol versus cimetidine on tolmetin-induced mucosal injury to the stomach and duodenum. Gastroentorology 1988, 95, 289–294.
Valentini, M., Cannizzaro, R., Bortolussi, R., Sozzi, M., Fracasso A., Fornasarig, M. Misoprostol versus ranitidine in prevention of gastroduodenal mucosal injury in cancer patients. Br J Rheumatology 1992, 31, 181.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
van Groenendael, J.H.L.M., Markusse, H.M., Dijkmans, B.A.C. et al. The effect of ranitidine on NSAID related dyspeptic symptoms with and without peptic ulcer disease of patients with rheumatoid arthritis and osteoarthritis. Clin Rheumatol 15, 450–456 (1996). https://doi.org/10.1007/BF02229641
Issue Date:
DOI: https://doi.org/10.1007/BF02229641