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Diagnosed with rheumatoid arthritis. Having sensitive stomach and taking diclofenac sodium SR. Stomach is hurting. Suggest a solution?

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This question is for a rheumatologist. My husband is 65 and has just been diagnosed with rheumatoid arthritis. He has a very sensitive stomach and was prescribed NSAIDs for his arthritis. He was prescribed diclofenac sodium SR 75 mgs b.i.d. They bothered his stomach after taking them for three days. After going back to his doctor he was prescribed ranitidine. This still did not help. He feels lousy both from the arthritis and his stomach hurting. What can we do? It will take months to get to see a rheumatologist. Surely there is something that can be done
Posted Sun, 20 Oct 2013 in Lupus
Answered by Dr. Parshant Aggarwal 14 hours later
Brief Answer:
switch ranitidine to PPI (e.g. omeprazole)

Detailed Answer:
Thanks for your query. The main treatment for Rheumatoid arthritis are the disease modifying drugs which control the disease process from within and anti inflammatory drugs are used only for a short term to control the pain. So your husband needs to be on disease modifying treatment (the agent of first choice is Methotrexate) and the dose needs to be optimised to adequately control the disease process while the dose of pain relievers (diclofenac in your case) needs to be decreased & then stopped. Currently for stomach symptoms ranitidine can be stopped and Proton pump inhibitors prescribed (e.g. omeprazole, lansaprazole) which are more effective. If still stomach symptoms persist then diclofenac needs to be stopped and switched to COX 2 inhibitors (e.g Etoricoxib) if there is no history of cardiovascular events. Regards
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