It's that time again!

Today is the first day of the annual meeting of the American College of Rheumatology (ACR). Each year thousands of rheumatologists, researchers, nurses, therapists and others involved in caring for people who have any of the 100 or so arthritis-related conditions descend on a major city's convention center. This year, they're all in Boston. Unfortunately, this year, I'm not. I love being at the ACR conference amidst the collaborations, explanations of what's been learned and press conferences about key scientific or clinical studies. But this year, I'm a nursing mom needed more here at home. In my place, Arthritis Today's nutrition and fitness editor, Kenna Simmons, is on site in Boston gathering up loads of information for us to share with our readers.

Today, one of her e-mails sounded ominous, as she told me about Dr. Gurkipal Singh saying there was an "impending health disaster." Dr. Singh was describing a growing problem that he calls the "gastroprotection gap." With the number of people developing arthritis on the rise due to the aging of the baby boom generation, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) has increased among older Americans. Older NSAIDs, such as aspirin, diclofenac, ibuprofen and naproxen, are known for causing gastrointestinal problems, such as ulcers. Beyond the pain of ulcers is the seriousness of the situation if they start to bleed – especially among the elderly. Bleeding ulcers can be fatal, so preventing them (and monitoring for them) is important. (Learn more about NSAIDs and side effects at www.arthritistoday.com. Click on Drug Guide.)

Protection against bleeding ulcers comes in the form of other medications, called proton pump inhibitors. These medications, such as Nexium, Prevacid and Prilosec, reduce the amount of acid in the stomach, whereas the traditional NSAIDs increase it. Dr. Singh's study shows that doctors had been getting really good at prescribing an acid reducer when they prescribed an NSAID – until the COX-2s came on the market. The COX-2s are a type of NSAID specifically designed to eliminate the gastrointestinal side effects. When the COX-2s Vioxx and Bextra were popular treatments, the rate of serious gastrointestinal complications was cut in half. But now that two of the three COX-2 drugs are no longer on the market (Celebrex still is available), and use of the COX-2s has declined, Dr. Singh found that the complication rate is jumping up again.

His study of Medicaid recipients in California shows that the percentage of people who receive medications to protect their stomachs while taking NSAIDs decreased from 35 percent to 14 percent in just one year (from 2004 to 2005). Ten years ago – before COX-2s were available and doctors had gastrointestinal complications top of mind – 79 percent of people were given stomach-protecting drugs. Since Vioxx and Bextra came off the market, gastrointestinal complications have gone up 21 percent. With the aging of the population, the increase in arthritis symptoms such as pain and swelling, and the return to using traditional NSAIDs again, Dr. Singh's study is a strong reminder for doctors to protect the stomachs of their patients when they hand out a prescription for an NSAID. And it's a call to action for patients to start questioning their doctors about the side effects of their arthritis treatments and how they can protect themselves. If both doctors and patients can take on that responsibility – and carry out their duties – I have hope that we'll avoid an impending health disaster.

Check back tomorrow to see what Kenna digs up in Beantown.