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Summary
A review of the clinical responses and side-effects encountered in an ‘open’ series of 293 consecutive patients suffering from rheumatic disorders and treated with ibuprofen during a 5-year period is presented. With the exception of 23 patients for whom it was a primary prescription, the patients were given ibuprofen because of either lack of effect or intolerance - chiefly gastro-intestinal - with other analgesic anti-inflammatory drugs. Low doses of 300 mg. to 600mg. daily were used in the early years of this study, but with increased confidence in the safety and efficacy of the drug, dosage was increased to 1200 mg. or more daily. The clinical response was rated as good or very good in this selected ‘hard-to-treat’ group, and 74 % of the patients suffering from rheumatoid arthritis considered it to be superior to previous medication and better tolerated. In those patients suffering from osteoarthrosis, 74.8 % claimed a better response from ibuprofen than from previous medication. In the rheumatoid groups, those patients who had a disease duration of 3 years or less, or who had never received steroids or not more than 2 previous non-steroidal drugs, fared appreciably better.
Side-effects occurred in 40 patients {13.6 %) and were mainly minor, but necessitated withdrawal of treatment in 31 patients (10.6%). The most serious was 1 case of melaena. No deaths occurred and no evidence of any hepatic, bone-marrow or renal dysfunction due to the drug was obtained.
Prospective and retrospective studies for possible ocular complications were undertaken with negative results. It is considered that toxic amblyopia due to a maculopathic lesion may be induced by ibuprofen, but this occurs very rarely and in the few cases reported the signs and symptoms settled rapidly on withdrawal of the drug.
Renal function studies were also undertaken in 18 patients who had received total dosages of ibuprofen from 0.43 kg. to 1.98 kg. and no evidence of renal tubular damage or renal papillary necrosis (analgesic nephropathy) was found.