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GPs are engulfed in a crisis in the treatment of rheumatoid arthritis after new figures exposed collapsing confidence in cox-2 inhibitors.

GP prescriptions for cox-2s plunged from 164,475 in December to 64,090 in February, figures from the company CompuFile reveal (see graph).

Fears over their safety have been growing since the withdrawal of rofecoxib in September, with valdecoxib being suspended only last week pending a safety review.

Rheumatology experts warned that prescribing options for arthritis had become 'extremely limited', with GPs being forced to return to standard analgesics.

Dr Graham Davenport, former president of the Primary Care Rheumatology Society and a GP in Wrenbury, south Cheshire, said GPs were rethinking their use of all anti-inflammatories, including conventional NSAIDs.

'It's a major problem now,' he said. 'Doctors are being very, very careful, playing safe and going back to standard analgesics and topical applications.'

The CompuFile data suggest GPs have been reluctant to put patients on conventional NSAIDs when switching from cox-2s. There has been no increase in prescribing for ibuprofen, diclofenac and naproxen since December.

GPs now write 100,000 fewer prescriptions a month for all NSAIDs combined than they did before Christmas.

GPs warned that the crisis had been sparked by media scares rather than hard data and called for a balanced evaluation of risks and benefits.

Dr Jim Kennedy, RCGP prescribing spokesperson, said: 'I think it would be deplorable if the cox-2 class was withdrawn. They do have a place but like all drugs that place needs to be refined. To remove the whole class on the current evidence would be a harsh judgment.'

Dr Iain Gilchrist, member of the Primary Care Rheumatology Society and a GP in Hatfield Heath, Essex, said it would be a 'great pity' if

cox-2s were withdrawn, given the lack of safe and effective

alternatives.

A study in the Postgraduate Medical Journal this week indicated that many elderly people who were taking NSAIDs should not have been because of the gastrointestinal risks.

By Nerys Hairon

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