Pertinent Insights On Drug-Induced Arthralgia With Commonly Prescribed Drugs

Robert G. Smith, DPM, MSc, RPh, CPed

   During this review, I noted duplicates were present, owing to the listing of medications by both brand name and generic name. Therefore, the actual number of different medications in the review was 117. Reported arthralgia adverse effects occurred with 78 out of 117 drugs reviewed (66.7 percent). This research revealed that 14 medications have prevalence rates of 5 percent or greater for drug-induced arthralgia. These medications and prevalence rates for drug-induced arthralgia are as follows:

• Risedronate (Actonel®, Warner Chilcott) 11.5 to 32.8 percent
• Fluticasone (Flovent®, GlaxoSmithKline) 1 to 19 percent
• Conjugated estrogen (Premarin®, Pfizer) 7 to 14 percent
• Rosuvastatin (Crestor®, AstraZeneca) 10.1 percent
• Venlafaxine (Effexor XR®, Pfizer) 1 to 10 percent
• Clopidogrel bisulfate (Plavix®, Bristol-Myers Squibb/Sanofi Aventis) 2.5 to 6.3 percent
• Clonidine (6 percent)
• Pregabalin (Lyrica®, Pfizer) 3 to 6 percent
• Carvedilol (1 to 6 percent)
• Meloxicam (0.5 to 5.3 percent)
• Atorvastatin calcium (Lipitor®, Pfizer) 5.1 percent
• Olanzapine (Zyprexa®, Eli Lilly) 5 percent
• Tramadol (1 to 5 percent)
• Lovastatin (0.5 to 5 percent)

   The number of reviewed medications with a noted arthralgia prevalence rate between 1 to 4.9 percent accounted for 30 (38.4 percent). The reviewed medications with a reported arthralgia prevalence rate of less than 1 percent accounted for seven (8.9 percent) reviewed medications. Twenty-seven (34.6 percent) of the 117 drugs reviewed had a narrative notation that researchers had reported arthralgia without any numerical prevalence rate. Thirty-nine medications of the 117 review drugs (33.3 percent) did not have any description of drug-induced arthralgia as an adverse effect.

   In my review, the most frequent explanation or mechanism for drug-induced arthralgia cited in the medical literature for 50 (64.1 percent) of the reviewed medications was “drug side effects causing joint symptoms in previously disease-free patients.” This was followed by “drug-induced electrolyte and fluid disturbances causing arthritis or arthralgia in nine (11.5 percent) of the reviewed medications while the explanations of “damage to joint” and “either serum sickness or the presence of antinuclear antibodies” were reasons for drug-induced arthralgia for seven (8.9 percent) of the reviewed medications. Drug-induced lupus erythematosus (DILE) was a possible explanation for three (3.8 percent) of the reviewed medications. Finally, osteonecrosis was a possible explanation for two (2.6 percent) of the 78 reviewed medications.

Keys To Diagnosing Adverse Effects Due To Drug-Induced Arthralgia

Although this article is based on subjective data, these adverse effects are common and can affect the patient’s quality of life. Moreover, the effect that prescription medications have on a patient’s overall health is profound. Drug-induced rheumatic disorders represent a broad clinical spectrum from asymptomatic biological abnormalities to severe and even life-threatening diseases, even though arthralgia is the only presenting clinical feature in many cases.3

   For example, previous studies have identified certain classes of medications that may contribute to the patient’s perception of arthralgia.2-4,14,15 Studies have well documented the precipitation of a transient arthralgia in previously arthritis-free patients.2-4

   Be aware that “drug side effects causing joint symptoms in previously disease-free patients” may need early recognition to avoid carrying out unnecessary clinical tests, which may delay treatment and contribute to higher medical costs. Both the clinical presentation and severity of drug-induced arthralgia may vary from one patient to another for the same drug, depending on the dose employed, the duration of therapy, the pathophysiological status of the patient and/or genetic and environmental factors. The clinician should remember that drug-induced arthralgias often resolve on withdrawal of the offending pharmacologic agent.

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