title: A patient with osteoarthritis and cardiovascular disease presenting with bilateral hip pain: a case report.
abstract: BACKGROUND
  The pharmacological management of osteoarthritis normally begins with the administration of acetaminophen or a nonselective nonsteroidal anti-inflammatory drug. However, acetaminophen may not be efficacious in all patients, and nonsteroidal anti-inflammatory drugs may be associated with gastrointestinal and cardiovascular adverse effects.
  
  
  METHODS
  A 79-year-old Caucasian man with bilateral hip pain was diagnosed with osteoarthritis of the hip. His past medical history included three prior myocardial infarctions, the most recent one occurring 2 years ago. He is taking aspirin 81 mg once daily. Despite no history of ulcer disease or bleeding, he has been reluctant to take nonsteroidal anti-inflammatory drugs, and because of his cardiac history there is a contraindication to cyclooxygenase-2-specific inhibitors. He was started on naproxen 220 mg twice daily, with the proton pump inhibitor omeprazole 20 mg once daily. Upon follow-up at 4 weeks, his hip pain had decreased from a rating of 7 (on a ten-point scale) to 5 on his left side and from 5 to 2 on his right side. The patient began a course of physical therapy in conjunction with a regimen of naproxen 440 mg in the morning and 220 mg at night, plus the omeprazole and acetaminophen 650 mg twice daily. He reported no gastrointestinal effects.
  
  
  CONCLUSIONS
  The addition of a proton pump inhibitor to nonsteroidal anti-inflammatory drug therapy can reduce the risk of peptic ulcer bleeding by >/=80%, making the incidence of gastropathy the same as with cyclooxygenase-2-specific inhibitors. The fact that naproxen is not associated with an increased risk of acute myocardial infarction made it an appropriate choice for this patient.
authors.affiliation: Mount Sinai School of Medicine, Department of Anesthesiology 1 Gustave L. Levy Place, New York 10029 USA. jennifer.yanow@mssm.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yanow
authors.forename: Marco
authors.initials: M
authors.lastname: Pappagallo