Millions of Americans with arthritis must decide between enduring painful, swollen joints or risking the development of a bleeding gastric ulcer, according to a new survey of physicians.

The Arthritis Foundation said that a survey of 1,009 physicians who treat arthritis patients showed that 93 percent of the doctors believe that aspirin, ibuprofen and some prescription anti-inflammatory drugs are the most useful of a limited number of medications available to treat arthritis.But the survey also found that 81 percent of the doctors regard ulcers and other digestive problems to be the most serious complication in the treatment of arthritis.

"When you look at the number of patients who take this medication, it becomes a major health problem," said Dr. Naurang M. Agrawal, a physician on an Arthritis Foundation advisory panel. He said about one in every five arthritis patients taking aspirin and the other so-called nonsteroidal anti-inflammatory drugs (NSAIDs) develop some type of gastric problem as a result.

And yet, he said, the NSAIDs remain the most effective drugs for control of the pain and swelling from arthritis.

The Arthritis Foundation said in a statement that in the United States about 37 million men, women and children - about one in every seven Americans - suffer from some form of arthritis. Osteroarthritis, the most common form, affects the elderly the most often - few who live past 60 escape at least a mild symptom. In severe cases, joints degenerate until they are useless.

Rheumatoid arthritis strikes usually in middle age and can lead quickly to disability in severe cases. In addition to joint swelling and pain, symptoms can include fever and fatigue.

Both of these types of arthritis are characterized by inflammation in the joints. Aspirin and other NSAIDs are effective because they control inflammation by inhibiting the production of prostaglandin, a hormone-like protein that is active in the inflammation process.

But Agrawal said that while the NSAIDs block prostaglandins at the joints, the drugs also deplete the hormones in the stomach and intestines where prostaglandins provide protection from ulcer development.

The result, said Agrawal, is that arthritis patients are relieved of joint pain, but then may suddenly develop ulcers.