Intelligent use of NSAIDs--where do we stand?
Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs commonly prescribed for a variety of medical conditions. They are potent pharmacological agents efficacious for inflammatory conditions, but have significant gastrointestinal (GI), renal and haematological toxicity that must not be taken lightly. The newer, more cyclooxygenase-(COX)-2-selective NSAIDs, have no effects on platelet function and little GI toxicity, but do have renal physiological effects. The superiority of one NSAID over another has not been clinically demonstrated in musculoskeletal conditions, nor has the efficacy of NSAIDs in non-inflammatory rheumatic conditions been shown to be better than that of simple analgesics. NSAIDs are indicated for primary therapy of inflammatory rheumatic diseases and the more selective COX-2 agents should be employed as first choice when economically feasible. NSAIDs should not be used indiscriminately for non-inflammatory osteoarthritis or musculoskeletal injuries, particularly in the elderly patient, in whom alternative, less toxic therapy should be sought.
Berger
R G
RG
University of North Carolina, Chapel Hill, NC 27514, USA. rberger@unch.unc.edu
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy; D003365:Costs and Cost Analysis; D051545:Cyclooxygenase 1; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases; D014947:Wounds and Injuries / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051545:Cyclooxygenase 1; D051546:Cyclooxygenase 2; C496511:PTGS1 protein, human; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases