Identifying and assessing benefit-risk in primary care--a family physician's perspective.
For the family physician, NSAIDs, both traditional and cyclo-oxygenase-2 inhibitors, are a valuable contribution to managing arthritis and other rheumatological conditions in primary care. Yet, many of the patients seen by the family doctor have complex comorbidities and polypharmacy issues. This review looks at the main considerations for primary-care physicians while choosing an anti-inflammatory treatment for a hypothetical patient case study. In addition to looking at the evidence for gastrointestinal and cardiovascular risk, the concomitant use of aspirin with an NSAID is also examined. New evidence for interaction between selective serotonin re-uptake inhibitors is reviewed and the interaction between angiotensin-converting enzyme inhibitors and NSAIDs is considered. Making careful judgements based on individual needs, medical history and comorbidities is recommended based on the evidence reviewed.
Ward
Richard
R
Crowfoot Village Family Practice, #210, 600 Crowfoot Crescent NW, Calgary ABT3G0B4, Canada. raward@direct.ca
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy*; D001241:Aspirin / Q000037:antagonists & inhibitors; D002318:Cardiovascular Diseases / Q000139:chemically induced; D004347:Drug Interactions; D005194:Family Practice / Q000379:methods; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin; D017367:Selective Serotonin Reuptake Inhibitors
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