title: The appropriate use of non-steroidal anti-inflammatory drugs in rheumatic disease: opinions of a multidisciplinary European expert panel.
abstract: BACKGROUND
  Given the safety issues of non-steroidal anti-inflammatory drugs (NSAID) and the robustness of guidelines, making treatment choices in daily clinical practice is increasingly difficult. This study aimed systematically to analyse the opinions of a multidisciplinary European expert panel on the appropriateness of different NSAID, with or without the use of a proton pump inhibitor (PPI), in individual patients with chronic rheumatic disease.
  
  
  METHODS
  /Using the Research and Development/University of California at Los Angeles appropriateness method, the appropriateness of five (non-)selective NSAID with or without a PPI was assessed for 144 hypothetical patient profiles, ie, unique combinations of cardiovascular and gastrointestinal risk factors. Appropriateness statements were calculated for all indications.
  
  
  RESULTS
  All options without PPI were considered appropriate in patients with no gastrointestinal/cardiovascular risk factors. Cyclooxygenase-2 selective inhibitors (C2SI) alone and non-selective NSAID plus PPI were preferred for patients with elevated gastrointestinal risk and low cardiovascular risk. Naproxen plus PPI was favoured in patients with high cardiovascular risk. For the combination of high gastrointestinal/high cardiovascular risk the use of any NSAID was discouraged; if needed, naproxen plus PPI or a C2SI plus PPI could be considered.
  
  
  CONCLUSIONS
  The panel results may support treatment considerations at the level of individual patients, according to their gastrointestinal/cardiovascular risk profile.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité - University Medicine, Free University and Humboldt University Berlin, Charitéplatz 1 10117, Berlin, Germany. gerd.burmester@charite.de
authors.forename: Gerd
authors.initials: G
authors.lastname: Burmester
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.forename: Luigi
authors.initials: L
authors.lastname: Biasucci
authors.forename: Matthias
authors.initials: M
authors.lastname: Hermann
authors.forename: Stefan
authors.initials: S
authors.lastname: Lohmander
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.forename: Carmelo
authors.initials: C
authors.lastname: Scarpignato
authors.forename: Josef
authors.initials: J
authors.lastname: Smolen
authors.forename: Chris
authors.initials: C
authors.lastname: Hawkey
authors.forename: Adam
authors.initials: A
authors.lastname: Bajkowski
authors.forename: Francis
authors.initials: F
authors.lastname: Berenbaum
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Breedveld
authors.forename: Peter
authors.initials: P
authors.lastname: Dieleman
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Thomas
authors.initials: T
authors.lastname: MacDonald
authors.forename: Emilio Martin
authors.initials: EM
authors.lastname: Mola
authors.forename: Tony
authors.initials: T
authors.lastname: Mets
authors.forename: Nele
authors.initials: N
authors.lastname: Van den Noortgate
authors.forename: Herman
authors.initials: H
authors.lastname: Stoevelaar
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*; D018570:Risk Assessment / Q000379:methods
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors