title: [Appropriate use of non-steroidal anti-inflammatory drugs in rheumatology: guidelines from the Spanish Society of Rheumatology and the Mexican College of Rheumatology].
abstract: OBJECTIVE
  To develop guidelines for the appropriate use of NSAIDs in rheumatology.
  
  
  METHODS
  We used a methodology modified from the one developed by RAND/UCLA. Two groups of panellists were selected, one by the CMR and another by the SER. Recommendations were proposed from nominal groups and the agreement to them was tested among rheumatologists from both societies by a tworound Delphi survey. The analysis of the second Delphi round supported the generation of the final set of recommendations and the assignment of a level of agreement to each of them. Systematic reviews of five recommendations in which the agreement was low or was divided were also carried out.
  
  
  RESULTS
  Here we present recommendations for the safe use of NSAIDs in rheumatic diseases, based on the best available evidence, expert opinion, the agreement among rheumatologists, and literature review. The trend is to reduce the frequency, duration and dose of NSAIDs in favour of non-pharmacological measures, analgesic drugs or disease modifying drugs. In addition, the recommendations help to identify profiles for increased toxicity, with an emphasis on gastrointestinal and cardiovascular risks. The recommendations deal with the course of action and monitoring in different risk groups and in patients using antiplatelet or anticoagulant drugs. The overall level of agreement is high.
  
  
  CONCLUSIONS
  The NSAIDs are safe and effective drugs for the treatment of rheumatic diseases. However, it is necessary to individualize its use according to their risk profile.
authors.affiliation: Servicio de Reumatología, Hospital General de Zona 32 (Villa Coapa), Instituto Mexicano del Seguro Social, México DF, México.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Bori Segura
authors.forename: Blanca
authors.initials: B
authors.lastname: Hernández Cruz
authors.forename: Milena
authors.initials: M
authors.lastname: Gobbo
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas Arbeloa
authors.forename: Mario
authors.initials: M
authors.lastname: Salazar Páramo
authors.forename: Leobardo
authors.initials: L
authors.lastname: Terán Estrada
authors.forename: José Federico
authors.initials: JF
authors.lastname: Díaz González
authors.forename: Rolando
authors.initials: R
authors.lastname: Espinosa Morales
authors.forename: Federico
authors.initials: F
authors.lastname: Galván Villegas
authors.forename: Luis Alberto
authors.initials: LA
authors.lastname: García Rodríguez
authors.forename: José María
authors.initials: JM
authors.lastname: Alvaro-Gracia Álvaro
authors.forename: Hilario
authors.initials: H
authors.lastname: Avila Armengol
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Javier
authors.initials: J
authors.lastname: Rivera Redondo
authors.forename: Lucio
authors.initials: L
authors.lastname: Ventura Ríos