Balancing cardiovascular and gastrointestinal risks in patients with osteoarthritis receiving nonsteroidal anti‑inflammatory drugs. A summary of guidelines from an international expert group

Abstract

Over the past 2 decades, extensive research has assessed the use of traditional nonsteroidal anti-inflammatory drugs (NSAIDs), and the newer cyclooxygenase-2 (COX-2) inhibitor drugs, in the treatment of chronic pain syndromes. The proper use of NSAIDs has been the subject of significant debate, bringing together multidisciplinary researchers and clinicians to discuss the risks and benefits of these therapies. Current guidelines discussing the proper use of NSAIDs do not address the issue of the risks of COX-2-selective NSAIDs and nonselective NSAIDs for both the gastrointestinal (GI) and cardiovascular (CV) systems in patients on low-dose aspirin. Accordingly, a multidisciplinary expert group was organized to review the current evidence with the aim of developing statements devoted to guide clinicians in making evidence-based and individualized selections of NSAIDs. This review will discuss and summarize the most recent evidence on this topic to give an insight into the most effective and safest therapeutic options, thus preventing serious adverse CV and GI events. NSAIDs should be used cautiously and as infrequently as possible, with nonpharmacological approaches prescribed first. If the use of NSAIDs is required, the choice should balance the possible CV and GI risks.

Disease Burden and Costs in Moderate-to-Severe Chronic Osteoarthritis Pain Refractory to Standard of Care: Ancillary Analysis of the OPIOIDS Real-World Study

“…[1,11,12]. Drugbased treatment should be customized for each patient, considering the benefit-risk balance of therapies and assuming that a safe and efficacious approach is not available at present [12][13][14]. NSAIDs, particularly topical forms, may be used in patients who do not respond to firstchoice painkillers such as acetaminophen, which is expected to have little clinical benefit on patient's pain [14,15].…”

Anti-inflammatory effects of oxymatrine on rheumatoid arthritis in rats via regulating the imbalance between Treg and Th17 cells

“…They reduce pain and swelling in RA, enhance recovery, and promote mobility and physical activity. However, NSAIDs do not slow the progression of the disease and may have adverse effects (21). The use of NSAIDs is associated with cardiovascular risk factors due to their effect in increasing systolic blood pressure, particularly in high-risk patients with diabetes, hypertension or heart disease (22,23).…”

Modification of cardiovascular pharmacotherapy in palliative care patients with cancer- narrative review

“…The use of ASA along with nonsteroidal anti -inflammatory drugs, which are step 1 in the analgesic ladder, reduces the efficacy of ASA and increases the risk of gastrointestinal bleeding. 53 The decision to continue ASA in palliative care should be based on whether it is used for primary or secondary prevention. Because the use of ASA in primary prevention in the general population is not widely accepted, it is even more debatable in palliative care where the goals of treatment shift away from prevention.…”