Table 2

Clinicians guide to anti-inflammatory therapy

No or low gastrointestinal risk

NSAID gastrointestinal risk

No cardiovascular risk (without aspirin)

Nonselective NSAID (cost consideration)

COX-2 selective inhibitor or Nonselective NSAID + PPI Or COX-2 selective inhibitor + PPI for patients with previous gastrointestinal bleeding

Cardiovascular risk^a (with aspirin)

Naproxen^b Addition of PPI if gastrointestinal risk of aspirin/NSAID combination warrants gastroprotection

Add PPI irrespective of NSAID COX-2 selective inhibitor + PPI for those with previous gastrointestinal bleeding

^aContraindications to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) include heart failure and treatment of perioperative pain in the setting of coronary artery bypass surgery. Contraindications for selective cyclo-oxygenase (COX)-2 inhibitors include established ischemic heart disease, cereberovascular disease, peripheral arterial disease, and treatment of perioperative pain within the setting of coronary artery bypass surgery. ^bNonselective or selective (low-dose) NSAID without established aspiring interaction if naproxen is ineffective. Data from Jones and coworkers [39]. PPI, proton pump inhibitor.

Berenbaum Arthritis Research & Therapy 2008 10(Suppl 2):S1   doi:10.1186/ar2462