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This article is part of the supplement: Gastroprotection: the role of proton pump inhibitors

Highly Accessed Review

Practical approaches to minimizing gastrointestinal and cardiovascular safety concerns with COX-2 inhibitors and NSAIDs

James M Scheiman1* and A Mark Fendrick2

Author Affiliations

1 Professor of Medicine in the Division of Gastroenterology at the University of Michigan Medical Center, Ann Arbor, Michigan, USA

2 Professor of Internal Medicine and Health Management Policy at the University of Michigan Medical Center, Ann Arbor, Michigan, USA

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Arthritis Research & Therapy 2005, 7(Suppl 4):S23-S29  doi:10.1186/ar1795

Published: 15 September 2005

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are highly effective in treating the pain and inflammation associated with osteoarthritis and rheumatoid arthritis, but it is well recognized that these agents are associated with substantial gastrointestinal toxicity. Treatment guidelines suggest that patients with one or more risk factors for NSAID associated ulcers should be prescribed preventive treatment. However, well over 80% of such patients may not receive an appropriate therapeutic intervention. Multiple strategies are available to reduce the risk for NSAID associated gastrointestinal complications. First, risk may be reduced by using non-NSAID analgesics. Second, use of the minimum effective dose of the NSAID may reduce risk. Third, co-therapy with a proton pump inhibitor or misoprostol may be desirable in at-risk patients. Use of cyclo-oxygenase-2 inhibitors may also reduce the risk for gastrointestinal events, although this benefit is eliminated in patients who receive aspirin, and cyclo-oxygenase-2 inhibitors may increase cardiovascular adverse events. The optimal management of NSAID related gastrointestinal complications must be based on the individual patient's risk factors for gastrointestinal and cardiovascular disease, as well as on the efficacy and tolerability of both the NSAID and accompanying gastroprotective agent.