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Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: What does the literature say?

Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: What does the literature say?
Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: What does the literature say?

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recommended and prescribed to treat pain in osteoarthritis. While measured to have a moderate effect on pain in osteoarthritis, NSAIDs have been associated with wide-ranging adverse events affecting the gastrointestinal, cardiovascular, and renal systems. Gastrointestinal toxicity is found with all NSAIDs, which may be of particular concern when treating older patients with osteoarthritis, and gastric adverse events may be reduced by taking a concomitant gastroprotective agent, although intestinal adverse events are not ameliorated. Cardiovascular toxicity is associated with all NSAIDs to some extent and the degree of risk appears to be pharmacotherapy specific. An increased risk of acute myocardial infarction and heart failure is observed with all NSAIDs, while an elevated risk of hemorrhagic stroke appears to be restricted to the use of diclofenac and meloxicam. All NSAIDs have the potential to induce acute kidney injury, and patients with osteoarthritis with co-morbid conditions including hypertension, heart failure, and diabetes mellitus are at increased risk. Osteoarthritis is associated with excess mortality, which may be explained by reduced levels of physical activity owing to lower limb pain, presence of comorbid conditions, and the adverse effects of anti-osteoarthritis medications especially NSAIDs. This narrative review of recent literature identifies data on the safety of non-selective NSAIDs to better understand the risk:benefit of using NSAIDs to manage pain in osteoarthritis.

1170-229X
15-24
Cooper, Cyrus
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Chapurlat, Roland
d9410f8c-4e4a-465b-8fb6-67efaadaad4c
Al-Daghri, Nasser
0bf1023c-a104-4f74-8b06-87780dfbd8b4
Herrero-Beaumont, Gabriel
44373e0b-5324-4603-9185-3c18015963d1
Bruyère, Olivier
ba727e54-ca17-4fa8-be3d-4729fb4b8c0d
Rannou, François
2b61556e-9368-4b92-8f27-25e6697230dc
Roth, Roland
5a82424f-5a06-47d8-85ad-d9fe260a9ad0
Uebelhart, Daniel
56d19cf5-f45b-46db-8170-356da80a9e52
Reginster, Jean Yves
08b05e27-73dd-4ce9-90e5-d64ec922147a
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Chapurlat, Roland
d9410f8c-4e4a-465b-8fb6-67efaadaad4c
Al-Daghri, Nasser
0bf1023c-a104-4f74-8b06-87780dfbd8b4
Herrero-Beaumont, Gabriel
44373e0b-5324-4603-9185-3c18015963d1
Bruyère, Olivier
ba727e54-ca17-4fa8-be3d-4729fb4b8c0d
Rannou, François
2b61556e-9368-4b92-8f27-25e6697230dc
Roth, Roland
5a82424f-5a06-47d8-85ad-d9fe260a9ad0
Uebelhart, Daniel
56d19cf5-f45b-46db-8170-356da80a9e52
Reginster, Jean Yves
08b05e27-73dd-4ce9-90e5-d64ec922147a

Cooper, Cyrus, Chapurlat, Roland, Al-Daghri, Nasser, Herrero-Beaumont, Gabriel, Bruyère, Olivier, Rannou, François, Roth, Roland, Uebelhart, Daniel and Reginster, Jean Yves (2019) Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: What does the literature say? Drugs and Aging, 36, 15-24. (doi:10.1007/s40266-019-00660-1).

Record type: Review

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recommended and prescribed to treat pain in osteoarthritis. While measured to have a moderate effect on pain in osteoarthritis, NSAIDs have been associated with wide-ranging adverse events affecting the gastrointestinal, cardiovascular, and renal systems. Gastrointestinal toxicity is found with all NSAIDs, which may be of particular concern when treating older patients with osteoarthritis, and gastric adverse events may be reduced by taking a concomitant gastroprotective agent, although intestinal adverse events are not ameliorated. Cardiovascular toxicity is associated with all NSAIDs to some extent and the degree of risk appears to be pharmacotherapy specific. An increased risk of acute myocardial infarction and heart failure is observed with all NSAIDs, while an elevated risk of hemorrhagic stroke appears to be restricted to the use of diclofenac and meloxicam. All NSAIDs have the potential to induce acute kidney injury, and patients with osteoarthritis with co-morbid conditions including hypertension, heart failure, and diabetes mellitus are at increased risk. Osteoarthritis is associated with excess mortality, which may be explained by reduced levels of physical activity owing to lower limb pain, presence of comorbid conditions, and the adverse effects of anti-osteoarthritis medications especially NSAIDs. This narrative review of recent literature identifies data on the safety of non-selective NSAIDs to better understand the risk:benefit of using NSAIDs to manage pain in osteoarthritis.

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e-pub ahead of print date: 9 May 2019

Identifiers

Local EPrints ID: 431438
URI: http://eprints.soton.ac.uk/id/eprint/431438
ISSN: 1170-229X
PURE UUID: 9788ef42-167d-470a-a0f6-ed4b2e4675b9
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 03 Jun 2019 16:30
Last modified: 26 Nov 2021 02:39

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Contributors

Author: Cyrus Cooper ORCID iD
Author: Roland Chapurlat
Author: Nasser Al-Daghri
Author: Gabriel Herrero-Beaumont
Author: Olivier Bruyère
Author: François Rannou
Author: Roland Roth
Author: Daniel Uebelhart
Author: Jean Yves Reginster

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