| Nonsteroidal anti-inflammatory drugs: use in rheumatology |
The primary effect of NSAIDs in rheumatology is symptom relief. Despite their widespread use in rheumatoid arthritis and osteoarthritis, they have not been shown to modify the disease process in these conditions. They may improve radiological outcomes when used continuously in ankylosing spondylitis.
Due to their toxicity, NSAIDs should always be used in the lowest possible dose, and for the shortest possible time. NSAID use should not delay the appropriate commencement of disease-modifying antirheumatic drugs where indicated. Topical drugs should be used where appropriate. Other issues to consider when prescribing NSAIDs are shown in Choice of NSAID.
An anti-inflammatory dose of fish oil ) should be considered as part of long-term treatment, to minimise NSAID use. Onset of this effect requires weeks to a few months.
Some NSAIDs have a role in the treatment of rheumatological conditions in children, and appear to be safe at recommended doses. The usual NSAID adverse effect profile applies to children, and renal impairment can occur in children who are dehydrated. For more information on the use of NSAIDs in children, refer to Pauciarticular-onset arthritis in the 'Children and adolescents' chapter of the Rheumatology guidelines.
Comments
Post a Comment