A rheumatologist's viewpoint

Attitudes to prescribing anti-inflammatory drugs have changed considerably over the last 25 years and there is now a recognition of the need to balance effectiveness with reduced risks of serious adverse reactions. Such serious side-effects often involve the upper gastrointestinal tract, and there are differences between anti-inflammatory drugs in the frequency with which they cause significant problems at this site. Anti-inflammatory drugs with a lesser propensity to cause gastrointestinal reactions may have an advantage. Several risk factors may be important for upper gastrointestinal side-effects including sex, age, history of dyspepsia, other diseases and the type of arthritis. Results from post-marketing surveillance studies of nabumetone in the United Kingdom and the Federal Republic of Germany showed that although patients with a previous history of dyspepsia were more likely to stop the drug due to an adverse reaction, the majority continued without any problem. Interestingly, patients with rheumatoid arthritis were more likely to stop therapy due to side-effects, though it was not clear if this was due to their disease or to multi-morbidity. Strategies are needed when prescribing anti-inflammatory drugs which take into account the type of patient, their disease, and the best drug. In many instances this could be nabumetone.