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[Use of NSAIDs in rheumatoid arthritis should be limited]

Mats Lindberg1

  • 1Akutcentret, Sygehus Sønderjylland, Egelund 10, 6200 Aabenraa, Denmark. mli@dadlnet.dk

Ugeskrift for Laeger
|April 16, 2013
PubMed

Insights

Non-steroidal anti-inflammatory drugs (NSAIDs) appear safe with methotrexate for rheumatoid arthritis, but aspirin may cause kidney and liver issues. Limiting NSAID use is recommended due to known side effects and safer alternatives.

Area of Science:

  • Pharmacology
  • Rheumatology
  • Drug Safety

Context:

  • Rheumatoid arthritis (RA) management often involves disease-modifying antirheumatic drugs (DMARDs) like methotrexate (MTX).
  • Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used for symptomatic relief in RA patients on MTX.
  • Evaluating drug interactions and safety profiles is crucial for optimizing RA treatment.

Purpose:

  • To assess the safety of concurrent use of NSAIDs, including aspirin, with methotrexate in rheumatoid arthritis patients.
  • To analyze evidence from published literature regarding potential adverse events associated with this drug combination.
  • To provide an evidence-based opinion on the appropriate use of NSAIDs in RA management.

Summary:

  • A Cochrane review of 17 publications found that concurrent anti-inflammatory doses of aspirin with methotrexate (MTX) were linked to renal and hepatic side effects.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) generally appeared safe when used concurrently with MTX.
  • Despite apparent safety with MTX, NSAIDs carry well-documented gastrointestinal, cardiovascular, and renal risks.

Impact:

  • Findings suggest a need for caution with aspirin use in MTX-treated RA patients, particularly regarding renal and hepatic function.
  • The study highlights the inherent risks of NSAIDs, advocating for judicious use in rheumatoid arthritis.
  • Recommends exploring safer therapeutic alternatives for symptom management in rheumatoid arthritis patients on methotrexate.

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