Current Trends in NSAID Prescribing for Osteoarthritis and Axial Spondyloarthritis: Insights From Moroccan...

Nonsteroidal anti-inflammatory drugs (NSAIDs) remain the cornerstone of symptomatic management in osteoarthritis (OA) and axial spondyloarthritis (axial SpA), but safety concerns have reshaped prescribing behaviors. This study aimed to describe current NSAID prescribing practices among Moroccan rheumatologists for both conditions.

A cross-sectional descriptive survey was conducted among rheumatologists from public and private sectors. Data were collected using a 30-item validated questionnaire approved by an expert committee.

Eighty-two rheumatologists participated. More than half (56.1%) reported having no absolute age limit for NSAID use, while 24% avoided NSAIDs in patients aged > 75 years. The most concerning combination was NSAIDs with vitamin K antagonists (96.3%), and the most cited contraindication was active gastroduodenal ulcer (85.4%). Only 13.4% routinely requested renal function tests before prescribing NSAIDs. Proton pump inhibitors were co-prescribed mainly for a history of gastrointestinal bleeding (93.9% with conventional NSAIDs; 87.8% with coxibs). Naproxen (95.1%), celecoxib (63.4%), and meloxicam (58.5%) were considered the safest for cardiovascular risk. Celecoxib was the first-line NSAID for OA (47.6%), while diclofenac was preferred for axial SpA (34.9%) and celecoxib in patients with inflammatory bowel disease (73.2%). Nearly half (47.6%) prescribed NSAIDs on an as-needed basis.

NSAID prescribing in OA and axial SpA is increasingly personalized, with choices guided by comorbidities and safety concerns. Celecoxib is preferred for OA, while diclofenac remains first-line for axial SpA, with caution in patients at gastrointestinal or cardiovascular risk.