Use and benefits of nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) continue to be used very widely in the community. Their use reflects the significant burden of rheumatic disease on the general population, and they form a basis for the treatment of inflammation in and around the joint. Furthermore, NSAIDs are also being used increasingly for nonrheumatic conditions, including acute and chronic pain, biliary and ureteric colic, and dysmenorrhea. Recent studies in osteoarthritis have suggested that a significant number of patients previously maintained on NSAIDs can be equally well treated using analgesic agents, such as paracetamol. In noninflammatory rheumatic diseases, analgesics and physical therapies should be the initial treatment of choice and, even in inflammatory rheumatic diseases, NSAID use may be reduced by the addition of pure analgesics to the treatment regimen. A large number of NSAIDs now exist, and there is variability in clinical response to NSAIDs among individual patients. Concern over the widespread use of NSAIDs is largely related to their side-effects. These include adverse reactions in the gastrointestinal tract, kidney, liver, dermis, and central nervous system, as well as hematologic problems. The potential for drug interactions with NSAIDs is also large, as they are often administered to a population with significant co-morbidities. NSAIDs play a major role in the management of acute and chronic rheumatic diseases, but their use needs to be tempered with the realization that they can cause potentially serious adverse reactions. These side-effects can be reduced by careful attention to the dose and duration of therapy, concomitant risk factors, and the combined use of more specific drugs to reduce disease activity. Furthermore, the gastrointestinal side-effects of NSAIDs may be treated and prevented by using appropriate therapy in combination with NSAIDs.