Comorbid Risk Factors Research Articles

34843 Serious adverse events associated with hormonal contraceptive use for acne treatment, based on reporting to the FDA Adverse Events Reporting Database

Hormones play a significant role in the pathogenesis of acne vulgaris. As such, combined hormonal contraceptives (CHCs) have been used to reduce acne severity. CHCs are not without risk, and more information is needed about serious adverse events (AE) and venous thromboembolism (VTE) risk due to CHC use in acne patients. Using data from FDA Adverse Events Reporting System, we examined the relative risk of AEs and VTE in patients prescribed CHCs for acne versus all other indications. We expected the cohort of women taking CHCs for acne reduction to be younger and have fewer comorbid risk factors for VTE, and thus that it would have a lower risk of AEs and VTE.

Spinal pain prevalence in Wales and associated risk factors.

ObjectivesSpinal pain predisposes patients to a more sedentary lifestyle, a major risk factor for cardiovascular disease and other comorbidities. There is little recent evidence of the current prevalence of spinal pain and associated risk factors in Wales. This analysis addresses this gap in knowledge. ApproachThis retrospective e-cohort study used linked National Survey for Wales (NSW) data and Welsh Demographic Services data held in the Secure Anonymised Information Linkage (SAIL) Databank. All years of the annual NSW data from 2016 to 2020 (N = 34,123) were used to determine the prevalence of spinal pain in Wales. The likelihood of developing spinal pain was quantified by multivariate regression cross-sectional analysis, adjusting for the presence of the same person in multiple years of the survey data. Predictors included socio-demographic and health status, including mental health and cardiovascular disease. ResultsSpinal pain affected 5% of people who took part in the NSW. This analysis also shows that spinal pain disproportionally affects some sub-populations of Wales. Factors associated with a greater likelihood of spinal pain were cardiovascular disease, presence of at least one mental health condition, living in a more deprived area, and education level. This is especially pertinent as the burden of cardiovascular risk is disproportionately elevated in the Welsh population and Wales represents a distinctive demographic, characterised by geographical constraints and low socio-economic status. These factors will be presented and discussed in detail. ConclusionThe prevalence of spinal pain and associated risk factors in Wales was quantified. This work will help inform public health action to encourage interventional and prevention strategies to improve the quality of life for those suffering with spinal pain across Wales.

Structural health determinants and comorbidity risk factors for COVID-19 outcomes among participants in the UK Biobank.

ObjectivesCOVID-19 disproportionately affects older patients with pre-existing health conditions. However at the time of writing, June 2021, the relationship between COVID-19, ethnicity and deprivation is unclear. We estimated associations between individual comorbidities and local deprivation with a range of COVID-19 outcomes, in a large national cohort: UK Biobank. ApproachData linkage between COVID-19 records in England with baseline participant information and secondary care diagnoses from the UK Biobank allowed estimation of associations between deprivation, comorbidities and COVID-19 outcomes. Multivariable logistic regression models were constructed for COVID-19 test results, hospitalisations and deaths recorded between 1st January 2020 to 31st March 2021. High-risk clusters for COVID-19 were mapped using principal components analysis and minimum variance stratification, according to age, comorbidities and deprivation. 27,306 participants tested for SARS-CoV-2 were eligible for inclusion. Of these, 5,196 tested positive, 2,724 were hospitalised and 475 died. ResultsPositive linear trends were observed between higher local deprivation and higher odds of SARS-CoV-2 infection, COVID-19 hospitalisations and deaths (p<0.001). The odds of testing positive was 19% lower for participants with cancer (adjusted odds ratio, aOR=0.81, 0.74-0.88). Higher odds of testing positive were associated with younger age, male sex, cerebrovascular disease and more severe deprivation. Participants with diabetes were at 42% higher odds of hospitalisation (aOR=1.42, 1.30-1.56). In addition to older age and male sex, strongest comorbidity risk factors for COVID-19 death were cerebrovascular disease, diabetes and mild liver disease with aOR of 1.78 (1.34-2.36), 1.71 (1.41-2.08) and 1.85 (1.31-2.61) respectively, after full adjustment. Participants recruited from North-West England were in highest clusters of COVID-19 risk, whilst participants from South England were at lowest risk. ConclusionThe burden of COVID-19 increased at higher levels of deprivation, and the presence of specific comorbidities. Individuals in more deprived areas were at significantly higher odds of infection, hospitalisation and death from COVID-19. Several cardiovascular comorbidities and associated risk factors were associated with COVID-19 hospitalisation and death.

Cognitive Dysfunction in Heart Failure: Pathophysiology and Implications for Patient Management.

There is increasing recognition of the prevalence and impact of cognitive dysfunction (CD) in heart failure (HF) patients. This contemporary review appraises the evidence for epidemiological association, direct pathophysiological links and emerging pharmacological and non-pharmacological interventions. Furthermore, we present evidence for care models that aim to mitigate the morbidity and poor quality of life associated with these dual processes and propose future work to improve outcomes. CD disproportionately affects heart failure patients, even accounting for known comorbid risk factors, and this may extend to subclinical left ventricular dysfunction. Neuroimaging studies now provide evidence of anatomical and functional differences which support previously postulated mechanisms of reduced cerebral blood flow, micro-embolism and systemic inflammation. Interventions such as multidisciplinary ambulatory HF care, education and memory training improve HF outcomes perhaps to a greater degree in those with comorbid CD. Additionally, optimisation of standard heart failure care (cardiac rehabilitation, pharmacological and device therapy) may lead to additional cognitive benefits. Epidemiological, neuroimaging and intervention studies provide evidence for the causal association between HF and CD, although evidence for Alzheimer's dementia is less certain. Specific reporting of cognitive outcomes in HF trials and evaluation of targeted interventions is required to further guide care provision.

A Scoping Review of Perinatal Outcomes for Canadian Individuals with Obesity 1980–2020

Background: Pre-pregnancy obesity has long been associated with a higher risk of antepartum, intrapartum, and postpartum complications, leading to classifying all patients within the WHO obese body mass index range (BMI ≥30 kg/m2) as high-risk. Excessive risk classification can lead to over-treatment and iatrogenic harm. Research supporting these increased risks comes from a variety of countries with different baseline population health and perinatal health care systems. Recent research documents that parturients with high pre-pregnancy BMI can have uncomplicated pregnancies and births. Here, the relationship between obesity and perinatal outcomes in a Canadian population is investigated using Canada as a model of a country with stable nutrition sufficiency and universal access to health care. Methods: We searched electronic databases PubMed, Ovid MEDLINE, and CINAHL for peer-reviewed articles in English that examined perinatal outcomes of singleton pregnancies in Canada between 1980 and 2020 based on pre-pregnancy obesity as the exposure of interest. Results: The search yielded 1946 results. After full-text screening, 21 articles met criteria for analysis. The impact of obesity on preterm labour, preterm birth, post-term delivery, labour induction, post-partum hemorrhage, and parturient morbidity and mortality in Canada remains inconclusive. The risk of hypertensive disorders, gestational diabetes, shoulder dystocia, and cesarean section delivery was significantly elevated as BMI increased. Operative vaginal delivery was less common in those with pre-pregnancy obesity. Conclusions: Though certain adverse perinatal outcomes are associated with increasing pre-pregnancy BMI, given the wide range of results and range of risk values, further research is required to better delineate comorbid risk factors that contribute to poorer outcomes. Nation-specific outcomes that reflect the accessibility of perinatal care and population health are a necessary baseline for the development of accurate health management guidelines.

Early age at diagnosis of endometrial intraepithelial neoplasia and association with body mass index and other clinical factors (389)

Early age at diagnosis of endometrial intraepithelial neoplasia and association with body mass index and other clinical factors (389)

Retinal Artery Occlusion and Associated Risk of Cerebrovascular Disease Related Hospitalization: A National Inpatient Study.

ObjectivesTo evaluate the demographic and comorbid risk factors for cerebrovascular disease (CVD) hospitalization in patients with retinal artery occlusion (RAO) and study the impact on hospitalization outcomes.MethodsWe conducted a retrospective cross-sectional study using the Nationwide Inpatient Sample (NIS, 2019). We included 62,255 adults (age 18-65 years) with the primary diagnosis of CVD. The study sample was divided by the co-diagnosis of RAO (N=1,700). A logistic regression model was used to evaluate the odds ratio (OR) of association for risk factors leading to CVD hospitalization in patients with RAO, with the non-RAO cohort as the reference category.ResultsThe majority of the CVD patients with RAO were elderly (51-65 years, 68%), females (54%), and whites (47%). Yet, demographics did not significantly impact the association with CVD hospitalization between RAO and non-RAO patients. There was a significant difference in the geographic distribution of CVD hospitalizations with RAO, with the highest prevalence in the East North Central Atlantic (21%) and South Atlantic (18%) regions, and the lowest in the Mountain (4%) and East South Central (4%) regions. Comorbid diabetes with complications (69%), and complicated hypertension (55%) were most prevalent in patients with RAO thereby increasing the risk for CVD hospitalization by 7.8 (95% CI 6.9-8.8) and 1.8 times (95% CI 1.6-1.9), respectively. Patients with RAO and having major severity of illness were at increased risk of CVD hospitalization (OR 2.8, 95% CI 1.9-3.9). Patients with RAO had a significant difference in adverse disposition, including transfer to the skilled nursing facility (SNF)/intermediate care facility (ICF) (32% vs. 24%) and requiring home health care (16% vs. 11%) compared to non-RAO patients.ConclusionThe prevalence of RAO in CVD hospitalization was 2.7%, and demographics did not have any impact on the increasing risk of CVD. Comorbid diabetes (by 685%) and hypertension (by 78%) potentially increase the risk of CVD hospitalization in patients with RAO. These patients have a major severity of illness, leading to an adverse disposition. This calls for a collaborative care model to improve the quality of life in these at-risk patients with RAO.

189 Association between psoriasis and sleep disturbance in the US: Results from National Health and Nutrition Examination Survey (NHANES)

Sleep deprivation can modulate the immune response and is a risk factor for cardiovascular, metabolic disease, and depression-the same comorbidities that are associated with psoriasis. Many psoriasis patients report subjective sleep disturbance characterized by difficulties initiating and maintaining sleep, as well as shortened sleep duration. However, no studies have compared the prevalence of sleep disturbance in individuals with and without psoriasis which is the aim of this study. This study was conducted using publicly available data from the 2011-2014 NHANES cycles.

Comorbidities and ethnic health disparities in the UK biobank.

The goal of this study was to investigate the relationship between comorbidities and ethnic health disparities in a diverse, cosmopolitan population. We used the UK Biobank (UKB), a large progressive cohort study of the UK population. Study participants self-identified with 1 of 5 ethnic groups and participant comorbidities were characterized using the 31 disease categories captured by the Elixhauser Comorbidity Index. Ethnic disparities in comorbidities were quantified as the extent to which disease prevalence within categories varies across ethnic groups and the extent to which pairs of comorbidities co-occur within ethnic groups. Disease-risk factor comorbidity pairs were identified where one comorbidity is known to be a risk factor for a co-occurring comorbidity. The Asian ethnic group shows the greatest average number of comorbidities, followed by the Black and then White groups. The Chinese group shows the lowest average number of comorbidities. Comorbidity prevalence varies significantly among the ethnic groups for almost all disease categories, with diabetes and hypertension showing the largest differences across groups. Diabetes and hypertension both show ethnic-specific comorbidities that may contribute to the observed disease prevalence disparities. These results underscore the extent to which comorbidities vary among ethnic groups and reveal group-specific disease comorbidities that may underlie ethnic health disparities. The study of comorbidity distributions across ethnic groups can be used to inform targeted group-specific interventions to reduce ethnic health disparities.

Impact of pelvic floor dysfunction in Aboriginal and Torres Strait Islander women attending an urban Aboriginal medical service.

Pelvic floor dysfunction causes high-level disease burden, with Aboriginal and Torres Strait Islander women less likely to have access to best management for these issues due to multiple sociocultural barriers. There is limited data on the impact of pelvic floor dysfunction in this specific population. To explore the impact of pelvic floor dysfunction on Aboriginal and Torres Strait Islander women attending an urban Aboriginal medical service, considering barriers and facilitators for care, and the services that are desired to address these conditions. This is a mixed methods project utilising the validated Pelvic Floor Impact Questionnaire 7 in combination with qualitative data from semi-structured interviews. Quantitative data were analysed using SPSS Version 24 and analysis included the use of means, SD and Fisher's exact test for comparison. Interview transcriptions were coded into initial themes using thematic analysis and a theoretical approach was used to capture common patterned responses. The majority of women reported urinary incontinence. Higher scores on the urinary impact questions were significantly associated with comorbid risk factors of chronic cough and obesity. Salient themes from interviews included help-seeking behaviours, embarrassment and normalisation of the condition. Women desired access to a pelvic floor physiotherapist, and preferred a female doctor and a consistent care provider. Pelvic floor disorders cause high disease burden for Aboriginal women across a broad age range with associated comorbid risk factors frequently occurring. This study suggests service improvement and care delivery strategies that may improve long-term outcomes for Aboriginal women with pelvic floor conditions.

SURGICAL TREATMENT OF OBESITY AS A RISK FACTOR FOR ATYPICAL HYPERPLASIA AND ENDOMETRIAL CANCER

The aim of the study is to analyze the literature available, to examine bariatric surgery as a treatment for people with metabolic syndrome (a risk factor for atypical endometrial hyperplasia), and to evaluate bariatric surgery significance in reducing endometrial cancer incidence.
 Materials and Methods. The authors scanned the platforms Springer, Pubmed, IFSO, and Google Scholar using such key words as metabolic syndrome, simple and atypical endometrial hyperplasia, endometrial cancer and bariatric surgery, methods for the metabolic syndrome correction in patients with endometrial cancer, effects of bariatric surgery on endometrial cancer, treatment of metabolic syndrome in patients-at-risk for endometrial cancer. The authors examined the articles published in English and Russian no longer than 10 years ago.
 Results. Metabolic syndrome is a risk factor for endometrial cancer and comorbidity. It expands the bariatric surgery alternatives for patients with Class 1 and Class 2 obesity.

Conservative Management in a Patient with Recurrent Boerhaave Syndrome

Boerhaave syndrome (BS) is a full thickness oesophageal tear. Most cases require surgical correction. In rare cases, conservative management can be attempted. This case describes a 30-year-old patient with a history of BS 9 months prior, managed conservatively at that time, presenting with 2 days of vomiting. Their vitals and physical examination were within normal limits. Imaging revealed extensive air tracking along the mediastinum, oesophagus, and bilateral neck and chest wall consistent with BS. Gastrographin and barium oesophagrams showed no contrast extravasation. The patient was successfully treated with conservative measures including pantoprazole, piperacillin-tazobactam, cessation of oral intake, and parenteral nutrition. This case represents one of only two documented cases of recurrent BS in an adult patient in which both cases were managed conservatively. Of these two cases, this is the first report with the second episode of BS occurring more than 4 weeks after the first episode. Additionally, unlike the other recurrent BS case that was conservatively managed, this patient lacked any known comorbid risk factors for development of BS. While the management of this case resembles the care provided in some prior case reports, the significant variation and lack of standardisation in the approach of conservative BS treatment posed a significant challenge in developing a therapeutic plan. Given the absence of high-quality studies about conservatively managed BS, an increased sample size of case reports detailing their non-procedural management approaches and their subsequent outcomes would hopefully eventually clarify an optimal treatment regimen, and allow for standardisation of conservative BS treatment.

Pregnancy outcomes following maternal exposure to statins: A systematic review and meta-analysis.

The objective of this meta-analysis was to determine whether maternal exposure to statins is associated with increased rates of major congenital malformations and other adverse pregnancy outcomes. PubMed/Medline, Web of Science and Reprotox® databases were searched. Cohort and case control studies with prenatal exposure to statins were included. Analysis of five cohort studies and one case-control study showed no significant increase in rate of major congenital malformations when the exposed group was compared with the control ([OR 1.27; 95% CI 0.80-2.04], [aOR 1.05; 95% CI 0.84-1.31]). A significant increase in heart defect risk was detected in the statin-exposed group when unadjusted ORs were combined (OR 2.47; 95% CI 1.36-4.49). Further analysis of the same outcome by using adjusted ORs showed no significant increase in heart defect risk in the statin-exposed group compared with the controls (aOR 1.24; 95% CI 0.93-1.66). A significantly lower live birth rate (OR 0.60, 95% CI 0.49-0.75) and a higher spontaneous abortion rate (OR 1.36; 95% Cl 1.06-1.75) were detected in the statin-exposed group. Gestational statin exposure was not associated with a significant increase in risk of major congenital malformations, heart defects and other adverse pregnancy outcomes, except spontaneous abortion and live birth rate, which may be associated with maternal comorbidity and other unadjusted risk factors. Further research focusing on particular statins is needed to draw more definitive conclusions.

Psychological Impacts on Patients with Alcohol Use Disorder: a Study in Southern Taiwan with Alcohol Use Disorders Identification Test (AUDIT) in 2020

IntroductionAlcohol consumption is a risk factor for various comorbidities, such as cirrhosis, chronic sclerosing stomatitis, and neuropsychiatric disorders.ObjectivesOur study examined the associations between psychological factors and alcohol addiction of the individuals with alcohol use disorder (AUD) in Southern Taiwan.MethodsDemographic information as well as suicidal history and sources of stress were collected from 177 participants. The extent of alcoholism was assessed by AUDIT questionnaire. Demographic and linear regression analyses were performed with the Statistical Software Stata version 12.0 (StataCorp LP, College Station, TX, USA).ResultsDemographic data, suicidal history and the causes of stress of patients divided by AUDIT scores are shown in Table 1. Among 177 participants, 17 (9.6%) had suicidal thoughts, 4 (2.3%) had suicide plan, 22 (12.5%) self-injured, and four-fifth of patients lived under pressure. Patients who self-harmed were with significant lower AUDIT scores of -7.24 (95% CI: -11.49 – -3.00) (Table. 2). The AUDIT scores of patients with physical stress, interpersonal difficulties and loneliness increased significantly by 6.71 (95% CI: 3.19 – 10.30), 6.14 (95% CI: 2.15 – 10.13) and 5.02 (95% CI: 0.93 – 9.11), respectively (Table. 3).ConclusionsOur findings indicated negative correlation with alcohol use and auto-inflicted injury. However, previous study showed systematic assessment of the association between suicide and AUD, and considered alcohol an important risk factor for suicide, which is related to mental health and affected by different genders and drinking patterns. Our results may provide reference for estimation of the alcohol-related psychological effects in Taiwan.DisclosureNo significant relationships.

Perceived Age as a Mortality and Comorbidity Predictor: A Systematic Review.

Perceived age is defined as how old a person looks to external evaluators. It reflects the underlying biological age, which is a measure based on physical and physiological parameters reflecting a person's aging process more accurately than chronological age. People with a higher biological age have shorter lives compared to those with a lower biological age with the same chronological age. Our review aims to find whether increased perceived age is a risk factor for overall mortality risk or comorbidities. A literature search of three databases was conducted following the PRISMA guidelines for studies analyzing perceived age or isolated facial characteristics of old age and their relationship to mortality risk or comorbidity outcomes. Data on the number of patients, type and characteristics of evaluation methods, evaluator characteristics, mean chronologic age, facial characteristics studied, measured outcomes, and study results were collected. Out of 977 studies, 15 fulfilled the inclusion criteria. These studies found an increase in mortality risk of 6-51% in older-looking people compared to controls (HR 1.06-1.51, p < 0.05). In addition, perceived age and some facial characteristics of old age were also associated with cardiovascular risk and myocardial infarction, cognitive function, bone mineral density, and chronic obstructive pulmonary disease (COPD). Perceived age promises to be a clinically useful predictor of overall mortality and cardiovascular, pulmonary, cognitive, and osseous comorbidities. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Drug-Induced Liver Injury in Paediatrics: A Short Review

Drug-induced liver injury (DILI) is an under-recognized cause of paediatric liver disease. Although DILI in children accounts for about 1% of all reported adverse drug reactions throughout all age groups and less than 10% of all clinical DILI cases, it is responsible for about 20% of acute liver failure (ALF) cases. A wide range of drugs, herbal products and nutritional supplements have been associated with the development of DILI through dose-dependent, idiosyncratic or indirect mechanism. Limited literature is available in pediatric population, making DILI a still challenging diagnosis. An accurate medical history is of pivotal importance and should investigate about drug consumption, clinical and laboratory findings, individual and family risk factors for drug-related side effects or comorbidities, the timing of the injury onset after the implicated agent has been started (latency). Clinical presentation of DILI varies from asymptomatic or very mild to serious and sometimes fatal conditions; laboratory tests may be helpful in ruling out other causes of liver injury but, with few exceptions, they are aspecific. Early suspicion and prompt withdrawal of the offending drug play a key role for a successful management of most cases.&#x0D; Rarely a specific therapy is available, as for acetaminophen toxicity, treated with N-acetylcysteine, and sodium valproate toxicity, where carnitine may be beneficial. Although controlled trials are not available yet, corticosteroids and ursodeoxycholic acid can be considered if no improvement is proven after discontinuation of drug.&#x0D; The present short review is not intended to deal with all aspects concerning DILI but to focus on epidemiology, pathogenesis, clinical features, practical management and current challenges in paediatric age.

Predicting 31- to 60-Day Heart Failure Rehospitalization Among Older Women.

The current study sought to identify social, hemodynamic, and comorbid risk factors associated with 31-to 60-day heart failure (HF) rehospitalization in African American and Caucasian older (aged >65 years) women. A non-equivalent, case-control, quantitative design study using secondary data analysis of medical records from a local community hospital in the Southeast region of the United States was performed over a 3-year period. Relationships between predictor variables and the outcome variable, 31- to 60-day HF rehospitalization, were explored. The full model containing all predictors was not able to distinguish between predictors (χ2[21, N = 188] = 35.77, p = 0.12). However, a condensed model showed that body mass index (BMI) level 1 (<25 kg/m2), BMI level 2 (>25 and <30 kg/m2), age 75 to 80 years, and those taking lipid-lowering agents were significant predictors. Subtype of HF (reduced or preserved) and race did not predict HF rehospitalization within the specified time period. Multiple comorbid risk factors failed to consistently predict rehospitalization, which may reflect dated HF-specific approaches and therapies. Future studies should evaluate contributions of current targeted post-discharge methods or therapies. [Research in Gerontological Nursing, 15(4), 179-191.].

Abstract No. 366 Assessing the role of psoas muscle cross-sectional area on amputation rates for patients with chronic limb-threatening ischemia (CLTI)

To evaluate psoas muscle cross-sectional area (PMCA) as a predictor of amputation rates, time to first amputation, and overall survival in patients with chronic limb-threatening ischemia (CLTI). Secondly, evaluate PMCA as it compares with other comorbidity variables and risk factors for amputation.

The relationship of life-course patterns of adiposity with type 2 diabetes, depression, and their comorbidity in the Northern Finland Birth Cohort 1966

ObjectivesType 2 diabetes (T2D) and comorbid depression challenges clinical management particularly in individuals with overweight. We aim to explore the shared etiology, via lifecourse adiposity, between T2D and depression.MethodsWe used data from birth until 46years from Northern Finland Birth Cohort 1966 (n = 6,372; 53.8% females). We conducted multivariate analyses on three outcomes: T2D (4.2%), depression (19.2%) and as comorbidity (1.8%). We conducted (i) Path analysis to clarify time-dependent body mass index (BMI) related pathways, including BMI polygenic risk scores (PRS); and (ii) Cox regression models to assess whether reduction of overweight between 7years and 31years influence T2D, depression and/or comorbidity. The models were tested for covariation with sex, education, smoking, physical activity, and diet score.ResultsThe odd ratios (OR) of T2D in individuals with depression was 1.68 [95% confidence interval (CI): 1.34–2.11], and no change in estimate was observed when adjusted for covariates. T2D and comorbidity showed similar patterns of relationships in the path analyses (P < 0.001). The genetic risk for obesity (PRS BMI) did not show direct effect on T2D or comorbidity in adulthood but indirectly through measures of adiposity in early childhood and mid-adulthood in the path analysis (P < 0.001). Having early-onset of overweight at 7years and 31years showed highest risk of T2D (OR 3.8, 95%CI 2.4–6.1) and comorbidity (OR 5.0, 95%CI 2.7–9.5), with mild-to-moderate attenuation with adjustments. Depression showed no significant associations.ConclusionsWe found evidence for overweight since childhood as a risk factor for T2D and co-morbidity between T2D and depression, influenced moderately by lifestyle factors in later life. However, no shared early life adiposity related risk factors were observed between T2D and depression when assessed independently in this Finnish setting.

The problem of long-term pain control in chronic rheumatic diseases

Pain is one of the main symptoms and the most distressing manifestation of rheumatic diseases (RD). Currently, non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the symptomatic treatment of RD in real clinical practice, but the effectiveness and tolerability of their longterm use remain insufficiently studied. Many patients with RD require long-term use of NSAIDs. In this case, the presence of comorbid pathology and risk factors for the development of drug complications should be taken into consideration, so the choice of NSAIDs should be based primarily on considerations of patient safety. Aceclofenac (Aertal®) has a pronounced analgesic potential and a good safety profile, which allows us to recommend it for long-term use.