Nonsteroidal Anti-inflammatory Drug Therapy In Patients Research Articles

A retrospective analysis of colchicine in combination with NSAIDs therapy in patients with systemic form of adult-onset Still's disease with serositis

Adult-onset Still's disease (AOSD) is increasingly viewed as autoinflammatory disease associated with the so-called inflammasomopathy. Proinflammatory cytokines, such as IL-18 and IL-1β, processed through the inflammasome machinery, play an important role in the pathogenesis of AOSD. AOSD is heterogenous, therefore there are two subtypes of the disease, systemic and articular, which probably imply different approaches for the treatment. Over 20% of patients with systemic AOSD have serositis. Recently, colchicine in combination with non-steroidal anti-inflammatory drugs (NSAIDs) has become the "gold standard" for recurrent pericarditis treatment. However, data on this combination therapy in AOSD are scarce. In this retrospective case series study, we assessed the medical history of 20 patients with a systemic form of AOSD. All patients had pericarditis and received а combination of NSAIDs (in most cases ibuprofen 600-800 mg x3 daily) and colchicine (1 mg daily) for treatment. 13/20 (65%) of patients responded to this combination of anti-inflammatory drugs. Of note, not only pericarditis, but also other manifestations were improved such as arthritis, rash, hepatomegaly, acute phase reactants, and abnormal liver tests. The low cost, safety and wide availability of such therapy make this option relevant and determine the need for further study.

Can NSAIDs Be Used Safely for Analgesia in Patients with CKD?: COMMENTARY.

The debate in this issue of Kidney360 addresses the quandary that exists regarding the safety of nonsteroidal anti-inflammatory drug (NSAID) use in patients with CKD. This is an important issue because pain syndromes are common in patients with CKD. Whereas NSAIDs are a widely used and effective analgesic, they can be associated with several adverse clinical kidney syndromes (Table 1), particularly in patients with underlying CKD (1,2). Clinicians struggle to achieve adequate analgesia while also avoiding toxicity in this group. However, is avoiding NSAIDs in patients with CKD too restrictive and unnecessary? Our two expert debaters Erin Baretto and Bruce Guthrie tackle the conundrum of whether NSAIDs can be safely used in patients with nondialysis CKD. They will present the PRO and CON sides of the debate. We provide background on NSAID therapy in patients with CKD to set the stage for the debate. View this table: Table 1. Clinical kidney syndromes of nonsteroidal anti-inflammatory drugs Pain management in patients with CKD is limited by a number of analgesic drug-related adverse effects (3). Reduced GFR and impaired tubular secretion put patients with AKI or CKD at increased risk of drug-related nephrotoxicity because of increased accumulation of parent drugs, and their metabolites, from impaired metabolism and excretion (4). A significant number of drugs with potential toxicity are concomitantly prescribed to patients with advanced CKD (5). As such, NSAIDs are considered a class of drugs that should be avoided in patients with CKD, particularly those with advanced CKD (6,7). This approach has led to increased opioid administration and …

Brief Report: Six-Week Treatment of Axial Spondyloarthritis Patients With an Optimal Dose of Nonsteroidal Antiinflammatory Drugs: Early Response to Treatment in Signal Intensity on Magnetic Resonance Imaging of the Sacroiliac Joints.

To evaluate the early effect of full-dose nonsteroidal antiinflammatory drugs (NSAIDs) on the extent and intensity of bone marrow edema of the sacroiliac (SI) joints on magnetic resonance imaging (MRI) in axial spondyloarthritis (SpA). A single-center, 6-week study of a cohort of consecutive patients with clinically suspected axial SpA was conducted. A total of 117 patients were screened. Forty patients who were diagnosed as having axial SpA and had presented with a positive MRI of the SI joints as defined by the Assessment of SpondyloArthritis international Society (ASAS) criteria were considered for a followup MRI after 6 weeks of an optimal dose of NSAIDs. Twenty patients completed the study. Disease activity was monitored by determining the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score every 2 weeks and the Bath Ankylosing Spondylitis Functional Index score at baseline and week 6. NSAID intake was assessed by the ASAS NSAID index. Primary end points were improvement in bone marrow edema of the SI joints on MRI and BASDAI response at week 6. Approximately one-third of eligible patients newly diagnosed as having axial SpA were unable to continue the full-dose NSAID schedule. The median NSAID index was 97% in patients who completed the study. There was a reduction of 1.1 units (10.5%) in mean Spondyloarthritis Research Consortium of Canada (SPARCC) scores at week 6 in comparison to baseline (P = 0.032). Overall, only 30% of the patients (6 of 20) had a minimal clinically important difference of ≥2.5 in SPARCC score. However, 80% of the patients displayed high-intensity lesions on STIR images at baseline, which decreased significantly at week 6 (P = 0.011). There was a significant decrease in the relative intensity of the region of interest (P = 0.007) and a mean decrease of 0.6 in the BASDAI score per 2 weeks of therapy (P = 0.001). Only 29.4% of the patients met the BASDAI criteria for 50% improvement (BASDAI50) at week 6. Our findings indicate a high level of dropout among patients receiving full-dose NSAID therapy in daily practice. In those who tolerated NSAID therapy, there was no clinically relevant decrease in SPARCC scores and low BASDAI50 response. However, we found a decrease in signal intensity of bone marrow edema of the SI joints as an early response to 6 weeks of optimal NSAID therapy in patients newly presenting with axial SpA.

Risk of Development of Medication Overuse Headache With Nonsteroidal Anti-inflammatory Drug Therapy for Migraine

The development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine. To critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine. The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts. The 1-year incidence of MOH was 2.5%. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95% confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95% confidence interval, 1.82-2.06). Acute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.

Nonsteroidal Anti-inflammatory Therapy and Recurrent Acute Anterior Uveitis

Objective: To investigate oral nonsteroidal anti-inflammatory drug (NSAID) therapy in the prevention of recurrences of uveitis in patients with recurrent nongranulomatous, idiopathic, or HLA-B27-associated acute anterior uveitis (AAU).Methods: Retrospective case series of 59 patients with recurrent AAU treated with celecoxib or diflunisal.Results: The average duration of NSAID therapy was 21.2 ± 5.7 months. The average number of relapses for all patients prior to systemic NSAID therapy was 2.84 per person-year follow-up. These relapses declined to 0.53 per person-year follow-up with NSAID therapy (p < .001). The relapse rates prior to and after treatment in the HLA-B27-positive group (n = 21) were compared with the relapse rates prior to and after treatment in the HLA-B27-negative group (n = 38) and were also statistically significant (p < .001).Conclusion: Morbid attacks and the cumulative exposure to corticosteroids can be prevented with systemic NSAID therapy in patients with recurrent AAU.

Abstract 4497: Non-Selective NSAIDs Increase Incidence of Peri-Procedural Infarct and Prolong Hospital Stay after Percutaneous Coronary Interventions

Non-steroidal anti-inflammatory drugs (NSAIDs) increase risk of CV events. We sought to evaluate hospital outcomes associated with NSAID therapy in patients undergoing percutaneous coronary interventions (PCI). Data on NSAID use in single institution treated, consecutive PCI patients (treatment period 2004 –2006, rofecoxib-treated subjects excluded) was merged with NY State Angioplasty Registry database, and studied with ANOVA, chi-square, Kaplan-Meier, and logistic regression analyses. Of 2933 ASA-treated PCI patients (29% females) only 78 (2.7%) were treated with non-selective (ns) NSAIDs and 15 (0.5%) with Celecoxib. Most commonly used ns-NSAIDs were Ibuprofen (n=47) and Ketorolac (n=16). Most common indications for NSAIDs were musculoskeletal pain (35%) or “non-cardiac” chest pain (9%). NSAID-treated patients were younger (56+/−12 in ns-NSAID, 60+/−12 in Celecoxib, and 62+/−12 years old in “no NSAID” groups; p&lt;0.001). More NSAID-treated patients had a history of myocardial infarction (p&lt;0.001) or reduced ejection fraction (p=0.008). NSAIDs treatment did not affect post-PCI in-hospital mortality (p=0.769). However, post-procedural myocardial infarction (MI) was more common in ns-NSAID-treated patients (5% in ns-NSAID, 0% in Celecoxib, and 1% in “no NSAID” groups, p=0.002), odds ratio 5.4 (95%CI of 1.9 –15.9, p=0.002). Post-procedural length of stay in survivors was also significantly longer in the ns-NSAID group (3.9+/− 3.4 days), as compared to Celecoxib (1.1+/− 0.3 days) or “no NSAID” groups (2.2 +/−3.3 days; p&lt;0.001). Ns-NSAID treatment remained predictive of prolonged hospital stay (p=0.011) after adjustment for age (p=0.033), ejection fraction (p&lt;0.001), and history of previous (p&lt;0.001) or post-procedural MI (p=0.001). We observed an increased incidence of peri-procedural MI and longer post-PCI length-of-stay in patients treated with non-selective NSAIDs, but not with Celecoxib. Poor outcomes in ns-NSAIDs treated PCI patients may be due to attenuation of aspirin’s anti-platelet effects by ns-NSAIDs. Pending results of the randomized trials, providers should limit use on non-selective NSAIDs in patients with coronary artery disease undergoing PCI.