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Nonsteroidal Anti-inflammatory Drugs: Making the Right Choices

Division of Rheumatology and Immunology, University of North Carolina School of Medicine, Chapel Hill.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prescribed pharmacologic agents in medicine. The ability of these drugs to decrease inflammation is linked to their inhibitory effect on the synthesis of prostaglandins. This mechanism also results in toxicity that can cause gastrointestinal ulceration and bleeding, renal failure, and worsening of preexisting congestive heart failure. The superiority of one NSAID over another has not been clinically demonstrated in musculoskeletal conditions, nor has the efficacy of NSAIDs in noninflammatory rheumatic conditions been shown to be better than that of simple analgesics, such as acetaminophen. The use of these drugs, particularly in the elderly patient with osteoarthritis, should be carefully considered, and alternative, less toxic therapies should be sought whenever possible.