Bolten W W, Krüger K, Reiter-Niesert S, Stichtenoth D O
Abt. Rheumatologie, Klaus Miehlke Klinik, Leibnizstr. 23, 65191, Wiesbaden, Deutschland.
Praxiszentrum Rheumatologie, München, Deutschland.
Z Rheumatol. 2016 Feb;75(1):103-16. doi: 10.1007/s00393-015-0018-6.
NSAIDs exert their anti-inflammatory and analgesic effects by inhibition of COX‑2, a key enzyme for proinflammatory prostanoid synthesis. Therapy with NSAIDs is limited by their typical gastrointestinal, cardiovascular and renal side effects, which are caused by inhibition of COX‑1 (gastrointestinal toxicity), COX‑2 (cardiovascular side effects) or both COX-isoenzymes (renal side effects). Appropriate prevention strategies should be employed in patients at risk. If gastrointestinal risk factors are present, co-administration of a proton pump inhibitor or misoprostol is recommended; in patients with cardiovascular risk, coxibs, diclofenac and high-dose ibuprofen should be avoided. Furthermore, drug interactions and contraindications should be considered. In patients with renal impairment (GFR < 30 ml/min) all NSAIDs must be avoided. Ulcer anamnesis is a contraindication for traditional NSAIDs. Preexisting cardio- or cerebrovascular diseases are contraindications for coxibs. Treatment decisions should be individually based with a continuous monitoring of the risk - benefit ratio and exploitation of non-pharmacological treatment options.
非甾体抗炎药通过抑制COX-2发挥其抗炎和镇痛作用，COX-2是促炎前列腺素合成的关键酶。非甾体抗炎药的治疗受到其典型的胃肠道、心血管和肾脏副作用的限制，这些副作用是由抑制COX-1（胃肠道毒性）、COX-2（心血管副作用）或两种COX同工酶（肾脏副作用）引起的。对于有风险的患者应采用适当的预防策略。如果存在胃肠道危险因素，建议联合使用质子泵抑制剂或米索前列醇；对于有心血管风险的患者，应避免使用环氧化酶抑制剂、双氯芬酸和高剂量布洛芬。此外，还应考虑药物相互作用和禁忌证。对于肾功能不全（肾小球滤过率<30 ml/min）的患者，必须避免使用所有非甾体抗炎药。溃疡病史是传统非甾体抗炎药的禁忌证。既往有心血管或脑血管疾病是环氧化酶抑制剂类药物的禁忌证。治疗决策应基于个体情况，持续监测风险效益比并采用非药物治疗方案。
