Brzezińska Olga, Cieplucha Agnieszka, Słodkowski Krystian, Lewandowska-Polak Anna, Makowska Joanna
Department of Rheumatology, Medical University of Lodz, Lodz, Poland.
Urology Unit, Maria Skłodowska-Curie Specialist Hospital in Zgierz, Zgierz, Poland.
Rheumatol Int. 2025 Mar 27;45(4):82. doi: 10.1007/s00296-025-05834-2.
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in patients with musculoskeletal disorders. However, hypersensitivity reactions to NSAIDs represent a significant clinical issue.This study aimed to assess the incidence of NSAID hypersensitivity in patients with musculoskeletal disorders and to identify associated risk factors.A total of 343 patients (aged 18-88) with chronic or recurrent musculoskeletal pain were enrolled. Participants completed a questionnaire regarding sociodemographic data, comorbidities, NSAID intake, and side effects. Patients with clinical features of NSAID hypersensitivity were identified and analysis of hypersensitivity risk factors was performed.The study included 343 patients suffering from rheumatic diseases, the most common of which were rheumatoid arthritis (45%), osteoarthritis (32%) and seronegative spondyloarthropathies (11%). However, 24.78% met the criteria for NSAID hypersensitivity. The most common reactions were NSAID-induced urticaria/angioedema (25.88%), delayed hypersensitivity, and NSAID-exacerbated respiratory disease (NERD). The symptoms were most frequently associated with ketoprofen (29%) and diclofenac (25%). Key risk factors for hypersensitivity included daily NSAID intake, asthma, chronic urticaria, smoking, aspirin use at cardiological doses, and a history of allergic reactions. Patients with hypersensitivity had significantly more chronic diseases compared to non-hypersensitive individuals (2.73 ± 2.29 vs. 1.68 ± 1.92; p = 0.0437). A logistic regression model demonstrated a sensitivity of 84.7% and specificity of 72.1% for identifying high-risk patients in teaching and respectively 80.0% and 71.7% in validation group.Identifying high-risk individuals can optimize pain management strategies and reduce adverse outcomes. Selective COX-2 inhibitors, paracetamol, or tramadol may be safer alternatives for patients at risk of hypersensitivity. Further studies are required to validate these findings in larger cohorts.
非甾体抗炎药（NSAIDs）广泛应用于肌肉骨骼疾病患者。然而，对NSAIDs的过敏反应是一个重大的临床问题。本研究旨在评估肌肉骨骼疾病患者中NSAID过敏的发生率，并确定相关危险因素。共纳入343例年龄在18至88岁之间的慢性或复发性肌肉骨骼疼痛患者。参与者完成了一份关于社会人口统计学数据、合并症、NSAID摄入情况和副作用的问卷。识别出具有NSAID过敏临床特征的患者，并对过敏危险因素进行分析。该研究纳入了343例患有风湿性疾病的患者，其中最常见的是类风湿关节炎（45%）、骨关节炎（32%）和血清阴性脊柱关节病（11%）。然而，24.78%的患者符合NSAID过敏标准。最常见的反应是NSAID诱导的荨麻疹/血管性水肿（25.88%）、迟发型过敏反应和NSAID加重的呼吸道疾病（NERD）。这些症状最常与酮洛芬（29%）和双氯芬酸（25%）相关。过敏的关键危险因素包括每日NSAID摄入量、哮喘、慢性荨麻疹、吸烟、心脏病学剂量的阿司匹林使用以及过敏反应史。与非过敏个体相比，过敏患者的慢性病明显更多（2.73±2.29对1.68±1.92；p = 0.0437）。逻辑回归模型显示，在教学组中识别高危患者的敏感性为84.7%，特异性为72.1%，在验证组中分别为80.0%和71.7%。识别高危个体可以优化疼痛管理策略并减少不良后果。对于有过敏风险的患者，选择性COX-2抑制剂、对乙酰氨基酚或曲马多可能是更安全的替代品。需要进一步研究在更大的队列中验证这些发现。
