The appropriate use of NSAIDs in arthritic conditions.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are an important component of therapy for many of the arthritides. They are of value in the treatment of rheumatoid arthritis (RA) and other arthritides with inflammatory characteristics and are frequently used to treat osteoarthritis (OA) when simple analgesics fail to provide relief. There is a great deal of interpatient variability with respect to response to NSAIDs; however, it is currently difficult to predict which patient will respond best to which drug. As a result, NSAID selection is based both on the medical history of the individual patient and the adverse-events profiles of the available agents. In general, patients on NSAIDs should be monitored closely for adverse events, particularly those patients with a history of, or risk factors for, gastrointestinal, renal, or hepatic disease. Use of the cytoprotective agent misoprostol is indicated in patients at high risk for gastrointestinal irritation. Although H2-antagonists in high dosages may be effective in the prophylaxis of gastropathy, there is some concern that use of these agents at usual dose levels may create a potential for adverse events by masking the pain associated with ongoing gastric erosive changes.