Safety of non-steroidal anti-inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people receiving methotrexate for inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis)

Colebatch, Alexandra N.; Marks, Jonathan L.; Edwards, Christopher J

doi:10.1002/14651858.cd008872.pub2

Cited by 60 publications

(50 citation statements)

References 112 publications

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“…A systematic review of RCTs and non-randomized studies regarding the safety of using NSAIDs and/or paracetamol with MTX in IA identified 17 studies, all in patients with RA [39]. Most of the included studies were of a low to moderate quality.…”

Section: Resultsmentioning

confidence: 99%

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Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

et al. 2012

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Objective. To develop evidence-based recommendations for pain management by pharmacotherapy in patients with inflammatory arthritis (IA).Methods. A total of 453 rheumatologists from 17 countries participated in the 2010 3e (Evidence, Expertise, Exchange) Initiative. Using a formal voting process, 89 rheumatologists representing all 17 countries selected 10 clinical questions regarding the use of pain medications in IA. Bibliographic fellows undertook a systematic literature review for each question, using MEDLINE, EMBASE, Cochrane CENTRAL and 2008–09 European League Against Rheumatism (EULAR)/ACR abstracts. Relevant studies were retrieved for data extraction and quality assessment. Rheumatologists from each country used this evidence to develop a set of national recommendations. Multinational recommendations were then formulated and assessed for agreement and the potential impact on clinical practice.Results. A total of 49 242 references were identified, from which 167 studies were included in the systematic reviews. One clinical question regarding different comorbidities was divided into two separate reviews, resulting in 11 recommendations in total. Oxford levels of evidence were applied to each recommendation. The recommendations related to the efficacy and safety of various analgesic medications, pain measurement scales and pain management in the pre-conception period, pregnancy and lactation. Finally, an algorithm for the pharmacological management of pain in IA was developed. Twenty per cent of rheumatologists reported that the algorithm would change their practice, and 75% felt the algorithm was in accordance with their current practice.Conclusions. Eleven evidence-based recommendations on the management of pain by pharmacotherapy in IA were developed. They are supported by a large panel of rheumatologists from 17 countries, thus enhancing their utility in clinical practice.

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Section: Resultsmentioning

confidence: 99%

“…The evidence regarding low-dose aspirin for the prevention of atherothrombotic disease is less clear, although pharmacokinetic data suggest that aspirin at daily doses of ≥650 mg has different pharmacokinetic properties and is more likely to increase risk in combination with MTX [39, 48–50]. …”

Section: Resultsmentioning

confidence: 99%

Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

et al. 2012

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“…A Cochrane systematic review examining the safety of NSAIDs among inflammatory arthritis patients concluded that the use of NSAIDs with methotrexate was generally safe when appropriate monitoring was performed [57]. However, the use of high-dose aspirin (e.g., 2 g daily) was associated with increased risk of kidney and liver toxicity.…”

Section: Pharmacologic Treatment Of Painmentioning

confidence: 99%

Effect and Treatment of Chronic Pain in Inflammatory Arthritis

Lee

2012

Curr Rheumatol Rep

135

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Pain is the most common reason patients with inflammatory arthritis see a rheumatologist. Patients consistently rate pain as one of their highest priorities, and pain is the single most important determinant of patient global assessment of disease activity. Although pain is commonly interpreted as a marker of inflammation, the correlation between pain intensity and measures of peripheral inflammation is imperfect. The prevalence of chronic, non-inflammatory pain syndromes such as fibromyalgia is higher among patients with inflammatory arthritis than in the general population. Inflammatory arthritis patients with fibromyalgia have higher measures of disease activity and lower quality of life than inflammatory patients who do not have fibromyalgia. This review article focuses on current literature involving the effects of pain on disease assessment and quality of life for patients with inflammatory arthritis. It also reviews non-pharmacologic and pharmacologic options for treatment of pain for patients with inflammatory arthritis, focusing on the implications of comorbidities and concurrent disease-modifying antirheumatic drug therapy. Although several studies have examined the effects of reducing inflammation for patients with inflammatory arthritis, very few clinical trials have examined the safety and efficacy of treatment directed specifically towards pain pathways. Most studies have been small, have focused on rheumatoid arthritis or mixed populations (e.g., rheumatoid arthritis plus osteoarthritis), and have been at high risk of bias. Larger, longitudinal studies are needed to examine the mechanisms of pain in inflammatory arthritis and to determine the safety and efficacy of analgesic medications in this specific patient population.

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“…Most elderly patient take many drugs which having the potential to displace MTX from serum proteins and/or to reduce MTX clearance. The most known are interaction with trimethoprim and sulfamethoxazole [TMP-SMX] and NSAIDs [30,32,33].…”

Section: Prevention and Management Of Mtx Toxicitymentioning

confidence: 99%

The Hematologic Toxicity of Methotrexate in Patients with Autoimmune Disorders

Rajnics¹,

Kellner²,

Kellner³

et al. 2017

J Neoplasm

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The incidence of auto-immune diseases is increasing nowa-days. Despite of the development of diagnosis and management of diseases, they remained chronic diseases. The patient's lifespan expansion requires long-term treatment with harmful agents, such as Methotrexate or other immuno-suppressive drugs. The Methotrexate toxicities are based on the duration and cumulative dosing of drug, and the combination with other drugs. Myelosuppression and consequent pancytopenia is the most frequent hematologic toxicity, which occur mostly later during low dose methotrexate administration.We demonstrate three cases of low dose Methotrexate toxicity in older patients with rheumatoid arthritis and psoriasis.All patients were treated with low dose Methotrexate along more than one year continuously.Two old patients with RA and another with psoriasis developed pancytopenia causing severe neutropenia, cutaneous bleeding, and bruising and septic condition. They required intravenous antibiotic therapy, corticosteroids and limited transfusion dependence as a result of low dose Methotrexate.We have assessed the possible causes of Methotrexate toxicities and found that all patients used non-steroid anti-inflammatory drugs because of pain and protonpump inhibitor to avoid development of peptic ulcer. Two patients recovered, another died in septic condition.We would like to drawn attention of hematologists, dermatologists and rheumatologists to the harmful effect of low dose methotrexate in this patient population and emphasize the role of rigorous and consequent hematologic testing to avoid these severe late complications.

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Safety of non-steroidal anti-inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people receiving methotrexate for inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis)

Cited by 60 publications

References 112 publications

Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative

Effect and Treatment of Chronic Pain in Inflammatory Arthritis

The Hematologic Toxicity of Methotrexate in Patients with Autoimmune Disorders

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