Safety of Nonsteroidal Antiinflammatory Drugs and/or Paracetamol in People Receiving Methotrexate for Inflammatory Arthritis: A Cochrane Systematic Review

Colebatch, Alexandra N.; Marks, Jonathan L.; Heijde, Désirée M van der; Edwards, Christopher J

doi:10.3899/jrheum.120345

Cited by 48 publications

(26 citation statements)

References 28 publications

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“…PsA patients are typically sero-negative for the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies; however, there is a greater chance of sero-positivity in PsA patients compared with the general population [6]. The common conventional treatment agents in PsA include NSAID, intra-articular steroid injections if a single joint is affected, and disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, leflunomide and cyclosporin [7][8][9][10][11][12]. Surprisingly, considering the widespread use, the effectiveness of these medications has not been well established in clinical studies [13].…”

Section: Psoriatic Arthritismentioning

confidence: 99%

Apremilast: a PDE4 inhibitor for the treatment of psoriatic arthritis

Abdulrahim¹,

Thistleton²,

Adebajo³

et al. 2015

Expert Opinion on Pharmacotherapy

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Section: Psoriatic Arthritismentioning

confidence: 99%

Apremilast: a PDE4 inhibitor for the treatment of psoriatic arthritis

Abdulrahim¹,

Thistleton²,

Adebajo³

et al. 2015

Expert Opinion on Pharmacotherapy

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“…NSAIDs may increase the activity or toxicity of sulfonylurea, hypoglycemic agents, oral anticoagulants, phenytoin, sulfonamides, and methotrexate by displacing these drugs from their protein binding sites and increasing the free fraction of the drug in plasma [47]. However, a recent Cochrane review concluded that concurrent use of NSAIDs with methotrexate appeared safe provided appropriate monitoring was performed [48]. NSAIDs may blunt the antihypertensive effects of β-blockers, angiotensin-converting enzyme inhibitors, and thiazides, leading to de-stabilization of blood pressure control [49].…”

Section: Effects Of Concomitant Drugs Diseases and Agingmentioning

confidence: 99%

Use of NSAIDs in treating patients with arthritis

2013

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Patients with rheumatic diseases, including rheumatoid arthritis and osteoarthritis, almost universally describe pain and stiffness as important contributors to reduced health-related quality of life. Of the treatment options available, NSAIDs are the most widely used agents for symptomatic treatment. NSAIDs are effective anti-inflammatory and analgesic drugs by virtue of their ability to inhibit biosynthesis of prostaglandins at the level of the cyclooxygenase enzyme. However, many of the adverse effects of NSAIDs are also related to inhibition of prostaglandin production, making their use problematic in some patient populations. For the clinician, understanding the biology of prostaglandin as it relates to gastrointestinal, renal, and cardiovascular physiology and the pharmacologic properties of specific NSAIDs is key to using these drugs safely. Of particular importance is the recognition of co-morbid conditions and concomitant drugs that may increase the risk of NSAIDs in particular patients. In patients with risk factors for NSAID toxicity, using the lowest dose of a drug with a short half-life only when it is needed is likely to be the safest treatment option. For those patients whose symptoms cannot be managed with intermittent treatment, using protective strategies is essential.

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“…However, there are no specific grounds to unreservedly prohibit the combination of NSAIDs and methotrexate 15 …”

Section: Methotrexate Mythsmentioning

confidence: 99%