Safety of Oral Non-Selective Non-Steroidal Anti-Inflammatory Drugs in Osteoarthritis: What Does the Literature Say?

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recommended and prescribed to treat pain in osteoarthritis. While measured to have a moderate effect on pain in osteoarthritis, NSAIDs have been associated with wide-ranging adverse events affecting the gastrointestinal, cardiovascular, and renal systems. Gastrointestinal toxicity is found with all NSAIDs, which may be of particular concern when treating older patients with osteoarthritis, and gastric adverse events may be reduced by taking a concomitant gastroprotective agent, although intestinal adverse events are not ameliorated. Cardiovascular toxicity is associated with all NSAIDs to some extent and the degree of risk appears to be pharmacotherapy specific. An increased risk of acute myocardial infarction and heart failure is observed with all NSAIDs, while an elevated risk of hemorrhagic stroke appears to be restricted to the use of diclofenac and meloxicam. All NSAIDs have the potential to induce acute kidney injury, and patients with osteoarthritis with co-morbid conditions including hypertension, heart failure, and diabetes mellitus are at increased risk. Osteoarthritis is associated with excess mortality, which may be explained by reduced levels of physical activity owing to lower limb pain, presence of comorbid conditions, and the adverse effects of anti-osteoarthritis medications especially NSAIDs. This narrative review of recent literature identifies data on the safety of non-selective NSAIDs to better understand the risk:benefit of using NSAIDs to manage pain in osteoarthritis.

Role of Ajwa dates in ameliorating diclofenac sodium-induced nephrotoxicity and cardiovascular risk factors in mice

“…Many reports recorded hepatotoxic and nephrotoxic effects as well as gastric ulceration and cardiovascular effects after DFS administration which can be attributed to the oxidative stress induced by DFS and its metabolites on the different tissues. 3 The oxidative stress-induced nephrotoxic effects of DFS impair glomerular filtration, resulting in abnormal renal parameters. 8 In this study, administration of DFS to adult male mice induced an increase in serum urea and creatinine levels, hyperglycemia, and alteration of the lipid profile compared to healthy control animals.…”

The aryl hydrocarbon receptor (AhR) as a breast cancer drug target

“…Nevertheless, 38 has potential to be investigated further for oncogenic studies via the AhR pathway. NSAIDs are widely used and available, but have been associated with upper GI complications . As these side effects are considered acceptable for the minor to moderate pain management these drugs are commonly used for, these side effects for an anticancer drug could be considered trivial.…”

Management of Osteoarthritis During the COVID‐19 Pandemic

“…International and national guidelines recommend NSAIDs for the treatment of severe pain and musculoskeletal pain in OA patients. 40 NSAIDs are the most commonly prescribed drugs, used by 60% of OA patients taking medication in Europe 41 and more than 50% across the United States. 42 NSAIDs may be divided into nonselective (nsNSAIDs), targeting both cyclooxygenase (COX)-1 and COX-2, and COX-2 selective (sNSAIDs).…”