Letter to the Editor

Treating Osteoarthritis in the Elderly: Should Recent Data on NSAIDs Change Our Way of Practice?

Authors: Harinder Singh, MD


To the Editor:

Osteoarthritis (OA) is one of the leading causes of chronic disability in the elderly, predominantly because of involvement of the knee and hip joints. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used to reduce pain and inflammation and improve function in OA patients. We have been aware of side effects of NSAIDs including renal and gastrointestinal toxicity for years. Recently, a few studies1–3have suggested that besides COX-2 inhibitors, some nonselective NSAIDs could also raise the relative risk of cardiovascular adverse events, such as acute myocardial infarction (MI). This warrants that we take a fresh look at NSAID use and their safety in the elderly.

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1. Singh G, Wu O, Langhorne P, et al. Risk of acute myocardial infarction with non-selective non-steroidal anti-inflammatory drugs: a meta-analysis. Arthritis Res Ther 2006;8:R153.
2. Hippisley-Cox J, Coupland C. Risk of myocardial infarction in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ 2005;330:1366.
3. Gislason GH, Jacobsen S, Rasmussen JN, et al. Risk of death or reinfarction associated with the use of selective cyclooxygenase inhibitors and nonselective nonsteroidal anti-inflammatory drugs after acute myocardial infarction. Circulation 2006;113:2906–2913.