Authors
Cyrus Cooper, Roland Chapurlat, Nasser Al-Daghri, Gabriel Herrero-Beaumont, Olivier Bruyère, François Rannou, Roland Roth, Daniel Uebelhart, Jean-Yves Reginster
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.
비스테로이드성 소염진통제는 퇴행성 관절염 환자의 통증 조절에 널리 사용되고 있는 약제이다. 퇴행성 골관절염 통증에 중간 정도의 효과가 있는 것으로 알려져 있어 사용되고 있지만 NSAIDs는 위장관계, 심혈관계 및 신장계에 영향을 미치는 광범위한 부작용을 고려하여 사용하여야 한다. 이번 리뷰 논문은 NSAIDs의 안정성에 대한 여러 논문을 종합해 퇴행성 관절염 환자에서 NASIDs 이익과 위험을 고려해 적절하게 처방할 수 있게 하기 위해 정리했다. 어떤 약제를 처방할지는 퇴행성 관절염 환자 개개인 특성을 고려해 처방해야 하며 부작용을 최소화하면서 퇴행성 관절염 통증을 관리하여야 한다.
Key Points
Although effective against inflammatory-mediated pain, non-steroidal anti-inflammatory drugs are associated with multiple class-specific toxicities affecting the gastrointestinal, cardiovascular, and renal systems. Some adverse effects are related to the class mechanism of action, while others appear to be pharmacotherapy specific.
The choice of any agent should be considered on an individual patient basis in osteoarthritis to provide adequate symptom relief while minimizing unwanted side effects.
출처: 대한내과학회
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