Appropriate Use of Non-steroidal Anti-inflammatory Drugs in Rheumatology: Guidelines From the Spanish Society of Rheumatology and the Mexican College of Rheumatology

Bori Segura, Gerardo; Hernández Cruz, Blanca; Gobbo, Milena; Lanas Arbeloa, Ángel; Salazar Páramo, Mario; Terán Estrada, Leobardo; Díaz González, José Federico; Espinosa Morales, Rolando; Galván Villegas, Federico; García Rodríguez, Luis Alberto; Álvaro-Gracia Álvaro, José María; Ávila Armengol, Hilario; Carmona, Loreto; Rivera Redondo, Javier; Ventura Ríos, Lucio

doi:10.1016/S2173-5743(09)70080-2

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Abstract

Objective

To develop guidelines for the appropriate use of NSAIDs in rheumatology.

Methods

We used a methodology modified from the one developed by RAND/UCLA. Two groups of panellists were selected, one by the CMR and another by the SER. Recommendations were proposed from nominal groups and the agreement to them was tested among rheumatologists from both societies by a 2-round Delphi survey. The analysis of the second Delphi round supported the generation of the final set of recommendations and the assignment of a level of agreement to each of them. Systematic reviews of 5 recommendations in which the agreement was low or was divided were also carried out.

Results

Here we present recommendations for the safe use of NSAIDs in rheumatic diseases, based on the best available evidence, expert opinion, the agreement among rheumatologists, and literature review. The trend is to reduce the frequency, duration, and dose of NSAIDs in favour of non-pharmacological measures, analgesic drugs, or disease modifying drugs. In addition, the recommendations help to identify profiles for increased toxicity, with an emphasis on gastrointestinal and cardiovascular risks. The recommendations deal with the course of action and monitoring in different risk groups and in patients using antiplatelet or anticoagulant drugs. The overall level of agreement is high.

Conclusions

The NSAIDs are safe and effective drugs for the treatment of rheumatic diseases. However, it is necessary to individualize its use according to their risk profile.

Keywords:

Anti-inflammatory agents

Guideline

Delphi technique

Review

Resumen

Objetivos

Elaborar recomendaciones para el uso apropiado de AINE en reumatología.

Métodos

Se utilizó una metodología modificada de RAND/UCLA. Se seleccionaron dos grupos de panelistas, uno por el CMR y otro por la SER. A partir de grupos nominales, se obtuvieron propuestas de recomendaciones, que fueron sometidas a la prueba de acuerdo entre los reumatólogos de ambas sociedades mediante encuesta Delphi a dos rondas. Del análisis de la segunda ronda Delphi, se extrajeron las recomendaciones finales y posteriormente se revisó el nivel de evidencia y el grado de acuerdo de la recomendación según el Centro de Medicina Basada en la Evidencia de Oxford. Finalmente, se efectuó revisión sistemática de cinco recomendaciones sin acuerdo.

Resultados

Se presentan recomendaciones sobre el uso seguro de los AINE en las enfermedades reumáticas, con base en la mejor evidencia disponible, la opinión de expertos, el acuerdo entre reumatólogos y la revisión de la literatura. La tendencia es disminuir la frecuencia, la duración y la dosis de AINE en favor de medidas no farmacológicas, analgésicos o fármacos modificadores de los síntomas o del curso de la enfermedad. Además, es obligado identificar perfiles de mayor riesgo de toxicidad, en especial gastrointestinal y cardiovascular. Se recomiendan pautas de actuación y monitorización en los diferentes grupos de riesgo y en pacientes con empleo de antiagregantes plaquetarios, anticoagulación o con terapias concomitantes. El porcentaje de acuerdo es elevado en la mayoría de los casos.

Conclusiones

Los AINE son medicamentos seguros y eficaces en el tratamiento de las afecciones reumáticas. No obstante, dado su perfil de riesgo, es necesario individualizar su uso.

Palabras clave:

Antiinflamatorios

Recomendaciones

Técnica Delphi

Revisión

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