Appropriate Use of Non-steroidal Anti-inflammatory Drugs in Rheumatology: Guidelines From the Spanish Society of Rheumatology and the Mexican College of Rheumatology
Uso apropiado de los antiinflamatorios no esteroideos en reumatología: documento de consenso de la Sociedad Española de Reumatología y el Colegio Mexicano de Reumatología
Gerardo Bori Seguraa, Blanca Hernández Cruzb, Milena Gobboc,
, Ángel Lanas Arbeload, Mario Salazar Páramoe, Leobardo Terán Estradaf, José Federico Díaz Gonzálezg, Rolando Espinosa Moralesh, Federico Galván Villegasi, Luis Alberto García Rodríguezj, José María Álvaro-Gracia Álvarok, Hilario Ávila Armengoll, Loreto Carmonac, Javier Rivera Redondom, Lucio Ventura Ríosn
Corresponding author
a Servicio de Reumatología, Hospital General de Zona 32 (Villa Coapa), Instituto Mexicano del Seguro Social, México DF, Mexico
b Servicio de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
c Unidad de Investigación, Fundación Española de Reumatología, Madrid, Spain
d Servicio de Digestivo, Hospital Clínico Universitario, Universidad de Zaragoza, IACS, CIBERehd, Zaragoza, Spain
e División de Investigación, Hospital de Especialidades CMNO, IMSS y CUCS, Universidad de Guadalajara, Guadalajara, Mexico
f Departamento de Medicina Interna, HGR n.° 1. IMSS, Morelia, Michoacán, Mexico
g Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
h Servicio de Reumatología, Instituto Nacional de Rehabilitación, México DF, Mexico
i Colegio Mexicano de Reumatología, México DF, Mexico
j Centro Español de Investigación Farmacoepidemiológica (CEIFE), Madrid, Spain
k Servicio de Reumatología, Hospital de La Princesa, Madrid, Spain
l Departamento de Medicina Interna, Hospital Civil de Guadalajara, Guadalajara, Mexico
m Servicio de Reumatología, Instituto Provincial de Rehabilitación, Madrid, Spain
n Servicio de Reumatología, Hospital Central Sur de Alta Especialidad, PEMEX, México DF, Mexico
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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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Elaborar recomendaciones para el uso apropiado de AINE en reumatología.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Fosbol EL, Gislason GH, Jacobsen S, Abildstrom SZ, Hansen ML, Schramm TK, et al. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 9 | 14 |
| 2024 October | 36 | 66 | 102 |
| 2024 September | 32 | 56 | 88 |
| 2024 August | 48 | 65 | 113 |
| 2024 July | 40 | 48 | 88 |
| 2024 June | 47 | 67 | 114 |
| 2024 May | 57 | 56 | 113 |
| 2024 April | 52 | 50 | 102 |
| 2024 March | 44 | 50 | 94 |
| 2024 February | 35 | 54 | 89 |
| 2024 January | 26 | 44 | 70 |
| 2023 December | 35 | 47 | 82 |
| 2023 November | 26 | 56 | 82 |
| 2023 October | 52 | 79 | 131 |
| 2023 September | 44 | 56 | 100 |
| 2023 August | 32 | 13 | 45 |
| 2023 July | 21 | 46 | 67 |
| 2023 June | 25 | 28 | 53 |
| 2023 May | 26 | 18 | 44 |
| 2023 April | 21 | 17 | 38 |
| 2023 March | 44 | 28 | 72 |
| 2023 February | 27 | 28 | 55 |
| 2023 January | 19 | 45 | 64 |
| 2022 December | 36 | 37 | 73 |
| 2022 November | 33 | 35 | 68 |
| 2022 October | 51 | 45 | 96 |
| 2022 September | 30 | 51 | 81 |
| 2022 August | 28 | 54 | 82 |
| 2022 July | 27 | 63 | 90 |
| 2022 June | 23 | 42 | 65 |
| 2022 May | 21 | 41 | 62 |
| 2022 April | 33 | 67 | 100 |
| 2022 March | 43 | 74 | 117 |
| 2022 February | 33 | 46 | 79 |
| 2022 January | 23 | 55 | 78 |
| 2021 December | 25 | 28 | 53 |
| 2021 November | 28 | 34 | 62 |
| 2021 October | 51 | 59 | 110 |
| 2021 September | 42 | 55 | 97 |
| 2021 August | 41 | 62 | 103 |
| 2021 July | 33 | 43 | 76 |
| 2021 June | 38 | 62 | 100 |
| 2021 May | 41 | 42 | 83 |
| 2021 April | 76 | 105 | 181 |
| 2021 March | 66 | 42 | 108 |
| 2021 February | 52 | 31 | 83 |
| 2021 January | 55 | 27 | 82 |
| 2020 December | 61 | 60 | 121 |
| 2020 November | 35 | 28 | 63 |
| 2020 October | 35 | 15 | 50 |
| 2020 September | 31 | 35 | 66 |
| 2020 August | 24 | 32 | 56 |
| 2020 July | 33 | 18 | 51 |
| 2020 June | 37 | 20 | 57 |
| 2020 May | 50 | 19 | 69 |
| 2020 April | 46 | 22 | 68 |
| 2020 March | 15 | 13 | 28 |
| 2020 February | 5 | 0 | 5 |
| 2019 August | 1 | 0 | 1 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
| 2018 May | 7 | 1 | 8 |
| 2018 April | 43 | 7 | 50 |
| 2018 March | 39 | 13 | 52 |
| 2018 February | 20 | 4 | 24 |
| 2018 January | 15 | 6 | 21 |
| 2017 December | 20 | 13 | 33 |
| 2017 November | 19 | 5 | 24 |
| 2017 October | 13 | 8 | 21 |
| 2017 September | 14 | 5 | 19 |
| 2017 August | 12 | 12 | 24 |
| 2017 July | 9 | 8 | 17 |
| 2017 June | 27 | 16 | 43 |
| 2017 May | 27 | 10 | 37 |
| 2017 April | 26 | 4 | 30 |
| 2017 March | 29 | 15 | 44 |
| 2017 February | 10 | 6 | 16 |
| 2017 January | 18 | 7 | 25 |
| 2016 December | 65 | 10 | 75 |
| 2016 November | 30 | 8 | 38 |
| 2016 October | 66 | 6 | 72 |
| 2016 September | 48 | 15 | 63 |
| 2016 August | 33 | 5 | 38 |
| 2016 July | 12 | 0 | 12 |
| 2016 April | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 1 | 0 | 1 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 16 | 3 | 19 |
| 2015 June | 11 | 17 | 28 |
| 2015 May | 31 | 25 | 56 |
| 2015 April | 18 | 23 | 41 |
| 2015 March | 21 | 17 | 38 |
| 2015 February | 16 | 15 | 31 |
| 2015 January | 11 | 19 | 30 |
| 2014 December | 20 | 23 | 43 |
| 2014 November | 15 | 28 | 43 |
| 2014 October | 11 | 23 | 34 |
| 2014 September | 18 | 15 | 33 |
| 2014 August | 18 | 24 | 42 |
| 2014 July | 19 | 14 | 33 |
| 2014 June | 27 | 13 | 40 |
| 2014 May | 28 | 24 | 52 |
| 2014 April | 23 | 28 | 51 |
| 2014 March | 25 | 29 | 54 |
| 2014 February | 23 | 29 | 52 |
| 2014 January | 22 | 42 | 64 |
| 2013 December | 25 | 17 | 42 |
| 2013 November | 16 | 27 | 43 |
| 2013 October | 26 | 36 | 62 |
| 2013 September | 30 | 26 | 56 |
| 2013 August | 16 | 18 | 34 |
| 2013 July | 28 | 21 | 49 |
| 2013 June | 21 | 23 | 44 |
| 2013 May | 20 | 22 | 42 |
| 2013 April | 23 | 20 | 43 |
| 2013 March | 16 | 18 | 34 |
| 2013 February | 19 | 13 | 32 |
| 2013 January | 20 | 24 | 44 |
| 2012 December | 20 | 25 | 45 |
| 2012 November | 14 | 31 | 45 |
| 2012 October | 5 | 18 | 23 |
| 2012 September | 5 | 4 | 9 |
| 2012 July | 3 | 0 | 3 |
| 2012 June | 8 | 0 | 8 |
| 2012 May | 8 | 0 | 8 |
| 2012 April | 12 | 0 | 12 |
| 2012 March | 12 | 0 | 12 |
| 2012 February | 3 | 0 | 3 |
| 2012 January | 7 | 0 | 7 |
| 2011 December | 5 | 0 | 5 |
| 2011 November | 7 | 0 | 7 |
| 2011 October | 5 | 0 | 5 |
| 2011 September | 3 | 0 | 3 |
| 2011 August | 1 | 0 | 1 |
| 2011 July | 3 | 0 | 3 |
| 2011 June | 7 | 0 | 7 |
| 2011 May | 2 | 0 | 2 |
| 2011 April | 5 | 0 | 5 |
| 2011 March | 5 | 0 | 5 |
| 2011 February | 13 | 0 | 13 |
| 2011 January | 13 | 0 | 13 |
| 2010 December | 13 | 0 | 13 |
| 2010 November | 7 | 0 | 7 |
| 2010 October | 14 | 0 | 14 |
| 2010 September | 10 | 0 | 10 |
| 2010 August | 9 | 0 | 9 |
| 2010 July | 10 | 0 | 10 |
| 2010 June | 7 | 0 | 7 |
| 2010 May | 6 | 0 | 6 |
| 2010 April | 21 | 0 | 21 |
| 2010 March | 14 | 0 | 14 |
| 2010 February | 7 | 0 | 7 |
| 2010 January | 12 | 0 | 12 |
| 2009 December | 14 | 0 | 14 |
| 2009 November | 15 | 0 | 15 |
| 2009 October | 18 | 0 | 18 |
| 2009 September | 8 | 0 | 8 |
| 2009 August | 16 | 0 | 16 |
| 2009 July | 10 | 0 | 10 |
| 2009 June | 55 | 0 | 55 |
| 2009 May | 8 | 0 | 8 |
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