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Cost-Conscious Prescribing of Nonsteroidal Anti-inflammatory Drugs for Adults With Arthritis: A Review and Suggestions

Cost-Conscious Prescribing of Nonsteroidal Anti-inflammatory Drugs for Adults With Arthritis: A... Abstract Salicylates and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of painful disorders. This article reviews the efficacy, side effects, and costs of these agents and proposes a practical approach to using them in a cost-effective manner. Although there may be some differences in efficacy among available drugs, these do not appear sufficient to justify using the more expensive agents in most cases. Adverse effects, especially gastrointestinal (GI), add to the cost of using these drugs. Aspirin and all nonsalicylate NSAIDs share a risk of causing gastric ulcer, upper GI bleeding, and GI perforation. Prostaglandin inhibition by these agents may lead to reduced glomerular filtration rate and renal failure. There may be modest differences in GI and renal risks with the different agents, but these are minimal. Prophylaxis against gastric ulceration with anti-ulcer drugs has been recommended, and one agent, misoprostol, is approved for use in the United States for this purpose. Whether use of prophylaxis will increase or decrease the costs associated with NSAID therapy remains to be determined. Nonacetylated salicylates may cause less GI adverse effects and may be somewhat "renal sparing." Strategies that would reduce the cost of care for painful musculoskeletal disorders without compromising quality of care include using acetaminophen instead of an NSAID for noninflammatory disorders, trying nonacetylated salicylates as less expensive and safer alternatives to NSAIDs, using one agent at a time, allowing sufficient time to evaluate the therapeutic effect before changing agents, returning to the least expensive and/or safest drug if a trial of several in succession fails to find one that is clearly better, and reserving prophylactic use of antiulcer agents for patients who are at especially high risk and for whom anti-inflammatory effects are clearly needed. (Arch Intern Med. 1992;152:1995-2002) References 1. McDuffie FC. The morbidity impact of rheumatoid arthritis on society . Am J Med. 1985;78:1-5.Crossref 2. Committee on Safety of Medicines. Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions, I . BMJ. 1986;292:614.Crossref 3. Roth SH. Non-steroidal anti-inflammatory drugs: gastropathy, deaths, and medical practice . Ann Intern Med. 1988;109:353-354.Crossref 4. Walt R, Katschinski B, Logan R, Ashley J, Langman M. Rising frequency of ulcer perforation in elderly people in the United Kingdom . Lancet. 1986;1:489-492.Crossref 5. Armstrong CP, Blower AL. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration . Gut. 1987;28:527-532.Crossref 6. Bloom BS. Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis . Am J Med. 1988;84( (suppl 2A) ):20-24.Crossref 7. Bartle WR, Gupta AK, Lazor J. Nonsteroidal anti-inflammatory drugs and gastrointestinal bleeding: a case-control study . Arch Intern Med. 1986;146:2365-2367.Crossref 8. Carson JL, Strom BL, Morse ML, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med. 1987;147:1054-1059.Crossref 9. Clinch D, Banerjee AK, Levy DW, Ostick G, Faragher EB. Non-steroidal anti-inflammatory drugs and peptic ulceration . J R Coll Physicians. 1987;21:183-187. 10. Collier DS, Pain JA: Non-steroidal anti-inflammatory drugs and peptic ulcer perforation . Gut. 1985;26:359-363.Crossref 11. Duggan JM, Dobson AJ, Johnson H, Fahey P. Peptic ulcer and non-steroidal anti-inflammatory agents . Gut. 1986;27:929-933.Crossref 12. Griffin MR, Ray WA, Schaffner W. Nonsteroidal anti-inflammatory drug use and death from peptic ulcer in elderly persons . Ann Intern Med. 1988;109:359-363.Crossref 13. Guess HA, West R, Strand LM, et al. Fatal upper gastrointestinal hemorrhage or perforation among users and nonusers of nonsteroidal anti-inflammatory drugs in Saskatchewan, Canada 1983 . J Clin Epidemiol . 1988;41:35-45.Crossref 14. Jick SS. Non-steroidal anti-inflammatory drugs and hospital admission for perforated peptic ulcer . Lancet. 1987;2:380-382.Crossref 15. Langman MJ. Ulcer complications and nonsteroidal anti-inflammatory drugs . Am J Med. 1988;84( (suppl 2A) ):15-19.Crossref 16. Levy M, Miller DR, Kaufman DW, et al. Major upper gastrointestinal tract bleeding: relation to use of aspirin and other non-narcotic analgesics . Arch Intern Med. 1988;148:281-285.Crossref 17. McIntosh JH, Byth K, Piper DW. Environmental factors in aetiology of chronic gastric ulcer: a case control study of exposure variables before the first symptoms . Gut. 1985;26:789-798.Crossref 18. McIntosh JH, Fung CS, Berry G, Piper DW. Smoking, nonsteroidal anti-inflammatory drugs, and acetaminophen in gastric ulcer: a study of associations and of the effects of previous diagnosis on exposure patterns . Am J Epidemiol. 1988;128:761-770. 19. Silverstein FE, Feld AD, Gilbert DA. Upper gastro-intestinal tract bleeding: predisposing factors, diagnosis, and therapy . Arch Intern Med. 1981;141:322-327.Crossref 20. Kurata JH, Abbey DE. The effect of chronic aspirin use on duodenal and gastric ulcer hospitalizations . J Clin Gastroenterol. 1990;12:260-266.Crossref 21. Somerville K, Faulkner G, Langman M. Non-steroidal anti-inflammatory drugs and bleeding gastric ulcer . Lancet. 1986;1:462-464.Crossref 22. Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons . Ann Intern Med. 1991;114:257-263.Crossref 23. Roth SH. NSAID and gastropathy: a rheumatologist's review . J Rheumatol. 1988;15:912-919. 24. Day RO, Graham GG, Williams KM, Champion GD, De Jager J. Clinical pharmacology of non-steroidal anti-inflammatory drugs . Pharmacol Ther. 1987;33:383-433.Crossref 25. Levy RA, Smith DL. Clinical differences among non-steroidal anti-inflammatory drugs: implications for therapeutic substitution in ambulatory patients . DICP. 1989;23:76-85. 26. Pirson Y, van Ypersele de Strihou C. Renal side effects of nonsteroidal antiinflammatory drugs: clinical relevance . Am J Kidney Dis. 1986;8:338-344.Crossref 27. O'Brien WM, Bagby GF. Rare adverse reactions to nonsteroidal anti-inflammatory drugs . J Rheumatol. 1985;12:785-790. 28. Semble EL, Wu WC. Antiinflammatory drugs and gastric mucosal damage . Semin Arthritis Rheum. 1987;16:271-286.Crossref 29. Simon LS, Mills JA. Nonsteroidal antiinflammatory drugs, I . N Engl J Med. 1980;302:1179-1185.Crossref 30. Simon LS, Mills JA. Nonsteroidal antiinflammatory drugs, II . N Engl J Med. 1980;302:1237-1242.Crossref 31. Soll AH, Weinstein WM, Kurata J, McCarthy D. Nonsteroidal anti-inflammatory drugs and peptic ulcer disease . Ann Intern Med. 1991;114:307-319.Crossref 32. Polisson RP. Selecting a NSAID for elderly patients . Hosp Ther. 1987;12:17-32. 33. Cardinale VA, ed. Drug Topics Red Book . Oradell, NJ: Medical Economics; 1990. 34. Clegg DO, Ward JR. Rheumatoid arthritis: using other NSAIDS when apirin fails . J Musculoskel Med. 1987;4:17-24. 35. Ward JR. Nonsteroidal (nonsalicylate) anti-inflammatory drugs . In: Roth SH, ed. Rheumatic Therapeutics . New York, NY: McGraw Hill International Book Co; 1985:383-396. 36. Liang MH, Fortin P. Management of osteoarthritis of the hip and knee . N Engl J Med. 1991;325:125-127.Crossref 37. Fisher NM, Prendergast DR, Gresham GE, Calkins E. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis . Arch Phys Med Rehabil. 1991;72:367-374. 38. Bradley JD, Brandt KD, Katz BP, Kalisinski LA, Ryan SI. Comparison of an antiinflammatory dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee . N Engl J Med. 1991;325:87-91.Crossref 39. Brooks PM, Walker JJ, Bell MA, Buchanan WW, Rhymer AR. Indomethacin-aspirin interactions: a clinical appraisal . BMJ. 1975;3:69-71.Crossref 40. Miller DR. Combination use of nonsteroidal antiinflammatory drugs . Drug Intell Clin Pharm. 1981;15:3-7. 41. Caruso I, Porro GB. Gastroscopic evaluation of antiinflammatory agents . BMJ. 1980;280:75-78.Crossref 42. Lanza FL, Rack MF, Wagner GS, Balm TK. Reduction in gastric mucosal hemorrhage and ulceration with chronic high-level dosing of entericcoated aspirin granules two and four times a day . Dig Dis Sci. 1985;30:509-512.Crossref 43. Lanza FL, Royer GI, Nelson RS. Endoscopic evaluation of effects of aspirin, buffered aspirin, and enteric-coated aspirin on gastric and duodenal mucosa . N Engl J Med. 1980;303:136-138.Crossref 44. Silvoso GR, Ivey KJ, Butt JH, et al. Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy . Ann Intern Med. 1979;91:517-520.Crossref 45. Carson JL, Strom BL, Morse ML, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med. 1987;147:1054-1059.Crossref 46. Hoftiezer JW, Silvoso GR, Burks M, Ivey KJ. Comparison of the effects of regular and enteric coated aspirin on gastroduodenal mucosa of man . Lancet. 1980;2:602-612. 47. Jaszewski R, Calzada R, Dhar R. Persistence of gastric ulcers caused by plain aspirin or nonsteroidal antiinflammatory agents in patients treated with a combination of cimetidine, antacids, and enteric coated aspirin . Dig Dis Sci. 1989;34:1361-1364.Crossref 48. Lanza FL, Karlin DA, Yee JP. A double-blind placebo controlled endoscopic study comparing the mucosal injury seen with orally and parenterally administerd nonsteroidal analgesic ketorolac tromethamine at therapeutic and subtherapeutic doses . Am J Gastroenterol. 1987;82:939. Abstract. 49. Estes D, Kaplan K. Lack of platelet effect with the aspirin analog, salsalate . Arthritis Rheum. 1980;23:1303-746.Crossref 50. Hawkey CJ. Non-steroidal anti-inflammatory drugs and peptic ulcers: facts and figures multiply, but do they add up? BMJ. 1990;300:278-284.Crossref 51. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal antiinflammatory drugs: a meta-analysis . Ann Intern Med. 1991;115:787-796.Crossref 52. Fries JF. NSAID gastropathy: the second most deadly rheumatic disease. Epidemiology and risk appraisal . J Rheumatol. 1991;18( (suppl 28) ): 6-10. 53. Rossi AC, Hsu JP, Faich GA. Ulcerogenicity of piroxicam: an analysis of spontaneously reported data . BMJ. 1987;294:147-5047.Crossref 54. Bunning RD, Barth WF. Sulindac: a potentially renal-sparing non-steroidal anti-inflammatory drug . JAMA. 1982;248:2864-2867.Crossref 55. Ciabattoni G, Cinotti GA, Pierucci A, et al. Effects of sulindac and ibuprofen in patients with chronic glomerular disease . N Engl J Med. 1984;310:279-283.Crossref 56. Svendsen UG, Gerstoft J, Hansen TM, Christensen P, Lorenzen I. The renal excretion of prostaglandins and changes in plasma renin during therapy with either sulindac or naproxen in patients with rheumatoid arthritis and thiazide treated heart failure . J Rheumatol. 1984;11:779-782. 57. Berg KJ, Talseth T. Acute renal effects of sulindac and ibuprofen in chronic renal failure . Clin Pharmacol Ther. 1985;37:447-452.Crossref 58. Brater DC, Anderson SA, Brown-Cartwright D, Toto RD. Effects of nonsteroidal anti-inflammatory drugs on renal function in patients with renal insufficiency and in cirrhotics . Am J Kidney Dis. 1986;8:351-355.Crossref 59. Kamper AL, Strandgaard S, Christensen P, Svendson UG. Effects of sulindac and naproxen in patients with chronic glomerular disease . Scand J Rheumatol. 1986;62( (suppl) ):26-31.Crossref 60. Ryan JR, McMahon F, Vargas R, et al. Effects of salsalate, aspirin, and naproxen on plasma renin activity and platelet thromboxane (TxB2) synthesis . Arthritis Rheum. 1986;29( (suppl) ):S103. Abstract. 61. Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal anti-inflammatory drugs . N Engl J Med. 1984;310:563-572.Crossref 62. Abraham PA, Stillman MT. Salsalate exacerbation of chronic renal insufficiency: relation to inhibition of prostaglandin synthesis . Arch Intern Med. 1987;147:1674-1676.Crossref 63. Stillman MT, Schlesinger PA. Nonsteroidal anti-inflammatory drug nephrotoxicity: should we be concerned? Arch Intern Med. 1990;150:268-270.Crossref 64. Johansson C. Ulcerogenic drugs and antiulcer compounds: effects on gastroduodenal mucosa . Scand J Gastroenterol. 1987;22( (suppl 128) ):24-32.Crossref 65. Fries JF, Miller SR, Spitz PW, Williams CA, Hubert HB, Bloch DA. Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use . Gastroenterology. 1989;96:647-655. 66. Fries JF, Williams CA, Bloch DA, Michel BA. Nonsteroidal anti-inflammatory drug-associated gastropathy: incidence and risk factor models . Am J Med. 1991;91:213-222.Crossref 67. Roth SH, Bennett RE, Mitchell CS, Hartman RJ. Cimetidine therapy in nonsteroidal anti-inflammatory drug gastropathy: double-blind long-term evaluation . Arch Intern Med. 1987;147:1798-801.Crossref 68. Ehsanullah RS, Page MC, Tildsley G, Wood JR. Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine . BMJ. 1988;297:1017-1021.Crossref 69. Bigard MA, Isal JP. Complete prevention by omeprazole of aspirin induced gastric lesions in healthy subjects . Gut. 1988;29:A712. Abstract. 70. Caldwell JR, Roth SH, Wu WC, et al. Sucralfate in treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal symptoms and mucosal damage . Am J Med. 1987;83( (suppl 3B) ):74-82.Crossref 71. Agrawal NM, Roth S, Graham DY, et al. Misoprostol compared with sucralfate in the prevention of non-steroidal anti-inflammatory drug-induced gastric ulcer . Ann Intern Med. 1991;115:195-200.Crossref 72. Abramowicz M. Misoprostol . Med Lett. 1989;31:21-22. 73. Graham DY, Agrawal NM, Roth SH. Prevention of NSAID-induced gastric ulcer with misoprostol: multicentre, double-blind placebo-controlled trial . Lancet. 1988;2:1277-1280.Crossref 74. Hillman AL, Bloom BS. Economic effects of prophylactic use of misoprostol to prevent gastric ulcer in patients taking nonsteroidal anti-inflammatory drugs . Arch Intern Med. 1989;149:2061-2065.Crossref 75. Edelson JT, Tosteson ANA, Sax P. Cost effectiveness of misoprostol for prophylaxis against nonsteroidal anti-inflammatory drug-induced gastrointestinal tract bleeding . JAMA. 1990;264:41-47.Crossref 76. Graham DY, Smith JL, Dobbs SM. Gastric adaptation occurs with aspirin administration in man . Dig Dis Sci. 1988;28:1-6.Crossref 77. Agrawal NM, Saggioro A. Treatment and prevention of NSAID induced gastroduodenal damage . J Rheumatol. 1991;18( (suppl 28) ):15-18. 78. Graham DY, Stromatt SC, Jaszewski R, White RH, Triadafilopoulos G. Prevention of duodenal ulcer in arthritics who are chronic NSAID users: a multicenter trial of the role of misoprostol . Gastroenterology. 1991;100:A75. Abstract. 79. Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs . Ann Intern Med. 1991;114:735-740.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Cost-Conscious Prescribing of Nonsteroidal Anti-inflammatory Drugs for Adults With Arthritis: A Review and Suggestions

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1992.00400220033006
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Abstract

Abstract Salicylates and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of painful disorders. This article reviews the efficacy, side effects, and costs of these agents and proposes a practical approach to using them in a cost-effective manner. Although there may be some differences in efficacy among available drugs, these do not appear sufficient to justify using the more expensive agents in most cases. Adverse effects, especially gastrointestinal (GI), add to the cost of using these drugs. Aspirin and all nonsalicylate NSAIDs share a risk of causing gastric ulcer, upper GI bleeding, and GI perforation. Prostaglandin inhibition by these agents may lead to reduced glomerular filtration rate and renal failure. There may be modest differences in GI and renal risks with the different agents, but these are minimal. Prophylaxis against gastric ulceration with anti-ulcer drugs has been recommended, and one agent, misoprostol, is approved for use in the United States for this purpose. Whether use of prophylaxis will increase or decrease the costs associated with NSAID therapy remains to be determined. Nonacetylated salicylates may cause less GI adverse effects and may be somewhat "renal sparing." Strategies that would reduce the cost of care for painful musculoskeletal disorders without compromising quality of care include using acetaminophen instead of an NSAID for noninflammatory disorders, trying nonacetylated salicylates as less expensive and safer alternatives to NSAIDs, using one agent at a time, allowing sufficient time to evaluate the therapeutic effect before changing agents, returning to the least expensive and/or safest drug if a trial of several in succession fails to find one that is clearly better, and reserving prophylactic use of antiulcer agents for patients who are at especially high risk and for whom anti-inflammatory effects are clearly needed. (Arch Intern Med. 1992;152:1995-2002) References 1. McDuffie FC. The morbidity impact of rheumatoid arthritis on society . Am J Med. 1985;78:1-5.Crossref 2. Committee on Safety of Medicines. Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions, I . BMJ. 1986;292:614.Crossref 3. Roth SH. Non-steroidal anti-inflammatory drugs: gastropathy, deaths, and medical practice . Ann Intern Med. 1988;109:353-354.Crossref 4. Walt R, Katschinski B, Logan R, Ashley J, Langman M. Rising frequency of ulcer perforation in elderly people in the United Kingdom . Lancet. 1986;1:489-492.Crossref 5. Armstrong CP, Blower AL. Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration . Gut. 1987;28:527-532.Crossref 6. Bloom BS. Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis . Am J Med. 1988;84( (suppl 2A) ):20-24.Crossref 7. Bartle WR, Gupta AK, Lazor J. Nonsteroidal anti-inflammatory drugs and gastrointestinal bleeding: a case-control study . Arch Intern Med. 1986;146:2365-2367.Crossref 8. Carson JL, Strom BL, Morse ML, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med. 1987;147:1054-1059.Crossref 9. Clinch D, Banerjee AK, Levy DW, Ostick G, Faragher EB. Non-steroidal anti-inflammatory drugs and peptic ulceration . J R Coll Physicians. 1987;21:183-187. 10. Collier DS, Pain JA: Non-steroidal anti-inflammatory drugs and peptic ulcer perforation . Gut. 1985;26:359-363.Crossref 11. Duggan JM, Dobson AJ, Johnson H, Fahey P. Peptic ulcer and non-steroidal anti-inflammatory agents . Gut. 1986;27:929-933.Crossref 12. Griffin MR, Ray WA, Schaffner W. Nonsteroidal anti-inflammatory drug use and death from peptic ulcer in elderly persons . Ann Intern Med. 1988;109:359-363.Crossref 13. Guess HA, West R, Strand LM, et al. Fatal upper gastrointestinal hemorrhage or perforation among users and nonusers of nonsteroidal anti-inflammatory drugs in Saskatchewan, Canada 1983 . J Clin Epidemiol . 1988;41:35-45.Crossref 14. Jick SS. Non-steroidal anti-inflammatory drugs and hospital admission for perforated peptic ulcer . Lancet. 1987;2:380-382.Crossref 15. Langman MJ. Ulcer complications and nonsteroidal anti-inflammatory drugs . Am J Med. 1988;84( (suppl 2A) ):15-19.Crossref 16. Levy M, Miller DR, Kaufman DW, et al. Major upper gastrointestinal tract bleeding: relation to use of aspirin and other non-narcotic analgesics . Arch Intern Med. 1988;148:281-285.Crossref 17. McIntosh JH, Byth K, Piper DW. Environmental factors in aetiology of chronic gastric ulcer: a case control study of exposure variables before the first symptoms . Gut. 1985;26:789-798.Crossref 18. McIntosh JH, Fung CS, Berry G, Piper DW. Smoking, nonsteroidal anti-inflammatory drugs, and acetaminophen in gastric ulcer: a study of associations and of the effects of previous diagnosis on exposure patterns . Am J Epidemiol. 1988;128:761-770. 19. Silverstein FE, Feld AD, Gilbert DA. Upper gastro-intestinal tract bleeding: predisposing factors, diagnosis, and therapy . Arch Intern Med. 1981;141:322-327.Crossref 20. Kurata JH, Abbey DE. The effect of chronic aspirin use on duodenal and gastric ulcer hospitalizations . J Clin Gastroenterol. 1990;12:260-266.Crossref 21. Somerville K, Faulkner G, Langman M. Non-steroidal anti-inflammatory drugs and bleeding gastric ulcer . Lancet. 1986;1:462-464.Crossref 22. Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons . Ann Intern Med. 1991;114:257-263.Crossref 23. Roth SH. NSAID and gastropathy: a rheumatologist's review . J Rheumatol. 1988;15:912-919. 24. Day RO, Graham GG, Williams KM, Champion GD, De Jager J. Clinical pharmacology of non-steroidal anti-inflammatory drugs . Pharmacol Ther. 1987;33:383-433.Crossref 25. Levy RA, Smith DL. Clinical differences among non-steroidal anti-inflammatory drugs: implications for therapeutic substitution in ambulatory patients . DICP. 1989;23:76-85. 26. Pirson Y, van Ypersele de Strihou C. Renal side effects of nonsteroidal antiinflammatory drugs: clinical relevance . Am J Kidney Dis. 1986;8:338-344.Crossref 27. O'Brien WM, Bagby GF. Rare adverse reactions to nonsteroidal anti-inflammatory drugs . J Rheumatol. 1985;12:785-790. 28. Semble EL, Wu WC. Antiinflammatory drugs and gastric mucosal damage . Semin Arthritis Rheum. 1987;16:271-286.Crossref 29. Simon LS, Mills JA. Nonsteroidal antiinflammatory drugs, I . N Engl J Med. 1980;302:1179-1185.Crossref 30. Simon LS, Mills JA. Nonsteroidal antiinflammatory drugs, II . N Engl J Med. 1980;302:1237-1242.Crossref 31. Soll AH, Weinstein WM, Kurata J, McCarthy D. Nonsteroidal anti-inflammatory drugs and peptic ulcer disease . Ann Intern Med. 1991;114:307-319.Crossref 32. Polisson RP. Selecting a NSAID for elderly patients . Hosp Ther. 1987;12:17-32. 33. Cardinale VA, ed. Drug Topics Red Book . Oradell, NJ: Medical Economics; 1990. 34. Clegg DO, Ward JR. Rheumatoid arthritis: using other NSAIDS when apirin fails . J Musculoskel Med. 1987;4:17-24. 35. Ward JR. Nonsteroidal (nonsalicylate) anti-inflammatory drugs . In: Roth SH, ed. Rheumatic Therapeutics . New York, NY: McGraw Hill International Book Co; 1985:383-396. 36. Liang MH, Fortin P. Management of osteoarthritis of the hip and knee . N Engl J Med. 1991;325:125-127.Crossref 37. Fisher NM, Prendergast DR, Gresham GE, Calkins E. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis . Arch Phys Med Rehabil. 1991;72:367-374. 38. Bradley JD, Brandt KD, Katz BP, Kalisinski LA, Ryan SI. Comparison of an antiinflammatory dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee . N Engl J Med. 1991;325:87-91.Crossref 39. Brooks PM, Walker JJ, Bell MA, Buchanan WW, Rhymer AR. Indomethacin-aspirin interactions: a clinical appraisal . BMJ. 1975;3:69-71.Crossref 40. Miller DR. Combination use of nonsteroidal antiinflammatory drugs . Drug Intell Clin Pharm. 1981;15:3-7. 41. Caruso I, Porro GB. Gastroscopic evaluation of antiinflammatory agents . BMJ. 1980;280:75-78.Crossref 42. Lanza FL, Rack MF, Wagner GS, Balm TK. Reduction in gastric mucosal hemorrhage and ulceration with chronic high-level dosing of entericcoated aspirin granules two and four times a day . Dig Dis Sci. 1985;30:509-512.Crossref 43. Lanza FL, Royer GI, Nelson RS. Endoscopic evaluation of effects of aspirin, buffered aspirin, and enteric-coated aspirin on gastric and duodenal mucosa . N Engl J Med. 1980;303:136-138.Crossref 44. Silvoso GR, Ivey KJ, Butt JH, et al. Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy . Ann Intern Med. 1979;91:517-520.Crossref 45. Carson JL, Strom BL, Morse ML, et al. The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs . Arch Intern Med. 1987;147:1054-1059.Crossref 46. Hoftiezer JW, Silvoso GR, Burks M, Ivey KJ. Comparison of the effects of regular and enteric coated aspirin on gastroduodenal mucosa of man . Lancet. 1980;2:602-612. 47. Jaszewski R, Calzada R, Dhar R. Persistence of gastric ulcers caused by plain aspirin or nonsteroidal antiinflammatory agents in patients treated with a combination of cimetidine, antacids, and enteric coated aspirin . Dig Dis Sci. 1989;34:1361-1364.Crossref 48. Lanza FL, Karlin DA, Yee JP. A double-blind placebo controlled endoscopic study comparing the mucosal injury seen with orally and parenterally administerd nonsteroidal analgesic ketorolac tromethamine at therapeutic and subtherapeutic doses . Am J Gastroenterol. 1987;82:939. Abstract. 49. Estes D, Kaplan K. Lack of platelet effect with the aspirin analog, salsalate . Arthritis Rheum. 1980;23:1303-746.Crossref 50. Hawkey CJ. Non-steroidal anti-inflammatory drugs and peptic ulcers: facts and figures multiply, but do they add up? BMJ. 1990;300:278-284.Crossref 51. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal antiinflammatory drugs: a meta-analysis . Ann Intern Med. 1991;115:787-796.Crossref 52. Fries JF. NSAID gastropathy: the second most deadly rheumatic disease. Epidemiology and risk appraisal . J Rheumatol. 1991;18( (suppl 28) ): 6-10. 53. Rossi AC, Hsu JP, Faich GA. Ulcerogenicity of piroxicam: an analysis of spontaneously reported data . BMJ. 1987;294:147-5047.Crossref 54. Bunning RD, Barth WF. Sulindac: a potentially renal-sparing non-steroidal anti-inflammatory drug . JAMA. 1982;248:2864-2867.Crossref 55. Ciabattoni G, Cinotti GA, Pierucci A, et al. Effects of sulindac and ibuprofen in patients with chronic glomerular disease . N Engl J Med. 1984;310:279-283.Crossref 56. Svendsen UG, Gerstoft J, Hansen TM, Christensen P, Lorenzen I. The renal excretion of prostaglandins and changes in plasma renin during therapy with either sulindac or naproxen in patients with rheumatoid arthritis and thiazide treated heart failure . J Rheumatol. 1984;11:779-782. 57. Berg KJ, Talseth T. Acute renal effects of sulindac and ibuprofen in chronic renal failure . Clin Pharmacol Ther. 1985;37:447-452.Crossref 58. Brater DC, Anderson SA, Brown-Cartwright D, Toto RD. Effects of nonsteroidal anti-inflammatory drugs on renal function in patients with renal insufficiency and in cirrhotics . Am J Kidney Dis. 1986;8:351-355.Crossref 59. Kamper AL, Strandgaard S, Christensen P, Svendson UG. Effects of sulindac and naproxen in patients with chronic glomerular disease . Scand J Rheumatol. 1986;62( (suppl) ):26-31.Crossref 60. Ryan JR, McMahon F, Vargas R, et al. Effects of salsalate, aspirin, and naproxen on plasma renin activity and platelet thromboxane (TxB2) synthesis . Arthritis Rheum. 1986;29( (suppl) ):S103. Abstract. 61. Clive DM, Stoff JS. Renal syndromes associated with nonsteroidal anti-inflammatory drugs . N Engl J Med. 1984;310:563-572.Crossref 62. Abraham PA, Stillman MT. Salsalate exacerbation of chronic renal insufficiency: relation to inhibition of prostaglandin synthesis . Arch Intern Med. 1987;147:1674-1676.Crossref 63. Stillman MT, Schlesinger PA. Nonsteroidal anti-inflammatory drug nephrotoxicity: should we be concerned? Arch Intern Med. 1990;150:268-270.Crossref 64. Johansson C. Ulcerogenic drugs and antiulcer compounds: effects on gastroduodenal mucosa . Scand J Gastroenterol. 1987;22( (suppl 128) ):24-32.Crossref 65. Fries JF, Miller SR, Spitz PW, Williams CA, Hubert HB, Bloch DA. Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use . Gastroenterology. 1989;96:647-655. 66. Fries JF, Williams CA, Bloch DA, Michel BA. Nonsteroidal anti-inflammatory drug-associated gastropathy: incidence and risk factor models . Am J Med. 1991;91:213-222.Crossref 67. Roth SH, Bennett RE, Mitchell CS, Hartman RJ. Cimetidine therapy in nonsteroidal anti-inflammatory drug gastropathy: double-blind long-term evaluation . Arch Intern Med. 1987;147:1798-801.Crossref 68. Ehsanullah RS, Page MC, Tildsley G, Wood JR. Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine . BMJ. 1988;297:1017-1021.Crossref 69. Bigard MA, Isal JP. Complete prevention by omeprazole of aspirin induced gastric lesions in healthy subjects . Gut. 1988;29:A712. Abstract. 70. Caldwell JR, Roth SH, Wu WC, et al. Sucralfate in treatment of non-steroidal anti-inflammatory drug-induced gastrointestinal symptoms and mucosal damage . Am J Med. 1987;83( (suppl 3B) ):74-82.Crossref 71. Agrawal NM, Roth S, Graham DY, et al. Misoprostol compared with sucralfate in the prevention of non-steroidal anti-inflammatory drug-induced gastric ulcer . Ann Intern Med. 1991;115:195-200.Crossref 72. 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Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1992

References

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