What are possible adverse effects of NSAIDS in the treatment of rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Coxibs, with their selectivity for COX-2, have been shown to be clinically efficacious and are accompanied by reduced gastrointestinal (GI) toxicity, the major adverse event related to the use of nonselective COX inhibitors (ie, NSAIDs). Other adverse effects, such as water retention, hypertension, and abnormal transaminase levels, are observed with both nonselective COX inhibitors and selective COX-2 inhibitors.

Whether and to what degree nonaspirin NSAIDs, coxibs, or both have increased cardiovascular toxicity has not been definitively settled. An analysis of 6 placebo-controlled trials comparing celecoxib with placebo found that the risk of cardiovascular death, myocardial infarction, stroke, heart failure, or thromboembolic events increased after celecoxib treatment in a dose-dependent fashion. [135]


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