Gastrointestinal and Cardiovascular Risks of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Time to Translate Knowledge into Practice

Arthritis is a complex disorder that comprises more than hundred distinct conditions involving damage to the joints of the body. Many mediators are known to be involved in the pathophysiology and progression of arthritis. These include cartilage-degrading enzymes, cytokines, leukotrienes (LTs), and prostaglandins (PGs). In the clinical management of osteoarthritis, the choice of drugs remains confusing and controversial. Since, their introduction, COX-II specific inhibitors have become a rapidly growing segment of the prescription drug market, especially in patients with osteoarthritis and rheumatoid arthritis. Researchers have recently focused on the potentially lethal side effects associated with their. Both NSAIDs and COX-2 inhibitors are equally effective and are associated with increased risk of GI, renal, and CV adverse effects. The COX-2 enzyme is also involved in the development of many organ systems, and its inhibition may lead to various congenital defects in neonates. Complete understanding of the patient's comorbid conditions and concomitant medications, coupled with precise monitoring during the treatment, may help to decrease the threat of adverse effects induced by non-selective NSAIDs and selective COX-2 inhibitors.