Nonsteroidal anti-inflammatory drug therapy
Nonsteroidal anti-inflammatory drugs (NSAIDs) play an important role in the management of many patients, including the elderly with both rheumatic and nonrheumatic disorders. Efficacy among the agents is similar and patient response is highly variable. Potential differences in toxicity may be more important than differences in efficacy when selecting an NSAID for a particular patient. Gastrointestinal toxicity is common and prevention and management differ from classic peptic ulcer disease. Recently, NSAID effects on the small bowel have been recognized to be clinically significant. Acute renal insufficiency related to NSAIDs may be avoided to some extent by careful patient selection. Current development of newer NSAIDs is focused on finding drugs offering significant advantages in terms of efficacy or toxicity, particularly the latter.