Management of @entity344 of nonsteroidal anti-inflammatory drugs during the therapy of XXXX . The rheumatologist's perspective.

@entity1 @entity4444 @entity137 @entity627 @entity548 @entity1421 @entity344 @entity112
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most widely used therapeutic agents for many important @entity627 . A large body of evidence indicates that the anti-inflammatory effects as well as the toxic side effects of NSAIDs can be attributed to their ability to inhibit prostaglandin synthesis. The most frequent side effect leading to discontinuation of NSAID therapy is upper @entity344 . This is a major problem for rheumatologists and their @entity1 since alternatives to NSAIDs are not readily available. The mechanism of upper @entity344 associated with NSAIDs can be attributed to their common ability to inhibit gastric @entity1421 synthesis, which suggests that gastrointestinal side effects often may not be avoided by substituting another NSAID, a prediction borne out by many @entity1 with @entity627 . However, there is some evidence that some @entity1 may differ in their susceptibility to gastrointestinal and other toxic effects, though this concept has not been rigorously studied in clinical trials. Thus, although changing the specific NSAID may prevent @entity344 in some @entity1 , many are intolerant to all NSAIDs. @entity1 who benefit from a specific NSAID, but in whom @entity344 develops, have limited options. Another NSAID may be substituted but at the risk of losing therapeutic efficacy and/or of continuing @entity137 . Alternatively, the side effects may be controlled while continuing therapy with the NSAID by one of several measures, including the use of antacids or a @entity112 (H2)-receptor antagonist, such as @entity4444 . The use of enteric-coated salicylates or nonacetylated salicylates may also provide satisfactory alternatives. However, @entity1 who have experienced major @entity344 , such as @entity548 or active peptic ulcers, should usually avoid NSAID therapy.
