Analgesics for Osteoarthritis—An Update
Background: Nonsteroidal Anti-inflammatory Drugs
NSAIDs work by blocking cyclooxygenase (COX) enzymes, particularly COX-1 and COX-2. COX-1 mediates the mucosal protection of the gastrointestinal (GI) mucosa. COX-2 mediates effects on pain and inflammation.
By blocking COX-2 enzymes, NSAIDs decrease pain and inflammation. Nonselective NSAIDs block both COX-1 and COX-2 enzymes. NSAIDs that block COX-1 can cause GI adverse effects, including bleeding.
Selective or partially selective (in vitro) NSAIDs block mostly COX-2, and thus should be safer with regard to GI adverse effects. However, it is unclear if partially selective NSAIDs are truly different from nonselective NSAIDs because COX-2 selectivity may be lost at higher doses. The effects of in vitro COX-2 selectivity on clinical outcomes is uncertain.
All NSAIDs can also cause cardiovascular adverse effects.
- Chou R, McDonagh M, Nakamoto E, et al. Comparative Effectiveness and Safety of Analgesics for Osteoarthritis: An Update of the 2006 Report. Comparative Effectiveness Review No. 38 (Prepared by Oregon Evidence-based Practice Center under Contract No. HHSA 290-2007-10057-I). Rockville, MD: Agency for Healthcare Research and Quality; October 2011. AHRQ Publication No. 11(12)-EHC076-EF. Available at: http://www.effectivehealthcare.ahrq.gov/reports/analgesicsupdate.cfm.
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