Update on nonsteriodal anti-inflammatory drugs.

PURPOSE OF REVIEW: This review addresses recent concerns about the cardiovascular safety of nonsteroidal anti-inflammatory drugs, the disease-modifying role of these drugs in ankylosing spondylitis, and their use in the understudied pediatric population.

RECENT FINDINGS: Several recent observational and controlled studies highlight the cardiovascular toxicity of rofecoxib, celecoxib, parecoxib, valdecoxib and naproxen. Concerns about cardiovascular safety raise questions about the chronic use of nonsteroidal anti-inflammatory drugs in patients with rheumatic diseases, including children. The risks of these drugs in the pediatric population are not well known and this review addresses the limited data available concerning nonsteroidal anti-inflammatory drug use in children. A recent trial in ankylosing spondylitis patients demonstrated continuous nonsteroidal anti-inflammatory drug use reduced the rate of syndesmophyte formation, suggesting that they may have a disease-modifying role in these patients.

SUMMARY: Nonsteroidal anti-inflammatory drugs have been in the spotlight this year. While preliminary evidence has supported novel roles for these drugs in ankylosing spondylitis and in cancer prevention, accumulating evidence shows that some cyclooxygenase-2 and perhaps all nonsteroidal anti-inflammatory drugs are associated with cardiovascular toxicity. Further research is needed to understand the magnitude and mechanism of this risk. Clinicians are compelled to weigh carefully the benefits and risks of therapy. Concerns about safety are balanced by optimism about their potential role in delaying the progression of ankylosing spondylitis.