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Episode 33: NSAIDS: Considering the Risks and Benefits

In our 33rd episode we follow-up our discussion of osteoarthritis by examining the risks and benefits of oral anti-inflammatories including Cox-2 inhibitors. We review the effects on pain relief and the theory of anti-inflammation. We discuss the possible gastrointestinal effects and possible approaches to reduce the risk. We consider the cardiovascular risks and debate the choices in prescribing. We finish by struggling to get in the last word.

Show Notes

1) Eradication of H. Pylori decreases the chance of a GI bleed in patients about to receive NSAIDs

Lancet 2002;359:9-13

2) Misoprostol decreases the chance of bleeds but increases the number of GI side effects

Ann Int Med 1995;123:241-9

3) PPI added to ASA (in patients with previous ulcer on ASA)

NEJM 2005;352:238-44

4) Naprosyn possibly protective for cardiac events

Lancet. 2004;364:2021-9

5) Possible impaired fracture healing with NSAIDs

Injury 2008;39:384-94

J Bone Joint Surg (Br) 2007;89:1553-60

Emerg Med J 2005;22:652-3

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