The data that have accumulated in recent years underscore the importance of carefully weighing the risks and benefits of traditional
NSAIDs and COX-2 selective inhibitors before making therapeutic decisions for the management of chronic
arthritis. In clinical practice, the majority of patients with moderate to severe
arthritis who might benefit from
NSAID or COX-2
therapy are likely to be elderly and, therefore, at higher risk for gastrointestinal and cardiovascular adverse events than younger persons. Thus, these patients are more likely to be taking low-dose
aspirin and using over-the-counter
NSAIDs for
pain. Selecting a combination of
therapies that provides relief from
arthritis-related symptoms, minimizes cardiovascular risk, and preserves the gastrointestinal mucosa is complex. Factors to consider include the interference of certain
NSAIDs, such as
ibuprofen or
naproxen, with the antiplatelet effects of
aspirin; direct effects of non-selective
NSAIDs and of COX-2 selective inhibitors on fluid retention and blood pressure; emerging data about cardiovascular risks associated with these drugs; differences between these agents with regard to associated gastrointestinal adverse event rates; and the feasibility of coadministration of anti-inflammatory
therapies with gastro-
protective agents.