Document Detail

Safety of Nonsteroidal Antiinflammatory Drugs and/or Paracetamol in People Receiving Methotrexate for Inflammatory Arthritis: A Cochrane Systematic Review.
MedLine Citation:
PMID:  22942332     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: To systematically review the literature on the safety of using nonsteroidal antiinflammatory drugs (NSAID) and/or paracetamol in people receiving methotrexate (MTX) for inflammatory arthritis (IA), as an evidence base for generating clinical practice recommendations.
METHODS: A systematic literature review was performed using the Cochrane Library, Medline, Embase, and conference proceedings for the American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) for 2008-2009. The search aimed to identify studies describing adverse events (AE) with the concurrent use of paracetamol and/or NSAID in people taking MTX for IA. Articles fulfilling our predefined inclusion criteria were systematically reviewed and quality appraised.
RESULTS: Seventeen publications out of 8681 identified studies were included in the review, all of which included people with rheumatoid arthritis (RA) using various NSAID; there were no identified studies for other forms of IA or with paracetamol. Of the studies examining concurrent use of MTX and NSAID, there were no reported adverse effects on lung, liver, or renal function, and no increase in MTX withdrawal or in major toxic reactions. However, transient thrombocytopenia was demonstrated in 1 study. Looking at specific NSAID, there were no clinically significant AE with concomitant piroxicam or etodolac, and only mild AE with celecoxib or etoricoxib. Antiinflammatory dose aspirin was demonstrated to have an adverse effect on liver and renal function.
CONCLUSION: In the management of RA, concurrent use of NSAID with MTX appears to be safe, provided appropriate monitoring is performed. The use of antiinflammatory doses of aspirin should be avoided.
Alexandra N Colebatch; Jonathan L Marks; Désirée M van der Heijde; Christopher J Edwards
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of rheumatology. Supplement     Volume:  90     ISSN:  0380-0903     ISO Abbreviation:  J Rheumatol Suppl     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-09-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7806058     Medline TA:  J Rheumatol Suppl     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  62-73     Citation Subset:  IM    
Address correspondence to Dr. C.J. Edwards, Department of Rheumatology, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK. E-mail:
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