When should COX-2 selective NSAIDs be used for osteoarthritis and rheumatoid arthritis?

Cyclo-oxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) are as effective as acetaminophen and nonselective NSAIDs in treating of osteoarthritis, and are equally effective in reducing pain and inflammation and improving of joint function for patients with rheumatoid arthritis, when compared with nonselective NSAIDs. The COX-2 selective NSAIDs also have a better gastrointestinal safety profile in short-term (6-12 month) treatment (strength of recommendation [SOR]: A, based on meta-analysis of randomized controlled trials with patient-oriented outcomes). However, with recent growing concern of the cardiovascular safety of COX-2 selective NSAIDs, it is imperative to select appropriate patients by considering benefit vs risks, which include serious gastrointestinal bleeding, history of intolerance to nonselective NSAID, cardiovascular disease or associated risks, renal disease, patient's preference, and cost.