Why and how to use NSAIDs in osteoarthritis.

There is an increasing body of evidence that an inflammatory process can be involved in the development and the progression of osteoarthritis. Such inflammation can be observed at both the cartilage, subchondral bone, and synovial tissue level. Of the 2 main categories of anti-inflammatory drugs [corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs)], NSAIDs are the most commonly used oral drugs in osteoarthritis. The symptomatic short-term effect of coxibs is similar to the conventional NSAIDs one and of greater magnitude than the one of analgesics such as paracetamol (acetaminophen). On the basis of current knowledge of potential gastrointestinal and, more importantly, cardiovascular side-effects, the still remaining important question is related to the efficacy-toxicity balance of a chronic systematic daily intake of NSAIDs versus an "at request" (PRN) intake.