AN EVIDENCE-BASED APPROACH TO PRESCRIBING NSAIDS IN MUSCULOSKELETAL DISEASE: A CANADLAN CONSENSUS

Objective: To make recommendations for the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) in primary care practice, particularly for patients at high risk for NSAID-induced complications. Options: The use of misoprostol to prevent gastrointestinal ulceration and other unwanted NSAIDs effects was considered. The role of cyclooxygenase-2 (COX-2) versus COX- 1 inhibiting agents was also examined. Outcomes: Reduction of complications associated with long-term use of NSAIDs. Evidence: Evidence was gathered in late 1995 from published research studies and reviews. Position papers were prepared by faculty and advisory board members and discussed at the Canadian NSAID Consensus Symposium in Cambridge, Ont., Jan. 26 and 27, 1996. Values: Recommendations were based on randomized, placebo-controlled clinical trials (level I evidence) and case-control studies (level 11 evidence) involving NSAID use when such evidence was available. When the scientific literature was incomplete or inconsistent in a particular area, recommendations reflect the consensus of the participants at the symposium (level 111 evidence). Physicians were recruited from across Canada for their expertise in rheumatology, gastroenterology, epidemiology, gerontology, family practice, and clinical and basic scientific research. Benefits, harms and costs: Although a reduction in complications due to inappropriate NSAID use should reduce costs of additional investigations, admissions to hospital and time lost from work,