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Pain pharmacotherapy in patients with inflammatory arthritis and concurrent cardiovascular or renal disease: a Cochrane systematic review.
J Rheumatol Suppl 2012; 90:81-4JR

Abstract

BACKGROUND

Pain in inflammatory arthritis (IA) is common and often multifactorial, and many different pharmacotherapeutic agents are routinely used for pain management. There are concerns that some current pain pharmacotherapies may increase the risk of adverse events in patients with concurrent cardiovascular (CV) or renal disease.

METHODS

A systematic literature review was performed searching Medline, Embase, Cochrane Central Register of Controlled Trials, DARE, and Cochrane Database of Systematic Reviews. We also hand-searched conference proceedings for the American College of Rheumatology and the European League Against Rheumatism for 2008-2009.

RESULTS

Our search identified 4782 studies, of which 190 were included for detailed review, but none met the inclusion criteria for our review. We identified 1 study of etoricoxib and diclofenac in non-IA populations [osteoarthritis (OA) or mixed OA and rheumatoid arthritis]. In that study, the presence of CV disease increased the likelihood of a further CV event 3-fold. Patients with 2 or more CV risk factors showed a 2-fold increased likelihood of adverse CV events.

CONCLUSION

Our review has highlighted a lack of specific evidence to guide clinicians in the management of pain in patients with IA and coexistent CV or renal disease. In the absence of this evidence, we suggest clinicians use nonsteroidal antiinflammatory drugs (NSAID) with caution in patients with preexisting CV disease or ≥ 2 CV risk factors. There is currently no evidence to advise clinicians considering other pain pharmacotherapies in the context of CV comorbidities. Current guidelines regarding the use of NSAID and opioids in moderate to severe renal impairment should also be applied to the IA population.

Authors+Show Affiliations

Department of Rheumatology, Southampton General Hospital, Southampton University Hospitals NHS Trust, Southampton, UK SO16 6YD. dr_jonmarks@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review
Systematic Review

Language

eng

PubMed ID

22942334

Citation

Marks, Jonathan L., et al. "Pain Pharmacotherapy in Patients With Inflammatory Arthritis and Concurrent Cardiovascular or Renal Disease: a Cochrane Systematic Review." The Journal of Rheumatology. Supplement, vol. 90, 2012, pp. 81-4.
Marks JL, van der Heijde DM, Colebatch AN, et al. Pain pharmacotherapy in patients with inflammatory arthritis and concurrent cardiovascular or renal disease: a Cochrane systematic review. J Rheumatol Suppl. 2012;90:81-4.
Marks, J. L., van der Heijde, D. M., Colebatch, A. N., Buchbinder, R., & Edwards, C. J. (2012). Pain pharmacotherapy in patients with inflammatory arthritis and concurrent cardiovascular or renal disease: a Cochrane systematic review. The Journal of Rheumatology. Supplement, 90, pp. 81-4. doi:10.3899/jrheum.120347.
Marks JL, et al. Pain Pharmacotherapy in Patients With Inflammatory Arthritis and Concurrent Cardiovascular or Renal Disease: a Cochrane Systematic Review. J Rheumatol Suppl. 2012;90:81-4. PubMed PMID: 22942334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pain pharmacotherapy in patients with inflammatory arthritis and concurrent cardiovascular or renal disease: a Cochrane systematic review. AU - Marks,Jonathan L, AU - van der Heijde,Désirée M, AU - Colebatch,Alexandra N, AU - Buchbinder,Rachelle, AU - Edwards,Christopher J, PY - 2012/9/4/entrez PY - 2012/9/4/pubmed PY - 2013/1/18/medline SP - 81 EP - 4 JF - The Journal of rheumatology. Supplement JO - J Rheumatol Suppl VL - 90 N2 - BACKGROUND: Pain in inflammatory arthritis (IA) is common and often multifactorial, and many different pharmacotherapeutic agents are routinely used for pain management. There are concerns that some current pain pharmacotherapies may increase the risk of adverse events in patients with concurrent cardiovascular (CV) or renal disease. METHODS: A systematic literature review was performed searching Medline, Embase, Cochrane Central Register of Controlled Trials, DARE, and Cochrane Database of Systematic Reviews. We also hand-searched conference proceedings for the American College of Rheumatology and the European League Against Rheumatism for 2008-2009. RESULTS: Our search identified 4782 studies, of which 190 were included for detailed review, but none met the inclusion criteria for our review. We identified 1 study of etoricoxib and diclofenac in non-IA populations [osteoarthritis (OA) or mixed OA and rheumatoid arthritis]. In that study, the presence of CV disease increased the likelihood of a further CV event 3-fold. Patients with 2 or more CV risk factors showed a 2-fold increased likelihood of adverse CV events. CONCLUSION: Our review has highlighted a lack of specific evidence to guide clinicians in the management of pain in patients with IA and coexistent CV or renal disease. In the absence of this evidence, we suggest clinicians use nonsteroidal antiinflammatory drugs (NSAID) with caution in patients with preexisting CV disease or ≥ 2 CV risk factors. There is currently no evidence to advise clinicians considering other pain pharmacotherapies in the context of CV comorbidities. Current guidelines regarding the use of NSAID and opioids in moderate to severe renal impairment should also be applied to the IA population. SN - 0380-0903 UR - https://www.unboundmedicine.com/medline/citation/22942334/Pain_pharmacotherapy_in_patients_with_inflammatory_arthritis_and_concurrent_cardiovascular_or_renal_disease:_a_Cochrane_systematic_review_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=22942334 DB - PRIME DP - Unbound Medicine ER -