Tackling Multicomplexity in Aging Patients with RA

NSAID Use

Using adjunct therapies in patients with pain is especially important because non-steroidal anti-inflammatory drugs (NSAIDs) are on the Beers list and should be avoided, if possible, by older adults, especially those with liver or kidney problems or those at risk of a gastrointestinal bleed.⁵

Dr. Makris recommended acetaminophen for patients who respond well to it, or topical NSAIDs, because they are safer than oral NSAIDs. Duloxetine or a similar agent may be helpful in the right context to also help with comorbid depressive symptoms.

However, NSAIDs may be the right choice for some patients if their pain can’t be well managed through other methods and if they are educated about the risks. Some patients may prefer to assume these risks if using an NSAID significantly improves their quality of life. To make the best decisions with respect to this and many other topics, it is critical to discuss with patients their needs, preferences and priorities.

Dr. Bühring pointed out, “It is about finding the safest drug, because none of these medications is going to be completely side effect free.”

Because calculating renal function can be less reliable in older adults, practitioners must diligently monitor for adverse effects from NSAIDs, even if patients have creatinine and glomerular filtration rate values in the normal range. Practitioners should aim for the lowest effective dose at the shortest duration feasible if an NSAID is prescribed.

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Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.

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