Non-steroidal anti-inflammatory drugs: is the balance shifting?

Non-steroidal anti-inflammatory drugs (NSAIDs) have been subject to repeated warnings about their adverse drug reaction profile. The emphasis is usually on upper gastrointestinal tract complications [1-3] but, with concern about the lower gut [4, 5] and other organ systems [6], a view has been advanced that NSAIDs can be bad for patients and that the prescription rate should be reduced [7]. hi particular, caution was counselled when the therapeutic indication for use was osteoarthritis since benefits were perceived as borderline when compared with simple analgesics. However, recent developments suggest that unintended effects of NSAIDs may not be uniformly adverse. Benefits to individuals and populations at risk of disease as diverse as ischaemic heart disease, bowel cancer and Alzheimer's disease have been identified and, if confirmed, these findings may alter the risk/benefit ratio.