Background Pain is a considerable problem for patients with rheumatoid arthritis (RA). Treatments including disease modifying antirheumatic drugs (DMARDs) and biologic therapies aim to suppress underlying inflammation which results in joint damage and pain. Despite these treatments, patients with RA still use painkillers. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed but do have a number of adverse effects. NICE guidelines  in the United Kingdom have been published advising against long term use of NSAIDs. The guidelines state that an assessment of risk factors should be made prior to prescribing and a proton pump inhibitor (PPI) should be co-prescribed to patients receiving NSAIDs.
Objectives Our aim was to audit the use of NSAIDs in patients diagnosed with rheumatoid arthritis against NICE guideline standards. We planned to collect data on how long patients were receiving NSAIDs for, the drugs prescribed and whether a PPI was co-prescribed.
Methods During a 4 week period all patients with RA taking a NSAID were identified during attendance at routine outpatient appointments. An audit proforma was completed documenting the NSAID taken, duration of treatment, the use of PPIs and risk factors for gastrointestinal bleeding. We also collected demographic data on sex and age. We documented the time since diagnosis of RA. The initial audit was completed in 2011. Following changes to practice we re-audited the use of NSAIDs in 2013 over a period of 2 weeks.
Results In 2011, 107 patients were identified with RA receiving a NSAID in a 4 week period. In 2013, 64 RA patients were identified in a 2 week period. Data included both patients with or without NSAIDs. 52% patients were taking a NSAID in 2013. In the initial audit, 23% were male, 32% were male in 2013. In 2011, 69% of patients had been on NSAIDs for more than 10 years. This had dropped to 40% in 2013. The most commonly prescribed NSAID in 2013 was Naproxen. This has changed from 2011 where the most commonly prescribed drug was Diclofenac. In 2011, 77% of patients had some form of gastro-protection. This dropped slightly to 73% in 2013. Fewer patients had gastrointestinal risk factors (10%) for being prescribed a NSAID in 2013 than in 2011 (30%).
Conclusions Our audit shows that a significant number of patients with RA are still requiring or prescribed NSAIDS. A significant proportion of our patients receiving NSAIDs had been on treatment for over 10 years although this does appear to be improving. The pattern of NSAID prescribing has altered and this has been in line with local guidelines. Less people that have significant risk factors are prescribed NSAIDs but the use of gastro-protection needs to be considered in patients who are on long term NSAID therapy. NSAIDs do still appear to have a role in the management of RA. Continued assessment of the risks and benefits of these drugs should be made.
NICE (2009) CG79 Rheumatoid arthritis: The management of rheumatoid arthritis in adults. National Institute for Health and Care Excellence.
Disclosure of Interest None declared
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