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Nonsteroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory, analgesic, and antipyretic agents. They are used to reduce pain, decrease stiffness, and improve function in patients with osteoarthritis (OA), rheumatoid arthritis (RA), and other forms of arthritis. They are also used for the treatment of pain including headache, dysmenorrhea, and postoperative pain.1-3 It is not known whether NSAID effectiveness results from the anti-inflammatory or analgesic effects or from other possible mechanisms.4 There are at least 20 different NSAIDs currently available in the United States (Table 74-1). Cyclooxygenase-2 selective inhibitors (COX-2 inhibitors [celecoxib]), have similar efficacy but with significantly decreased gastrointestinal (GI) and platelet effects.5-7 Several topical NSAIDs including diclofenac or salicylates for chronic pain have been approved in the United States; however, similar drugs have been available in Europe for a number of years. One study of a diclofenac liquid included an oral diclofenac comparator demonstrating no difference in efficacy from the topical agent in chronic dosing in treatment of the pain of osteoarthritis of the knee.8

TABLE 74-1

Nonsteroidal Anti-Inflammatory Medications

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