THE TOXICITY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS AND ANTIRHEUMATICDRUGS - AN INTRODUCTION

The toxicity of nonsteroidal antiinflammatory drugs (NSAID) and antirh eumatic drugs is well known, As a group, they constitute one of the mo st common causes of reporting to adverse drug reaction agencies and ar e a major cause of morbidity. An appreciation of the gastrointestinal (GT) toxicity of NSAID has led to a decrease in their use worldwide, p articularly for osteoarthritis. Although the potential for GI toxicity occurs with all NSAID(1), data are now emerging that suggest that a h ierarchy of NSAID may occur in regard to this particular adverse event (2). Pulmonary toxicity, hepatotoxicity, and nephrotoxicity are also s een with NSAID, Much data on adverse reaction to NSAID has come from c ontrolled trials or postmarketing surveillance, Individual case report s will often alert the profession that a particular (peculiar) adverse drug reaction is likely to occur. More formal evaluation then needs t o be instituted to assess the true incidence of the adverse reactions. Toxicity with antirheumatic drugs is also commonly seen(3). Adverse r eactions are major reasons for a patient being unable to continue a sl ow acting antirheumatic drug (SAARD), and patients need to be monitore d closely to reduce adverse reactions to a minimum. Data on the true i ncidence of adverse reactions to antirheumatic drugs are sparse and it is hard to develop appropriate guidelines for monitoring these compou nds to reduce toxicity to a minimum. Adverse reactions to SAARD are mu ch more individual than to the NSAID, but include major organ systems such as the liver, lungs, kidneys, and the bone marrow. Many SAARD act as immunosuppressives and thus potentially increase the risk of infec tious complications. Longterm toxicity, such as oncogenesis, may also be a problem with some immunosuppressive drugs, and longterm followup needs to be established. The discussion in this section of these proce edings will focus on the following questions: What are the major adver se reactions to nonsteroidal and antirheumatic drugs? How do we define these adverse drug reactions in terms of their severity? How do we me asure these adverse reactions? How do we improve the collection of lon gterm data on adverse reactions to nonsteroidal and antirheumatic drug s? Are there any toxicity indices that can be used to assess toxicity? What strategies do we need to develop for reducing toxicity to nonste roidal and antirheumatic drugs to a minimum?