Nonsteroidal anti-inflammatory drugs in systemic lupus erythematosus

Up to 80% of patients with systemic lupus erythematosus (SLE) are treated w ith nonsteroidal antiinflammatory drugs (NSAID) for musculoskeletal symptom s, serositis and headache. This survey reviews the literature on nan-select ive and selective inhibitors of cyclooxygenases, with an emphasis on the ef ficacy and safety profile reported in SLE patients. No lupus-specific data on gastro-intestinal side effects of NSAID exist. Both non-selective Cox in hibitors and selective Cox-2 inhibitors induce renal side effects, includin g sodium retention and reduction of the glomerular filtration rate. Lupus n ephritis is a risk factor for NSAID-induced acute renal failure, but not fo r rare idiosyncratic toxic renal reactions to NSAID. In refractory nephroti c syndrome, NSAID have been used successfully. Cutaneous and allergic react ions to NSAID are increased in SLE patients as well as hepatotoxic effects, particularly with high dose aspirin. Whereas a variety of central nervous system side effects of NSAID are probably no more common in SLE patients th an others, aseptic meningitis has been reported more frequently. Ovulation and pregnancy can be adversely affected by Cox inhibitors. The antiplatelet effect of aspirin and non-selective Cox inhibitors has a therapeutic poten tial in patients with antiphospholipid syndrome (APS). In summary, treatmen t of SLE with NSAID requires awareness for the increased frequency of some side effects and close monitoring of toxicity.