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 non-select ive and selective inhibitors of cyclooxygenases with an emphasis on the eff icacy and safety profile reported in SLE patients. No lupus-specific data o n gastro-intestinal side effects of NSAID exist. Both non-selective Cox-inh ibitors and selective Cox-2 inhibitors induce renal side effects including sodium retention and reduction of the glomerular filtration rate. Lupus nep hritis is a risk factor for NSAID-induced acute renal failure, but not for rare idiosyncratic toxic renal reactions to NSAID. In refractory nephrotic syndrome, NSAID have been used successfully. Cutaneous and allergic reactio ns to NSAID are increased in SLE patients as well as hepatotoxic effects, p articularly with high dose aspirin. Whereas a Variety of central nervous sy stem side effects of NSAID are probably no more common in SLE patients than in others, aseptic meningitis has been reported more frequently. Ovulation and pregnancy can be adversely affected by Cox-inhibitors. The antiplatele t effect of aspirin and non-selective Cox-inhibitors has a therapeutic pote ntial in patients with the antiphospholipid syndrome (APS). In summary, tre atment of SLE with NSAID requires awareness for the increased frequency of some side effects and close monitoring of toxicity.