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Non-steroidal anti-inflammatory drugs in psoriatic arthritis: clinical practice suggestions based on scientific evidence and expert opinion

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
Collaborator/s: F. Atzeni1, C. Baldi2, S. Bellando Randone3, F. Caso4, M.S. Chimenti5, A. Delle Sedie6, S. Gentileschi7, N. Girolimetto8, G. Guidelli9, L. Idolazzi10, A. Lo Gullo11, M. Lorenzin12, M.M. Luchetti13, A. Ortolan14, V. Picerno15, F.M. Perrotta16, N. Possemato17, R. Scrivo18, C. Selmi19, F. Sensi20, V. Venerito21

 

  1. Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan, Italy. maria.manara@gmail.com
  2. Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna Delle Grazie Hospital of Matera, Potenza, Italy.
  3. Rheumatology Unit, Azienda Ospedaliero Universitaria of Cagliari, Monserrato, and Department of Medical Sciences and Public Health, University of Cagliari, Italy.
  4. Rheumatology Unit, Department of Internal Medicine, Azienda USL IRCCS Ospedale Santa Maria Nuova, Reggio Emilia; and University of Modena and Reggio Emilia, Modena, Italy.
  5. Clinical Rheumatology Unit, ASST Gaetano Pini-CTO, Milan, and Department of Clinical Sciences and Community Health, University of Milan, Italy.
  6. Rheumatology Unit, Department of Medicine (DIMED), University of Padova, Italy.
  7. Academic Rheumatology Unit, Dipartimento di Medicina e Scienze per la Salute ‘Vincenzo Tiberio’, University of Molise, Campobasso, Italy.
  8. Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy.
  9. Rheumatology Institute of Lucania (IReL), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna Delle Grazie Hospital of Matera, Potenza, and University of Basilicata, Department of Health of Science, Potenza, Italy.
  10. Academic Rheumatology Unit, Dipartimento di Medicina e Scienze per la Salute “Vincenzo Tiberio”, University of Molise, Campobasso, Italy.
  11. Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy.
  12. Rheumatology Unit, Department of Internal Medicine, Azienda USL IRCCS Ospedale Santa Maria Nuova, Reggio Emilia; and University of Modena and Reggio Emilia, Modena, Italy.
  13. Rheumatology Clinic, Humanitas San Pio X, Milano, Italy.

  1. University of Messina
  2. Azienda Ospedaliera Universitaria Senese
  3. University of Firenze
  4. University of Naples Federico II
  5. University of Rome Tor Vergata
  6. University of Pisa
  7. University of Siena
  8. Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia
  9. IRCCS Humanitas Research Hospital, Rozzano, Milan
  10. University of Verona
  11. Rheumatology Unit, ARNAS Garibaldi, Catania
  12. University of Padova
  13. Università Politecnica delle Marche
  14. University of Padova
  15. Rheumatology Department of Lucania - San Carlo Hospital, Potenza, Italy
  16. Università degli Studi del Molise
  17. Rheumatology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia
  18. Sapienza University of Rome
  19. Department of Biomedical Sciences, Humanitas University, Milan
  20. AO San Camillo Forlanini, Roma
  21. University of Bari "Aldo Moro"

Study Group on Spondyloarthritis and Psoriatic Arthritis ‘Antonio Spadaro’ of the Italian Society for Rheumatology

CER18105
2025 Vol.43, N°5
PI 0897, PF 0906
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PMID: 40153331 [PubMed]

Received: 23/08/2024
Accepted : 20/01/2025
In Press: 20/03/2025
Published: 08/05/2025

Abstract

OBJECTIVES:
The aim of this study was to provide evidence- and expert-based indications for the use of non-steroidal anti-inflammatory drugs (NSAIDs) in psoriatic arthritis (PsA).
METHODS:
A working group, composed of six rheumatologists with known expertise in the management of PsA and seven methodologists, identified key research questions related to NSAID use in PsA, which guided the systematic literature review (SLR) in Medline and Embase databases. RCTs and observational studies published until 26/1/2022 were included for efficacy and safety questions, respectively. Based on the results of the systematic search, the working group developed statements, which were evaluated by a multidisciplinary group of external reviewers through a Delphi exercise.
RESULTS:
The SLR retrieved only 7 manuscripts of interest, 5 RCTs and 2 observational studies. The drugs evaluated in the RCTs were indomethacin, diclofenac, ibuprofen, nimesulide, and celecoxib. These studies addressed peripheral joint involvement but not the other domains of PsA. Nimesulide and celecobix were reported to be significantly more effective than placebo in controlling joint inflammatory-related symptoms in the short-term. Based on this evidence and on expert opinion, the working group developed 12 statements on the use of NSAIDs in PsA.
CONCLUSIONS:
This study provides a set of indications that may be helpful to the practicing rheumatologist in the prescription of NSAIDs for the relief of the symptoms due to the various clinical manifestations of PsA.

DOI: https://doi.org/10.55563/clinexprheumatol/j7b6t5

Rheumatology Article