The incidence of hypersensitivity to non-steroid anti-inflammatory drugs in the group of patients with rheumatoid musculoskeletal disorders: the cross-sectional study.

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in patients with musculoskeletal disorders. However, hypersensitivity reactions to NSAIDs represent a significant clinical issue.This study aimed to assess the incidence of NSAID hypersensitivity in patients with musculoskeletal disorders and to identify associated risk factors.A total of 343 patients (aged 18-88) with chronic or recurrent musculoskeletal pain were enrolled. Participants completed a questionnaire regarding sociodemographic data, comorbidities, NSAID intake, and side effects. Patients with clinical features of NSAID hypersensitivity were identified and analysis of hypersensitivity risk factors was performed.The study included 343 patients suffering from rheumatic diseases, the most common of which were rheumatoid arthritis (45%), osteoarthritis (32%) and seronegative spondyloarthropathies (11%). However, 24.78% met the criteria for NSAID hypersensitivity. The most common reactions were NSAID-induced urticaria/angioedema (25.88%), delayed hypersensitivity, and NSAID-exacerbated respiratory disease (NERD). The symptoms were most frequently associated with ketoprofen (29%) and diclofenac (25%). Key risk factors for hypersensitivity included daily NSAID intake, asthma, chronic urticaria, smoking, aspirin use at cardiological doses, and a history of allergic reactions. Patients with hypersensitivity had significantly more chronic diseases compared to non-hypersensitive individuals (2.73 ± 2.29 vs. 1.68 ± 1.92; p = 0.0437). A logistic regression model demonstrated a sensitivity of 84.7% and specificity of 72.1% for identifying high-risk patients in teaching and respectively 80.0% and 71.7% in validation group.Identifying high-risk individuals can optimize pain management strategies and reduce adverse outcomes. Selective COX-2 inhibitors, paracetamol, or tramadol may be safer alternatives for patients at risk of hypersensitivity. Further studies are required to validate these findings in larger cohorts.