Nonsteroidal anti-inflammatory drugs (NSAIDs)

U Dose reduction or cessation may be considered for all patients taking NSAIDs whose symptoms are under control and are relatively stable. U Some patients may find intermittent use of NSAIDs as effective as continuous use. U Maximise non-pharmacological treatments for example, heat packs, massage, exercise, physiotherapy. U Maximise the use of alternative analgesics such as paracetamol or topical NSAIDs. U Estimation of cardiac and gastrointestinal bleeding risk for individual patients may guide the selection of the most appropriate NSAID and dose, with or without PPIs. U Cessation should be considered in patients who develop gastrointestinal side effects or anaemia. Elderly patients may present with subtle symptoms such as unexplained loss of weight, anorexia etc.