A review of the benefits and risks of nonsteroidal anti-inflammatory drugs in the management of mild-to-moderate osteoarthritis

Table 2 NSAID selection stratification grid

	No or low NSAID GI risk	NSAID GI risk
No CV risk (without aspirin)	• Nonselective NSAID (cost consideration)	• COX-2-specific inhibitor or nonselective NSAID + proton-pump inhibitor^a
		• COX-2-specific inhibitor + proton-pump inhibitor for patients with prior GI bleeding
Yes CV risk (with aspirin)	• Naproxen^b	• Proton-pump inhibitor, irrespective of NSAID
	• Addition of proton-pump inhibitor if GI risk of aspirin/NSAID combination warrants gastroprotection	• Naproxen if CV risk outweighs GI risk
		• COX-2-specific inhibitor + proton-pump inhibitor for patients with previous GI bleeding

COX-2 = cyclooxygenase-2; CV = cardiovascular; GI = gastrointestinal; NSAID = nonsteroidal anti-inflammatory drug.
^aMisoprostol at full dosage (200 μg qid) may be substituted for a proton-pump inhibitor.
^bNonselective or selective (low-dose) inhibitor without established aspirin interaction if naproxen is ineffective.
From Scheiman and Fendrick ⁴⁸