NSAID Cardiovascular Risk in SpA — SCE Rheumatology MCQ

Correct answer: C — Use an NSAID for symptom control at the lowest effective dose, with periodic cardiovascular, gastrointestinal and renal risk review and consideration of gastroprotection

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as E

A is correct. NSAIDs remain initial pharmacological treatment for axial spondyloarthritis symptoms, but treatment should be individualised and used at the lowest effective dose. Long-term use requires review of cardiovascular, gastrointestinal and renal risk factors, adverse effects and ongoing benefit, with gastroprotection considered where appropriate. Duration alone does not mandate withdrawal. Axial inflammation does not abolish NSAID cardiovascular toxicity, and COX-2 selectivity does not make an NSAID cardiovascularly risk-free. Continuous maximum-dose treatment is not recommended solely to prevent radiographic progression. If NSAIDs are contraindicated, poorly tolerated or provide inadequate control despite appropriate trials, alternative treatment—including biologic or targeted synthetic DMARD therapy when eligibility criteria are met—should be considered.

Reference: National Institute for Health and Care Excellence. Spondyloarthritis in over 16s: diagnosis and management, NG65, recommendations 1.4.2 and 1.8.4, 2017 (current guidance). https://www.nice.org.uk/guidance/ng65/chapter/Recommendations