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NSAID Gastroprotection — SCE Rheumatology MCQ

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EasyRheumatology PharmacologyNSAID GastroprotectionSCE Rheumatology

A 55-year-old woman with RA on long-term NSAIDs develops dyspepsia and iron deficiency anaemia. According to NICE guidance on gastroprotection what co-prescription is recommended for RA patients on regular NSAIDs?

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Correct answer: E — A PPI (e.g. Omeprazole Lansoprazole) should be co-prescribed with regular NSAID use for gastroprotection particularly in patients with additional GI risk factors (age >65 concomitant glucocorticoids anticoagulants/antiplatelets previous GI bleed)

NICE guidance recommends PPI gastroprotection for patients on regular NSAIDs (not just PRN use). Risk factors for NSAID-related GI complications that particularly warrant gastroprotection include: age ≥65 previous GI bleeding or ulcer concomitant glucocorticoid use concomitant anticoagulant or antiplatelet therapy smoking alcohol use and Helicobacter pylori infection. PPIs (Omeprazole Lansoprazole) are the preferred gastroprotective agents as they provide superior protection compared with H2 receptor antagonists. Misoprostol is an alternative but less well tolerated. In high-risk patients COX-2 selective NSAIDs with PPI provide the lowest GI risk profile.

Reference: NICE CG184 NSAID prescribing; BNF gastroprotection guidance