NSAID and gastropathy: a rheumatologist's review.

Nonsteroidal antiinflammatory drug (NSAID) use, salicylate and nonsalicylate, is all too commonly associated with gastropathy. The problem is reviewed as significantly impacting upon the success of the most common treatment of most forms of arthritis. Blockade of prostaglandin products by NSAID is recently recognized as a basis for the ultimate failure of adaptive cytoprotection to respond to putative threat and restore the gastric mucosa. A cohort of such patients, based upon risk factors especially noted in elderly women taking longterm high sustained doses of NSAID is identified for purposes of closer clinical monitoring. Issues of prophylaxis, adjustment of arthritis regimens to NSAID gastropathy, and gastroprotective measures are reviewed as strategic responses to this recently recognized and described iatrogenic problem of arthritis management.