Non-steroidal anti-inflammatory drugs in psoriatic arthritis: clinical practice suggestions based on scientific evidence and expert opinion

Objectives: The aim of this study was to provide evidence- and expert-based indications for the use of non-steroidal anti-inflammatory drugs (NSAIDs) in psoriatic arthritis (PsA). Methods: A working group, composed of six rheumatologists with known expertise in the management of PsA and seven methodologists, identified key research questions related to NSAID use in PsA, which guided the systematic literature review (SLR) in Medline and Embase databases. RCTs and observational studies published until 26/1/2022 were included for efficacy and safety questions, respectively. Based on the results of the systematic search, the working group developed statements, which were evaluated by a multidisciplinary group of external reviewers through a Delphi exercise. Results: The SLR retrieved only 7 manuscripts of interest, 5 RCTs and 2 observational studies. The drugs evaluated in the RCTs were indomethacin, diclofenac, ibuprofen, nimesulide, and celecoxib. These studies addressed peripheral joint involvement but not the other domains of PsA. Nimesulide and celecobix were reported to be significantly more effective than placebo in controlling joint inflammatory-related symptoms in the short-term. Based on this evidence and on expert opinion, the working group developed 12 statements on the use of NSAIDs in PsA. Conclusions: This study provides a set of indications that may be helpful to the practicing rheumatologist in the prescription of NSAIDs for the relief of the symptoms due to the various clinical manifestations of PsA.