A pharmacist's audit of antirheumatic drugs

Repeat prescribing of non-steroidal anti-inflammatory drugs excluding aspirin: how careful are we?

About 5% of all National Health Service prescriptions in Britain and a quarter of reports of suspected adverse reactions are accounted for by non-steroidal anti-inflammatory drugs. Their prescription was investigated in two computerised group practices serving 11850 patients. Altogether 198 patients receiving repeat prescriptions of non-steroidal anti-inflammatory drugs were identified and relevant clinical details extracted from their notes. Of these patients, 119 were over 65 years old; 172 were receiving one of six different non-steroidal anti-inflammatory drugs; and 76 were taking drugs that can interact with non-steroidal anti-inflammatory drugs. Ninety one patients had one or more medical conditions that may be aggravated by non-steroidal anti-inflammatory drugs, and 36 had experienced side effects important enough for their treatment to be changed. A questionnaire to assess opinions and knowledge of non-steroidal anti-inflammatory drugs was given to 42 general practitioners and 26 rheumatologists. Although the two groups showed a comparable knowledge of the properties and costs of non-steroidal anti-inflammatory drugs, they differed significantly in their views on the circumstances under which these drugs should be used. Clear guidelines on the prescription of these drugs would indicate when careful monitoring is essential for patients to benefit from them safely.

Cross-sectional study of rheumatoid arthritis treatment in a university hospital

Drug prescribing patterns for the management of inpatients and outpatients with rheumatoid arthritis (RA) were investigated. The population of patients resembled published epidemiological descriptions of RA patients with respect to age and sex distribution. Multiple drug therapy was common in the treatment of both hospitalised and clinic patients. 90% of all patients with RA received non-steroidal anti-inflammatory drug (NSAID) therapy, indomethacin and naproxen being the two most frequently prescribed NSAIDs for both in- and outpatients. The vast majority of inpatients (85%) and outpatients (79%) received slow-acting antirheumatic drug (SAARD) treatment. 13% of hospitalised patients received H2-antagonist drugs in addition to their NSAIDs. A high proportion of inpatients (46%) received oral corticosteroids in the management of their rheumatoid arthritis, while only 15% of clinic patients were prescribed corticosteroids.