From the Guidelines
For a 90-year-old female with an inflamed left wrist, acetaminophen (Tylenol) would be the safest first-line option, though it's technically not an NSAID. If an NSAID is necessary, a low-dose, short-term course of naproxen (220mg twice daily with food) or ibuprofen (200mg three times daily with food) for 3-5 days would be reasonable, as supported by the EULAR evidence-based recommendations for the management of hand osteoarthritis 1. The medication should be taken with food to reduce gastrointestinal irritation. Topical NSAIDs like diclofenac gel applied to the wrist 3-4 times daily may be even safer as they minimize systemic absorption, as recommended by experts' propositions developed through three Delphi rounds 1. In elderly patients, all NSAIDs carry increased risks of gastrointestinal bleeding, kidney injury, and cardiovascular events, highlighting the need for caution and monitoring for side effects including stomach pain, black stools, swelling, or shortness of breath 1. Non-pharmacological approaches should also be employed, including rest, ice for 15-20 minutes several times daily, compression with a light wrist wrap, and elevation. If symptoms persist beyond 5-7 days or worsen, medical evaluation is necessary to rule out fracture or other serious conditions. It's essential to consider the patient's individual characteristics, such as comorbidity and co-medication, when deciding on the treatment approach, as emphasized by the EULAR recommendations 1. Given the potential risks and benefits, the decision to use oral NSAIDs should be based on individual patient characteristics and made after full and open discussion with the patient, with a focus on minimizing risks and optimizing quality of life 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Nonsteroidal Anti-Inflammatory Options
For a 90-year-old female with an inflamed left wrist, the choice of nonsteroidal anti-inflammatory (NSAID) should be made with consideration of the potential risks and benefits, particularly in terms of renal and cardiovascular safety.
- The study 2 compares celecoxib, rofecoxib, and acetaminophen, noting that specific COX-2 inhibitors like celecoxib offer a significant advance in therapy due to their gastrointestinal safety.
- Another study 3 focuses on the renal safety and tolerability of celecoxib, suggesting that it may offer an improved renal safety profile in patients at risk for NSAID-induced renal toxicity, including the elderly.
- A comparison between celecoxib and naproxen 4 indicates that celecoxib may spare renal hemodynamic function in healthy elderly subjects, although effects on sodium excretion and urinary prostaglandin E2 and 6-keto-prostaglandin F1alpha excretion are similar to those of nonspecific cyclooxygenase inhibitors like naproxen.
Renal Function Considerations
When considering the impact on renal function:
- The review 5 highlights that both traditional NSAIDs and COX-2 inhibitors can affect renal function, particularly in patients whose renal function is prostaglandin-dependent, leading to potential hypertension and edema.
- A study 6 analyzing the cardiorenal effects of celecoxib compared to diclofenac and ibuprofen found that celecoxib was associated with a similar incidence of hypertension or edema to diclofenac but significantly lower than ibuprofen, and had fewer initiations of antihypertensives compared to ibuprofen.
Conclusion Not Provided as per Request
Given the information and focusing on the request for a specific format without a conclusion section, the details provided aim to inform about the considerations for NSAID choice in a 90-year-old female with an inflamed wrist, emphasizing renal and cardiovascular safety.