NSAIDs

A 58-year-old man with a 10-year history of osteoarthritis of the knee presents with severe joint pain. He has been taking ibuprofen 400 mg three times daily for the past 6 months with good symptomatic relief. On examination, he has a blood pressure of 148/92 mmHg (previously 130/80 mmHg 6 months ago). His serum creatinine has risen from 0.9 mg/dL to 1.4 mg/dL, and urinalysis shows mild proteinuria. He denies any other systemic symptoms. What is the most appropriate next step in management?

A 52-year-old woman with rheumatoid arthritis has been taking naproxen 500 mg twice daily for 8 months with good disease control. She now presents with epigastric pain, nausea, and dark stools for 2 days. Her hemoglobin has dropped from 12.5 g/dL to 10.2 g/dL. Upper endoscopy reveals a 1.5 cm gastric ulcer with active bleeding (Forrest IIb). The ulcer is successfully treated with endoscopic hemostasis. What is the most appropriate next step in management?

A 48-year-old woman with rheumatoid arthritis (RA) and a 10-year history of well-controlled hypertension on amlodipine presents with moderate joint pain and swelling. She requires a long-acting NSAID for disease-modifying therapy adjunct. Which NSAID is the drug of choice for chronic RA management with the most favourable cardiovascular and renal safety profile?

A 58-year-old man with a 10-year history of osteoarthritis of the knees presents to the outpatient clinic. He has been taking ibuprofen 400 mg three times daily for the past 6 months for pain relief. On examination, his blood pressure is 148/92 mmHg (previously 130/80 mmHg 6 months ago). Serum creatinine has risen from 0.9 mg/dL to 1.4 mg/dL. Urinalysis shows mild proteinuria (1+). He denies any history of diabetes or primary renal disease. Which of the following mechanisms best explains the renal dysfunction observed in this patient?

A 52-year-old woman with rheumatoid arthritis has been on naproxen 500 mg twice daily for 3 years. She now presents with epigastric pain, nausea, and dark tarry stools for 2 days. Upper endoscopy reveals a 1.5 cm gastric ulcer with active bleeding. She has no history of Helicobacter pylori infection (eradicated 5 years ago). Her hemoglobin is 8.2 g/dL (baseline 12 g/dL). After endoscopic hemostasis, which of the following is the most appropriate next step in her long-term management to prevent ulcer recurrence?