The Argument for Aspirin as the NSAID of Choice in the Management of Rheumatoid Arthritis

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Abstract
In view of their costliness, the use of newer NSAIDs is justified if they are demonstrably more effective, less toxic, or better tolerated than aspirin (ASA). However, there is no evidence that any is more effective than ASA, and their widely assumed comparable effectiveness has not been demonstrated convincingly. In terms of clinically meaningful overt and even occult gastrointestinal blood loss, ASA is indistinguishable from the newer NSAIDs. Most NSAIDs evoke fewer unpleasant gastrointestinal symptoms than ASA does, although current recording of such symptoms has magnified the ASA experience. Prescribing a new NSAID before ASA requires a heuristic assertion of comparable effectiveness, misconception of overt toxicities, and belief in the meaningfulness of data demonstrating differential tolerance. The trade-off is increased expense and unknown long-term toxicity.