Non-steroidal anti-inflammatory drugs (NSAIDs) remain the drug of choice for musculoskeletal pain, but when treating rheumatic disorders all the patient’s risk factors must be considered – in particular, the gastrointestinal and cardiovascular risks. Though adequate results are not yet available, there is an urgent need to set up treatment protocols with patient safety in mind. Dr Yasser el-Miedany provides a clinical guideline.