A study in the British Medical Journal has raised concerns about the risk of heart attack associated with a group of painkillers used for arthritis.
High doses of NSAIDs have been linked with heart attacks
Non-steroidal anti-inflammatory (NSAIDs) had already come under scrutiny after data suggested an increased risk of heart attack and stroke.
But what are the findings of the study and what do they mean for patients?
Q: What are NSAIDs?
Non-steroidal anti-inflammatory drugs are a group of painkillers, which include ibuprofen, that reduce both inflammation and pain and are commonly used by patients with arthritis.
The newest type of NSAIDs are called COX-2 inhibitors, which were developed to avoid some of the stomach problems, such as bleeding and ulcers, which can be triggered by other types of painkillers.
Q: Did we know that the drugs increased the risk of heart attack?
Experts had already concluded that the whole class of COX-2s increased the risk of heart attack and stroke, and strong warnings were added to the drug information leaflets.
One of the drugs - Vioxx (rofecoxib) - was withdrawn from the market by Merck.
There had been concerns raised over the more traditional NSAIDs but the Committee for Safety on Medicines concluded there was not enough evidence to say whether they increased the risk of heart attack or stroke or not.
What does this latest research tell us?
By pooling data from all trials of NSAIDs which had recorded data on cardiovascular problems, researchers have quantified the risk associated with different types of the drugs.
They found a similar increased risk of heart attack or stroke with COX-2 drugs and with high doses of two other painkillers - ibuprofen and diclofenac - compared with patients taking placebo.
But the absolute risk is very small, equating to three extra heart attacks or strokes for every 1,000 patients who take the drugs for a year.
Should I stop taking anti-inflammatory painkillers?
The doses of painkillers such as ibuprofen that can be bought over the counter are very low and do not carry any risk of heart attack.
Likewise, people taking high-doses of the drugs for a short period of time, for example if they have an injury, are very unlikely to have an increased risk of heart attack.
This study found that only very high doses of ibuprofen, 800mg three times a day which is double the daily recommended dose - carry an increased risk.
This type of dose will only be given on prescription to people with severe chronic pain such as those with arthritis.
Should people who take high-doses stop using the drugs?
These medications are vital to people with arthritis to control their pain.
If people have concerns they can talk to their doctor about the options available but as long as they are aware of the risks they are free to choose.
The risk is very small, and many patients feel the benefits outweigh any side-effects.
As a precaution, it is recommended that people take the lowest dose they can manage for the shortest possible time.