A drug group which inhibits the enzyme cyclo-oxygenase and is more selective than its predecessor group, the non-steroidal anti-inflammatory drugs (NSAIDS), and so is claimed to be less likely to cause gastrointestinal side-effects. The national institute for clinical excellence (NICE) recommended in 2001 that these drugs (which include celecoxib, etodolac and meloxicam) should not be used routinely in rheumatoid arthritis or osteoarthritis. They should rather be used in preference to standard NSAIDs for patients with a history of gastroduodenal ulcer, perforation or gastrointestinal bleeding. They are also advised instead of NSAIDS for those at high risk of such ill-effects, such as those over 65 or taking other medications that affect the gut, those taking maximum doses of NSAIDs, or those who are debilitated.