Nonsteroidal Anti-Inflammatory Drugs for Arthritis
What are nonsteroidal anti-inflammatory drugs (NSAIDs)?
NSAIDs are drugs that can reduce pain, fever, and inflammation. Inflammation is the body's protective response to irritation or injury and is recognized by redness, warmth, swelling, and pain. NSAIDs can be used to treat the symptoms of many types of arthritis and soft tissue inflammation such as tendonitis, bursitis, and sprains. It can also be used for gout attacks.
It is important to remember that NSAIDs treat the symptoms and do not cure arthritis. These drugs only work as long as you are taking them. There are lower dosages of NSAIDs available over the counter, but higher dosages of most of these drugs require a doctor's prescription.
How do NSAIDs work?
NSAIDs block the production of certain body chemicals called prostaglandins that are involved in inflammation and pain. More specifically, NSAIDs work by blocking an enzyme called cyclooxygenase (COX).
Are all NSAIDs the same?
There are no major differences between NSAIDs in their ability to reduce pain and inflammation. However, each patient may respond differently to each class of NSAIDs. Also, for patients with certain medical conditions, some NSAIDs may be safer to take than others. Some NSAIDs may be more convenient for patients, since they need to be taken only once or twice a day. Generic drugs are available for some NSAIDS and are less expensive than brand name drugs.
How are NSAIDs prescribed?
When you are prescribed a particular NSAID, your health care provider balances the risks and benefits of your medical condition with the safety, convenience, and cost of the NSAID. NSAIDs are prescribed in different dosages, depending on your condition and other medical problems. Your health care provider may prescribe higher dosages of NSAIDs if you have rheumatoid arthritis, for example, because often there is a lot of swelling, redness, and stiffness in the joints. You may be prescribed NSAIDs for the short term when treating an injury or overuse conditions. Lower dosages may be all that is needed for osteoarthritis that affects only one joint or for short-lasting muscle injuries, since there is generally less swelling and usually no warmth or redness to the joints.
No single NSAID is guaranteed to work. Your health care provider may need to prescribe several types of NSAIDs to find the one that works best for you.
When taking NSAIDs, be sure to follow your doctor's orders or the directions on the label. If you are having more pain or a sudden increase in pain, do not increase your dosage of NSAIDs without talking to your doctor. Higher than recommended doses of NSAIDs or taking more than one type of NSAID at one time can increase your chances of having side effects.
What are some common side effects of NSAIDs?
Although NSAIDs are pretty safe drugs, it is important that you are familiar with the most common side effects, especially if you need to take NSAIDs chronically (for months or years).
The side effects can range from mild (they go away when the dosage is reduced), to life-threatening (requiring hospitalization).
Common side effects:
- Stomach pain or heartburn – this is the most common side effect.
- Stomach ulcers – as many as 5% of patients may develop a stomach ulcer while taking NSAIDs. Ulcers may cause stomach pain, but some ulcers develop with no pain at all.
- Bleeding – NSAIDs (especially aspirin) increase the tendency to bleed in general (not just from ulcers). You should not take NSAIDs before surgery. NSAIDs should be avoided if you are taking blood-thinning medications (such as Coumadin®).
- Increased risk of cardiovascular events (stroke or heart attack) especially when they are used for long periods of time or in very high-risk settings (immediately after heart surgery).
- Blood pressure elevation.
- Headaches, dizziness, lightheadedness, or a decrease in alertness (less awareness/readiness, ability to respond quickly).
- Ringing in the ears – may be due to treatment with salicylates, including aspirin. This can be eliminated by decreasing the dosage.
- Allergic reactions – rashes, wheezing and throat swelling rarely occur.
- Liver or kidney problems are rare side effects. These problems can be evaluated by blood tests in patients who take NSAIDs for long periods of time. People with any kidney problems should not take NSAIDs for long periods of time.
*Please note: The side effects listed are the most common. All possible side effects are not included. Always contact your health care provider if you have questions about your particular medication.*
For those patients who need to take prescription NSAIDs for long periods of time, careful monitoring (including blood work), can help reduce your risk of side effects. However, serious side effects including ulcers, bleeding, and obstruction can occur without any warning.
If you need to take an over-the-counter NSAID every day for more than two weeks, talk with your health care provider. Over-the-counter NSAIDs are effective pain-relievers, but they are intended for short-term use. When taking NSAIDs for long periods of time, you should be carefully monitored by your health care provider so he or she can detect harmful side effects and modify your treatment if necessary.
What side effects should I tell my healthcare provider about right away?
It is important to call your doctor if you experience any of the following side effects:
- Fluid retention (recognized by swelling around the ankles, feet, lower legs, hands, and possibly around the eyes)
- Unusual weight gain
- New occurrence of black, tarry stools in patients not taking iron pills
- Vomiting, especially if blood is present in vomit
Who is more likely to develop ulcers while taking NSAIDs?
It is impossible to predict if someone will develop an ulcer while taking NSAIDs. However, several factors may place a person at high risk for developing an ulcer while taking NSAIDs:
- Over 65 years old
- Previous history of stomach ulcers
- Multiple medical problems
- Use of prednisone or blood thinning medication when taking NSAIDs
- Kidney failure (partial or complete)
How can side effects be minimized?
There is no way to completely avoid the side effects of any drug, but there are strategies you and your doctor can use to reduce your risk of developing some side effects:
- Take the NSAID with food to reduce the risk of stomach symptoms. Contact your health care provider if your stomach symptoms are not relieved after a few days of taking the drug with food.
- Use acetaminophen (such as Tylenol®) instead of NSAIDs, especially if you are at high risk of developing an ulcer or know that you have an ulcer.
- Use coated aspirin (such as Ecotrin®) so the medication does not directly irritate your stomach.
- Avoid once-a-day types of NSAIDs – especially if you are over age 65. These medications stay in your body longer and may not be as safe.
- Ask your health care provider about taking a stomach acid blocker such as omeprazole (Prilosec® or Nexium®) or a stomach protector like misoprostol (Cytotec®) if you have an increased risk of ulcers.
- Always take the lowest possible dosage and use for the shortest time period to help control symptoms.
- Be aware of all possible side effects of NSAIDs, especially the more serious ones, and report these changes to your doctor.
Can I take NSAIDs if I'm being treated for high blood pressure?
Nonsteroidal anti-inflammatory agents can raise blood pressure in some people. Some people with known high blood pressure (hypertension) may have to stop taking NSAIDs if blood pressure increases in spite of taking their blood pressure medications as directed by their doctor.