Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

General Indications

By definition, arthritis means joint tissues become persistently inflamed. This means your joints may feel hot, red, swollen and painful, and your mobility may be affected. Many different medications work to reduce the symptoms of the pain and inflammation of arthritis. These can be divided into two broad categories: those that contain cortisone, and those that don't. The medications that do not contain cortisone are called Nonsteroidal (meaning no cortisone) Anti-Inflammatory Drugs, or NSAIDs (pronounced En-sedz).

This very large category of medications - which range from the familiar ASA (Aspirin, Entrophen, Novasen) to ibuprofen (Motrin), to the newest class of NSAIDs, the coxibs (Celebrex) and a host of others - reduce the production of certain substances that 'fuel' persistent inflammation. The list of NSAIDs is long and new ones keep being added. The newest NSAID in Canada is called meloxicam (Mobicox) - it is an anti-inflammatory which has been available in Europe for several years.

While NSAIDs have quick-acting pain-relieving properties, their real therapeutic purpose is to minimize day-to-day inflammation, which can permanently damage cartilage and bone over a short space of time. If you have inflammatory arthritis or are going through a periodic inflammatory phase of osteoarthritis, you'll need to be patient. Persistent inflammation can usually be reduced by NSAID therapy within two to four weeks of continuous use. For more severe inflammatory arthritis, rheumatologists may also prescribe a slow-acting disease-modifying drug (DMARD).

NSAIDs are used widely for a host of complaints and conditions other than arthritis. They're sometimes used to reduce the frequency of headaches or unusually painful menstrual cramps, for example; dentists prescribe NSAIDs for dental surgery, and family doctors prescribe them for back injuries, to name just a few applications. Some NSAIDs are available over-the-counter in your pharmacy and some require a prescription from your doctor. If you are taking any over-the-counter medications, it is important to let your doctor know. You should not take over-the-counter NSAIDs with the prescription NSAIDs because of the increased risk of side effects.

Take As Directed

The number of tablets and number of times you take them a day varies greatly with the type of anti-inflammatory medication. (Go to 'Commonly Prescribed NSAIDs,' after you've finished reading these general indications.) Take your NSAID exactly as prescribed by your doctor: More is not better! These medications are not like pain-relievers that can be used, within certain limits, 'as needed.' To reduce inflammation effectively, anti-inflammatories must be taken on a continuous basis and at the specific dose prescribed for you, even on days when you feel good.

Less is not better, either: Lowering your daily dose without informing your doctor isn't a good idea, since cutting back by a whole or even a half-tablet can eliminate any anti-inflammatory benefit the NSAID provides and still leave you at risk for side effects. Furthermore, if you tamper with your prescribed dosage, your doctor is no longer getting an accurate picture of how the medication is working.

Side Effects

With inflammatory arthritis, it's sometimes difficult to distinguish symptoms of the disease from side effects from the medication. Keep in mind that many health complaints, such as:

• fatigue
• flu-like symptoms
• weight loss
• hair loss
• dry eyes, mouth or vagina
• chest pain
• jaw pain
• numbness or tingling in the hands and feet

are related to the underlying disease, and not the medication.

The most common side effects of NSAIDs are constipation and indigestion, because most anti-inflammatories are acidic in nature and also promote acid production in the stomach. Other strong acid producers - and thus stomach irritants - include caffeine (coffee, tea, cola, chocolate), alcohol and nicotine. If your stomach's bothering you, try reducing your intake of these irritants. Anti-inflammatories are generally taken with food; most people find this helps reduce heartburn and indigestion.

You might also find that taking your anti-inflammatory with an eight-ounce glass of water helps: the water dilutes the acid produced by the stomach and helps dissolve the tablet. Fluid intake also helps reduce constipation. Stomach pain, heartburn and indigestion should be easily relieved by an antacid (such as Maalox , Mylanta, Gelusil, etc.). If symptoms persist, notify your doctor.

Other side effects can be more serious, particularly the risk of stomach ulceration. NSAIDs can thin the mucous lining that protects the stomach from acid and digestive juices, making you more susceptible to ulcers and bleeding. Usually, an ulcer causes severe pain, nausea and vomiting, but some ulcers produce no symptoms whatsoever. Some signs of stomach bleeding include vomit that looks like coffee grounds, and black, tarry bowel movements. In either case, see your doctor immediately.

Also, avoid taking extra non-prescription ASA or ibuprofen (Advil, MotrinIB), if you're taking a prescription anti-inflammatory as they increase the risk of stomach upset and gastrointestinal bleeding. For additional pain relief, headaches or fevers, acetaminophen is a safe alternative with a prescription anti-inflammatory.

NSAIDs can also affect your blood pressure, kidneys and liver. These are things that will need to be monitored by your doctor. If you are taking a blood thinner (e.g. warfarin), you should not use traditional NSAIDs.

NSAID Nuisances

A number of rare nuisance complaints associated with anti-inflammatories are related to too high a daily dose. Consult your doctor, if you experience:

• ringing or buzzing in the ears, or loss of hearing,
• dizziness, drowsiness, confusion, inability to concentrate
• worse headaches than usual or nightmares.

Although rare and associated with only a few anti-inflammatories, increased sun sensitivity has been reported by some people on NSAID therapy. If you're travelling south for a winter break, remember the tropical sun is many times stronger than it is in Canada. To counter this effect, use a sun screen with an SPF rating of at least 15 that protects against both UVA and UVB rays. The best advice, of course, is to stay out of the sun entirely, but if you do go out, pick your times with care: Try to avoid hours when the sun's at its strongest, and be sure to wear a broad-brimmed sun hat and long sleeves, in addition to your sun screen.

This page was last reviewed/updated on : 02/23/2008