Nonsteroidal anti-inflammatory drugs reduce the inflammation that accompanies arthritis.
NSAIDs work by preventing an enzyme called cyclooxygenase (COX) from making hormone-like chemicals called prostaglandins. Prostaglandins are one of the body’s biggest contributors to inflammation.
Your body makes two different kinds of cyclooxygenase: COX-1 helps protect your stomach lining and COX-2 plays a role in inflammation. Most NSAIDs are nonspecific, meaning they interfere with both COX-1 and COX-2. While this helps relieve pain and inflammation, it also leaves your stomach vulnerable to ulcers and bleeding.
A specific type of NSAID, called a selective COX-2 inhibitor, blocks the COX-2 enzyme more than the COX-1 enzyme. The only selective COX-2 NSAID currently available in the United States is the prescription drug celecoxib (Celebrex).
Choosing an NSAID
The different NSAIDs work similarly, but some people respond better to one than another. If you’re just starting on NSAIDs, your doctor will likely have you try an over-the-counter (OTC) option. If you don’t get good relief, your doctor can switch you to another one.
Ibuprofen and naproxen are available in both OTC and prescription versions. OTC versions come in about half the strength of the prescription versions. At these lower doses, NSAIDs provide only pain relief. The anti-inflammatory benefits of NSAIDs are achieved at the higher doses found in prescription medicines.
The pain-relieving effects of NSAIDs begin quickly -- within a few hours. However, swelling and warmth in joints may take longer to get better; it can take up to two weeks before you see full benefits.
If you need short-term relief during a flare or while your other arthritis medicines take effect, your doctor may prescribe a short-acting NSAID that has to be taken several times per day. But if you’ll be taking the drugs for an extended time, your doctor may select one that needs to be taken only once or twice per day. If you are at high risk for GI problems, your doctor may choose celecoxib or recommend an additional medication that protects your stomach.
Benefits and Risks
Gastrointestinal (GI) Problems:
Heart Attack and Stroke
Having an inflammatory type of arthritis (like rheumatoid or psoriatic arthritis) or diabetes or being obese already increases your odds of developing heart problems, so adding the risks of long-term NSAID use must be considered carefully.
Kidney Problems and Fluid Retention:
Interaction with Other Medicines
Side Effects and Solutions
Side Effects and Solutions
Here are some common unwanted effects of NSAIDs, and ways you can help ease them.
Gastrointestinal (GI) Problems
Stomach discomfort caused by NSAID use can usually be avoided by taking each dose after a full meal or with an antacid or other drug that protects the stomach.
Another option if you develop GI problems is to switch to the COX-2 selective inhibitor celecoxib (Celebrex). This drug has a lower risk of causing stomach problems than other NSAIDs.
Limit alcohol use when taking NSAIDs. It increases your risk of internal bleeding.
Be careful of combining medicines. Taking NSAIDs with a corticosteroid or a blood thinner such as warfarin (Coumadin) can increase your risk of GI bleeding. You can also cause problems if you take your prescription NSAID and then unwittingly take another medicine, such as an OTC cold remedy, that also contains an NSAID – so carefully read the label of any OTC medication you take occasionally.
The best thing you can do to prevent heart problems due to NSAID use is to reduce your other risk factors. Smoking, high blood pressure, high cholesterol and diabetes are significant risk factors for heart disease. Commit yourself to controlling, reducing or eliminating those other risk factors.
If you take medicine for high blood pressure, have your pressure checked regularly while taking NSAIDs.
If you take low-dose aspirin to prevent heart attack and stroke, some NSAIDs, including ibuprofen and naproxen, can interfere with that protective effect. So be sure to discuss NSAID choice with your doctor.
Take the lowest effective dose of NSAID for the shortest amount of time possible. And make sure you aren’t getting NSAIDs from multiple sources.
Be aware of allergic symptoms, like rash, hives, facial swelling, wheezing and difficulty breathing. If you have a mild reaction, antihistamines like diphenhydramine (Benadryl) will ease the symptoms until the medicine works its way out of your system.
If you have a serious reaction, like throat swelling or breathing difficulty, call 911 immediately.
If you know you have kidney disease, check with your doctor before you take any NSAID, including over-the-counter ones.
Simple blood and urine tests can be used to test your kidney function.
NSAID-related kidney problems are usually reversible once you stop taking these medicines.
Bruising and Bleeding
Be certain to check with your doctor or pharmacist before starting an NSAID, or any new medication or supplement, to be sure that your medications don’t interact and cause bleeding. For example, bleeding can be a serious problem if you take NSAIDs on top of blood thinners like warfarin (Coumadin). Certain herbal supplements, including willow bark, are also known to thin the blood or prevent clotting, so you must be careful about taking them together with NSAIDs.
Because of their effects on blood clotting, your doctor will tell you to stop taking NSAIDs before any surgery.
Take with food.
If you are considering long-term therapy, talk to your doctor about whether you might need a COX-2 inhibitor or an additional medication to protect your stomach.
Be aware of potential interactions with your other, regular medications and supplements, and any OTC drug you might take occasionally.
Do not use if you recently have had heart bypass surgery (CABG); talk to your doctor about using NSAIDs if you have existing heart disease.
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