NSAIDs -- or nonsteroidal anti-inflammatory drugs -- are commonly used to treat rheumatoid arthritis (RA). NSAIDS help manage the chronic pain, inflammation, and swelling associated with RA.
NSAIDs do not slow RA progression. If there is not good relief of RA symptoms with NSAIDs, your doctor may add other medications. Medications such as methotrexate or biologics help ease RA symptoms when NSAIDs aren't enough. These more potent drugs also help prevent further joint damage.
Prostaglandins send messages to trigger inflammation that results in pain and swelling. NSAIDs block prostaglandins by blocking Cox enzymes (specifically, Cox-1 and Cox-2 enzymes). This decreases inflammation and reduces pain and stiffness.
While prostaglandins trigger inflammation, they also send a few good messages as well, for example, protecting the stomach lining and kidneys. By blocking prostaglandins entirely, NSAIDs can sometimes cause stomach ulcers, bleeding, and even kidney damage.
NSAIDs vary in their potency and how they are eliminated from the body. It seems the more an NSAID blocks the Cox-1 enzyme, the greater the tendency is to cause stomach ulcers and promote bleeding.
Prevacid Naprapac combines naproxen with the acid blocker Prevacid to reduce the chance of developing stomach ulcers. Vimovo is a combination of naproxen and the acid blocker Nexium.
Cox-2 inhibitors offer the same pain relief as standard NSAIDs but have a lower risk of stomach problems.
Celebrex is the only Cox-2 inhibitor.
Doctors first became aware of the link between NSAIDs and heart disease and stroke with the Cox-2 inhibitor Vioxx. Vioxx was removed from the market because of the link with heart attacks and stroke.
After much research, the FDA decided to put a strong black box warning on all prescription NSAIDs to alert consumers of this increased risk.
While the actual risk of heart attack and stroke with NSAIDs is unknown, there are medical studies in progress to help find that answer. The risk is likely greatest for people with heart disease risk factors, such as high blood pressure, high cholesterol, diabetes, and smoking.
You and your doctor can decide if NSAIDs are right for you. Many people with rheumatoid arthritis take NSAIDs for relief of pain and swelling.
Side effects vary from one NSAID to another. The most common side effects include:
The chance of getting an ulcer or stomach bleeding increases even more if you also take corticosteroids and/or blood thinners, or anticoagulants. Also, the longer you use NSAIDs, the greater the risk of stomach bleeding and ulcers. Older adults have an increased risk of stomach bleeding and ulcers, as do those who drink alcohol and smoke cigarettes.
There are ways to reduce the risk of stomach irritation when taking NSAIDs for rheumatoid arthritis. People at high risk of stomach bleeding may need a strong stomach acid blocker to help prevent ulcers.
If you take NSAIDs to ease the inflammation, pain, and stiffness of RA, be sure to talk with your doctor about ways to protect your stomach.
Since NSAIDs can affect the kidneys, your doctor will likely check your kidney function from time to time. This is a simple blood test.
If you have asthma, make sure your arthritis doctor knows. Certain NSAIDs may be safer for you. You and your doctor can determine if NSAIDs are right for you.
Be sure your doctor is aware of all drugs and supplements you are taking. NSAIDs may interact with blood thinners, cyclosporine, lithium, or methotrexate. Be sure to let your doctor know if you are sensitive to aspirin.
NSAIDs do not slow RA progression. If there is not good relief of RA symptoms with NSAIDs, your doctor may add other medications. Medications such as methotrexate or biologics help ease RA symptoms when NSAIDs aren't enough. These more potent drugs also help prevent further joint damage.
RAtv from WebMD
Related content
© 2009 WebMD, LLC. All rights
reserved.
How Do NSAIDs Treat Rheumatoid Arthritis?
When you have pain from rheumatoid arthritis, the damaged tissue releases chemicals called prostaglandins, which are like hormones.Prostaglandins send messages to trigger inflammation that results in pain and swelling. NSAIDs block prostaglandins by blocking Cox enzymes (specifically, Cox-1 and Cox-2 enzymes). This decreases inflammation and reduces pain and stiffness.
While prostaglandins trigger inflammation, they also send a few good messages as well, for example, protecting the stomach lining and kidneys. By blocking prostaglandins entirely, NSAIDs can sometimes cause stomach ulcers, bleeding, and even kidney damage.
NSAIDs vary in their potency and how they are eliminated from the body. It seems the more an NSAID blocks the Cox-1 enzyme, the greater the tendency is to cause stomach ulcers and promote bleeding.
What Are Some NSAIDS Used for Rheumatoid Arthritis?
- Aspirin (Bufferin, Bayer)
- Celecoxib (Celebrex)
- Diclofenac (Cataflam, Voltaren)
- Diflunisal (Dolobid)
- Etodolac (Lodine)
- Fenoprofen (Nalfon)
- Flurbiprofen (Ansaid)
- Ibuprofen (Advil, Motrin)
- Indomethacin (Indocin)
- Ketoprofen (Oruvail, Orudis)
- Ketorolac (Toradol)
- Meloxicam (Mobic)
- Nabumetone (Relafen)
- Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- Oxaprozin (Daypro)
- Piroxicam (Feldene)
- Salsalate (Amigesic)
- Sulindac (Clinoril)
- Tolmetin (Tolectin)
Prevacid Naprapac combines naproxen with the acid blocker Prevacid to reduce the chance of developing stomach ulcers. Vimovo is a combination of naproxen and the acid blocker Nexium.
What Is a Cox-2 Inhibitor?
Cox-2 inhibitors are a newer form of prescription NSAID and work similarly to older NSAIDs. However, Cox-2 inhibitors are less likely to cause stomach problems, such as ulcers.Cox-2 inhibitors offer the same pain relief as standard NSAIDs but have a lower risk of stomach problems.
Celebrex is the only Cox-2 inhibitor.
Do All NSAIDs Increased Risk of Heart Attack and Stroke?
All prescription NSAIDs are linked to an increased risk of heart attack and stroke.Doctors first became aware of the link between NSAIDs and heart disease and stroke with the Cox-2 inhibitor Vioxx. Vioxx was removed from the market because of the link with heart attacks and stroke.
After much research, the FDA decided to put a strong black box warning on all prescription NSAIDs to alert consumers of this increased risk.
While the actual risk of heart attack and stroke with NSAIDs is unknown, there are medical studies in progress to help find that answer. The risk is likely greatest for people with heart disease risk factors, such as high blood pressure, high cholesterol, diabetes, and smoking.
You and your doctor can decide if NSAIDs are right for you. Many people with rheumatoid arthritis take NSAIDs for relief of pain and swelling.
What Are the Side Effects of NSAIDs?
Most people take NSAIDs with few to no side effects. However, some people do have stomach pain, and NSAIDs may cause stomach ulcers.Side effects vary from one NSAID to another. The most common side effects include:
- Stomach problems, including pain, constipation, diarrhea, gas, nausea, and stomach ulcers
- Abnormal kidney function
- Anemia
- Dizziness
- Swelling in the legs
- Abnormal liver tests (blood tests)
- Headaches
- Easy bruising
- Ringing in the ears
Is There a Serious Risk of Stomach Ulcers With NSAIDs?
It is estimated that more than 100,000 Americans are hospitalized each year from ulcers and stomach bleeding linked to NSAID use.The chance of getting an ulcer or stomach bleeding increases even more if you also take corticosteroids and/or blood thinners, or anticoagulants. Also, the longer you use NSAIDs, the greater the risk of stomach bleeding and ulcers. Older adults have an increased risk of stomach bleeding and ulcers, as do those who drink alcohol and smoke cigarettes.
There are ways to reduce the risk of stomach irritation when taking NSAIDs for rheumatoid arthritis. People at high risk of stomach bleeding may need a strong stomach acid blocker to help prevent ulcers.
If you take NSAIDs to ease the inflammation, pain, and stiffness of RA, be sure to talk with your doctor about ways to protect your stomach.
Can I Take NSAIDs if I Have High Blood Pressure?
If you have high blood pressure or kidney disease, talk to your doctor. NSAIDs reduce the blood flow to the kidneys, which may cause them to not work as well. This causes fluid to build up in your body. The more fluid in your bloodstream, the higher your blood pressure.Since NSAIDs can affect the kidneys, your doctor will likely check your kidney function from time to time. This is a simple blood test.
Can I Be Allergic to NSAIDs?
NSAIDs can cause allergies. This is most worrisome in people with asthma. Experts aren't sure why, but some people with asthma are sensitive to NSAIDs. The drugs may worsen breathing, and many specialists recommend that people who have asthma stay away from any NSAID. The risk may be even greater in people with sinus problems or nasal polyps.If you have asthma, make sure your arthritis doctor knows. Certain NSAIDs may be safer for you. You and your doctor can determine if NSAIDs are right for you.
Are There Special Precautions for Using NSAIDs for Rheumatoid Arthritis?
NSAIDs should be used with caution if you have kidney or liver disease, heart failure, high blood pressure, diabetes, lupus, asthma, or ulcers.Be sure your doctor is aware of all drugs and supplements you are taking. NSAIDs may interact with blood thinners, cyclosporine, lithium, or methotrexate. Be sure to let your doctor know if you are sensitive to aspirin.
No comments:
Post a Comment