Non-steroid anti-rheumatic drugs (NSAR): reducing pain and inflammation

Nonsteroidal antirheumatics (NSAR) are useful for those arthritis patients who suffer from pain, inflammation or both – especially for those who suffer from inflammatory types of arthritis such as rheumatoid arthritis and ankylosing spondylitis.

First-line defense drugs

If you are taking a drug to alleviate arthritis pain, it is probably one of the many NSAR drug s that are on the market. ''Nonsteroidal'' means that these drugs don't contain prednisolon or any other corticosteroid drugs which also have anti-inflammatory effects. NSAR drugs are used against pain caused by arthritis as well as other kinds of pain, including headaches, menstrual pain and toothache.

Patients who are known to have had asthma attacks, rashes or any other allergic reactions to aspirin should avoid NSAR drugs.

Aspirin, first put on the market in 1900, is now classified as an NSAR drug. All NSAR drugs have some things in common; they alleviate pain in small doses, and they alleviate both pain and inflammation i larger doses. Many people who suffer from osteoarthritis take NSAR drugs to reduce pain but most of them don't need large doses, since OA usually doesn't cause inflammation. However, for people suffering from OA and also suffering from inflammation or those suffering from any type of inflammatory arthritis, taking larger doses of NSAR drugs to reduce inflammation can be a great help, since inflammation damages joints and causes a great amount of pain. Many NSAR drugs can be bought over-the-counter, among the rest, ibprofen. They are available under many trade names, and some of them presuppose higher doses and are sold only on prescription.

How to take NSAR drugs and not upset your stomach

Gastrointestinal upset is one of the most common (and also most serious) problems that come with NSAR drugs. However, if you are taking NSAR drugs to treat arthritis, here are some precautions you can take to ensure that you do not upset your stomach:

  1. Take your drug with a glass of water during a meal.
  2. Don't lie down after you have taken the drug; wait at least 15-30 minutes
  3. Limit your alcohol intake as much as possible, since taking NSAR drugs and drinking alcohol can increase risk of gastrointestinal upset
  4. Ask your physician if it is possible to take some days to pause and not take the drug. A few days of rest after a few days of taking the drug can give the stomach time to regenerate. If pain and inflammation become too heavy during the pause, you can perhaps replace NSAR drugs with a paracetamol.
  5. Consult your physician before taking various NSAR drugs simultaneously, even if you intend to take them in small doses. Combining various NSAR drugs in doses that have an anti-inflammatory effect can significantly increase the risk of gastrointestinal upset.
  6. If you are taking aspirin occasionally, some types of aspirin that contain substances that reduce gastric acid levels (such as buffered aspirin) can reduce stomach upset, although they are not necessarily gentler for the stomach after a continuous use. Also, coated aspirin can help. The special coating prevents the aspirin to dissolve in the stomach; instead, it dissolves in the small intestine. However, a certain disadvantage of this NSAR is that you will have to wait longer to feel the effects because of the coating.

"For" and "against" NSAR drugs

NSAR drugs prevent the forming of prostaglandines, chemicals that cause pain. NSAR drugs suppress the effect of ''bad'' prostaglandines by blocking the enzyme cyclooxygenase 2 (COX-2).

Unfortunately, besides blocking COX-2, standard NSAR drugs also block COX-1 which produces 'good' prostalglandines that protect the stomach wall and other parts of the gastrointestinal system by regenerating their mucosa. Without that mucous layer, the ever-present acetic and eroding juices can damage the gastrointestinal system. It is not surprising that NSAR drugs used in large doses (which is the reason why they are available only on prescription) will more probably cause problems than those NSAR drugs that are available over-the-counter.

If you are at a higher risk of having gastrointestinal complications, you should maybe try a combination of diclofenac and misoprostol. This drug mixes diclofenac NSAR with misoprostol, artificial prostalglandines that help protect the gastrointestinal system.

Even if they help reduce pain and inflammation, NSAR drugs can cause severe gastrointestinal problems, including ulcers and severe bleeding. In UK, 1-2 % of all patients taking NSAR drugs are admitted to hospital because of severe gastrointestinal issues every year, and these drugs are estimated as the cause of death in 2500-3000 cases. However, this statistics should be perceived from a different angle as well: NSAR drugs are one of the most common types of drugs, and most people that are taking them have no serious complications.

Choosing the right NSAR

All NSAR drugs basically function in the same way, so they are expected to be beneficial to patient's health no matter which NSAR drug they are taking. However, patients suffering from arthritis very often have a specific reaction to NSAR drugs, so for patients who have no positive effect from a certain NSAR drug, another NSAR drug could be extremely beneficial. Sometimes patients have to try several NSAR drugs before they find the right one, and that means to find the drug which helps and does not cause side effects. The general rule is that if a certain NSAR drug works, it effects will be visible in 7-14 days.

The American rheumatology faculty recommends osteoarthritis patients to avoid indometacin, since research has shown that a continuous use of that NSAR can actually speed up cartilage deterioration. In UK, this drug is usually avoided, and is replaced by ibuprofen that carries less risk of gastrointestinal problems.

Source: an excerpt from the book "Living with arthritis"

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