Worldwide, NSAIDs are the most commonly used class of drugs for the treatment of arthritis and have been used for more than thirty years. The two most important facts to remember about NSAIDs are that they are prescribed to treat inflammation associated with arthritis or injury to other body tissues, and as the name indicates, NSAIDs do not contain steroids.

How NSAIDs Work

NSAIDs work by inhibiting the enzyme cyclooxygenase (COX), which catalyzes arachidonic acid to prostaglandins and leukotrienes. Prostaglandins, which can be found in nearly all tissues and organs of the body, are mediators of inflammation. NSAIDs have the ability to reduce inflammation, pain, and fever.

There are two forms of cyclooxygenase, known as COX-1 and COX-2. Older, traditional NSAIDs block both COX-1 and COX-2 enzymes. A subclass of NSAIDs, called COX-2 selective inhibitors, was marketed for the treatment of arthritis in 1999. COX-2 selective inhibitors, also referred to as COX-2 inhibitors or COX-2 drugs, were developed because they were believed to have a superior gastrointestinal profile to traditional NSAIDs, which target both forms of COX. COX-1 enzyme also has a protective effect for the lining of the stomach.

Side Effects and Contraindications

There are side effects associated with NSAIDs that should not be ignored. The esophagus, small intestine, and large intestine may become irritated from NSAID use. NSAIDs can cause stomach irritation with the possibility of more serious complications including ulcers or stomach bleeding. The bleeding may occur without warning and cause death in some cases.

Pregnant women should not take NSAIDs. People who are over sixty-five years old, people who previously had a bleeding ulcer, as well as people who take blood thinners or corticosteroid medications are more at risk for developing complications.

Many doctors recommend that people who take NSAIDs also take a medication to protect the stomach. Prilosec is sold over-the-counter; your doctor can prescribe Nexium, Protonix, Prevacid, Aciphex, and Cytotec.

NSAIDs can also cause kidney problems, fluid retention, high blood pressure, heart failure, and liver problems in certain patients. Your doctor can monitor for adverse effects associated with NSAID use by performing routine blood tests. You should try to find the lowest effective dose of the NSAID you are using, as the risk of side effects will be less.

Drug Class: NSAIDs

There are some drugs that are classified as NSAIDs:

• Motrin (ibuprofen)

• Naprosyn (naproxen)

• Orudis (ketoprofen)

• Ansaid (flurbiprofen)

• Arthrotec (diclofenac sodium/misoprostal)

• Cataflam (diclofenac potassium)

• Clinoril (sulindac)

• Daypro (oxaprozin)

• Dolobid (diflunisal)

• Feldene (piroxicam)

• Indocin (indomethacin)

• Lodine (etodolac)

• Meclomen (meclofenamate sodium)

• Mobic (meloxicam)

• Nalfon (fenoprofen calcium)

• Ponstel (mefenamic acid)

• Relafen (nabumetone)

• Tolectin (tolmetin sodium)

• Voltaren (diclofenac sodium)

Salicylates are another subset of NSAIDs:

• Aspirin

• Disalcid (salsalate)

• Magnesium salsalate

• Trilisate (choline magnesium trisalicylate)

The COX-2 selective NSAIDs include:

• Celebrex

• Vioxx (no longer marketed)

• Bextra (no longer marketed)

Individual patient response to a particular NSAID can vary, making it necessary for some patients to try several different NSAIDs before determining which is most effective. NSAIDs can be taken with other arthritis medications. You can take an NSAID with a DMARD, analgesic, steroid, or biologic drug. However, you should not use two NSAIDs together.