NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

NSAIDs are often considered a second line of defense against arthritis pain.  They are usually used for their pain relieving side effects as opposed to their anti- inflammatory affects.

Inflammation is responsible for many of the damaging effects of joint cartilage and is a key component of OA.  Inflammation causes chemical wear.  Controlling inflammation is critical to controlling cartilage damage.

NSAIDs are available over the counter and are fairly inexpensive. Some popular forms include aspirin, ibuprofen (Motrin, Advil), naproxen (Alleve, Naprosyn), and ketoprofen.  If necessary, prescription strength NSAIDs (Relafen, Voltaren, Mobic) may be obtained through a physician. They prevent inflammation by inhibiting cyclooxygenase enzymes that promote the production of prostaglandins, thromboxanes, and prostacyclin.  These are all inflammatory mediators.1

Many studies have demonstrated reduced pain and swelling and increased functional scores when taking NSAIDs.

Kivitz et al performed a randomized study comparing naproxen, Celebrex and placebo for the treatment of hip OA. The researchers studied 1061 patients taking varying doses of the three drugs. The results showed that regardless of the dosage, naproxen and Celebrex were both more effective than placebo at treating the symptoms of hip OA. They also found naproxen to be just as effective as Celebrex in treating pain associated with hip OA.

Caution should be used when taking NSAIDs as they can cause stomach irritation, bleeding, and or ulcers. NSAIDs are contraindicated for patients over 65 years of age who take corticosteroids, are diabetic, have a history of stomach ulcers, kidney, or liver problems.

It has been suggested that as many as 16,000 deaths per year may be linked to complications of taking NSAIDs.  This number may or may not be accurate, but certainly should alert one’s attention to the potential effects of taking this medication.

NSAIDs have been correlated with elevations in blood pressure, renal failure and worsening of symptoms of congestive heart failure in some patients. 

Though the benefits of NSAIDs are clear, one should exercise caution when taking NSAIDs for extended periods.  It seems prudent that these medications should be taken on an intermittent basis and one should consider “drug holidays” when taking for long periods.  Consider alternating with Tylenol, for instance.  Annual blood work and medical examination is recommended.