Medications - NSAIDs

[PsA_Mod_Squad]

Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used to relieve pain and reduce minor inflammation. However, NSAIDs do not reduce the long-term damaging effects of psoriatic arthritis on the joints.

For PsA, NSAIDs must be taken continuously and at a high dose to have an antiinflammatory effect. Although commonly sold over the counter for pain relief, NSAIDs rarely have an immediate effect.Generally a week to ten days will give you an indication if they will work for you.

NSAIDs work to reduce pain and inflammation by inhibiting enzymes, called cyclooxygenases. By inhibiting cyclooxygenases, NSAIDs help to prevent and/or reduce pain and inflammation. Cyclooxygenase enzyme inhibition is also responsible for many of the side effects of NSAIDs.

There are two main types of NSAIDs, nonselective and selective. The terms nonselective and selective refer to different NSAIDs’ ability to inhibit specific types of cyclooxygenase (COX) enzymes. Nonselective NSAIDs – Nonselective NSAIDs inhibit both COX-1 and COX-2 enzymes to a significant degree.Selective NSAIDs – Selective NSAIDs inhibit COX-2, an enzyme found at sites of inflammation, more than the type that is normally found in the stomach, blood platelets, and blood vessels (COX-1).

Nonselective NSAIDs include drugs commonly available without prescription, such as aspirin, ibuprofen (Advil, Motrin, Nuprin), and naproxen (Aleve), as well as many prescription-strength NSAIDs.

Selective NSAIDs (also called COX-2 inhibitors) are as effective in relieving pain and inflammation as nonselective NSAIDs and are less likely to cause gastrointestinal injury. Celecoxib (Celebrex) is a selective NSAID that is available in the United States. Other selective NSAIDs that can be found elsewhere in the world include etoricoxib (Arcoxia) and lumiracoxib (Prexige).

Selective NSAIDs are sometimes recommended for people who have had a peptic ulcer, gastrointestinal bleeding, or gastrointestinal upset when taking nonselective NSAIDs. Selective NSAIDs have less potential to cause ulcers or gastrointestinal bleeding. NSAIDS have significant side effects, including gastrointestinal bleeding, fluid retention, and an increased risk of heart disease. The risks need to be weighed carefully against the benefit when taking these drugs.

Most people tolerate NSAIDs without any difficulty. However, side effects can occur. The most common side effects include high blood pressure, stomach problems including ulcers, liver and kidney dysfunction and ringing in the ears (tinnitus)

The risk of developing stomach problems can be reduced by taking an anti-ulcer medication in addition to an NSAID. Anti-ulcer agents that reduce gastrointestinal damage from NSAIDs include those that inhibit stomach acid production such as antacid histamine blockers, such as famotidine (Pepcid) or ordinary doses of the acid production inhibitors, such as omeprazole (Prilosec) or lansoprazole (Prevacid) Your doctor may prescribe something specific.

NSAIDs of all the medications we take most often cause the most and most serious side effects, if for no other reason than people overlook the potential problems. Only the steroids are more dangerous to our systems. Long term use of NSAIDs should include regular blood work. Make sure your rheumatoligist is managing the use of these powerful drugs. NSAIDS should never be self prescribed long term.

[tntlamb]

Diclofenac Flector, Voltaren, Arthrotec

One of the more common NSAIDS for PsA is Diclofenac. It was perhaps the most commonly used for a period until it fell out of favor because of its effects on the GI system. More recently however it has found its way back into the arsenal because of the Risks involved with the COX –2 NSAIDS discovered in early 2004.

There is continuing interest as more recent research has found it to be particularly effective with patients using Biologic and other immuno-suppresent drugs as it has been found effective against most strains of multidrug-resistant E. coli,. So it could possibly treat uncomplicated urinary tract infections caused by E Coli or even prevent them. It has also shown effectiveness in treating Salamonella and is under investigation for the treatment of tuberculosis both concerns for PsA patients.

If used with PPI or other anti-ulcer type drugs, many of the GI effects can be mitigated. They make under several different labels prescribed combination of diclofenac and mispoprostol, a synthetic prostaglandin (PGE1which protects the gastric mucosa from ulcer Arthrotec is the most common brand. None the less long term uses should also include regular blood work because of its possible effect on kidneys and the liver.

It is also used a tropical treatment both as a gel an/or time release patch (Flector or Voltaren) In combination with other treatments this has been particularly effective for many of us with a specific area of pain. Also becoming common is the use of Diclofenac in compounded medications mixed with topical anesthetic, DMSO and even capiscan for hands and other “tough” areas

These additional uses as well as its unique action may explain its high potency - it is the most potent NSAID on a broad basis. It like all medications should be discussed with your doctor.