Everyday Health—January 2, 2014
Symptoms of rheumatoid arthritis (RA) such as sore and swollen joints can leave you reaching for nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin and ibuprofen to help relieve discomfort. It’s important to realize, however, that just because these medications are available over the counter doesn’t mean they’re completely harmless — or that they’re the right choice for everyone with RA.
NSAIDs and How They Work for RA
NSAIDs help relieve RA pain and reduce inflammation, swelling, and fever. They work by decreasing the amount of prostaglandins in the body. Prostaglandins are produced by the enzymes COX-1 and COX-2 and cause inflammation. Depending on the NSAID you take, it may block both COX enzymes or just COX-2.
Proper RA treatment usually involves more than just NSAIDs, however. While these inexpensive drugs can help relieve RA pain, they don’t actually slow the progression of the disease. Therefore, it’s important to talk to your doctor about other treatment options like disease-modifying anti-rheumatic drugs or biologics along with NSAIDs.
The Risks of NSAIDs for RA
While NSAIDs can be helpful in treating RA pain, they come with some risks.
You'll want to carefully consider the amount of NSAIDs you take. “There’s no question that the risk of NSAIDs is dose-related,” says Theodore Fields, MD, director of the Rheumatology Faculty Practice Plan and attending physician at Hospital for Special Surgery in New York City. “The more you take and the longer you take it, the greater the risk.”
Finally, when taking NSAIDs for RA, be sure to watch for drug interactions. Don’t use two different NSAIDs at the same time. Also, be sure to discuss all medications and supplements you take with your doctor. Of particular concern are blood thinners and corticosteroids, but it’s a good idea to evaluate everything with your doctor before beginning prolonged use of NSAIDs.
Can Anyone Take NSAIDs for RA?
While NSAIDs are generally safe for treating RA, they aren’t right for everyone. “People with heart failure, significant fluid retention problems, significant coronary disease, and active ulcers or significant kidney problems should be extremely cautious with NSAIDs,” Dr. Fields says, “and more often than not they shouldn’t take NSAIDs at all or, if they do, always take them under the close guidance of their doctor.” Anyone with these conditions, as well as women who are pregnant or planning to get pregnant, should consult their doctor before taking any over-the-counter NSAIDs for RA.
It’s also important to know that there can be an element of trial and error when starting NSAID treatment — people respond in a variety of ways to different NSAIDs, so if one isn't working for you, another may provide better results. Fields recommends giving each NSAID at least two weeks to build up in your bloodstream in order to know whether or not it’s relieving pain sufficiently for you.
As with any RA treatment, talk to your doctor if you’re experiencing any negative side effects or new symptoms in order to adjust your treatment plan accordingly.
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