N.A.S.S Dingwall Branch Information Page

NSAIDs

NSAIDs are known as 'non-steroidal' drugs to distinguish them from corticosteroids which are powerful steroidal drugs with dramatic anti-inflammatory properties. Although effective in arthritic conditions, corticosteroids by mouth are reserved for use only after other treatments have proved unsuccessful. However, a corticosteroid injected directly into a swollen and painful joint may produce very effective short-term pain relief usually without adverse effects.

An NSAID has two separate actions. In a single dose it has similar pain-relieving activity (analgesia) to that of paracetamol and can therefore be used to ease mild or intermittent pain. Addi-tionally, if taken regularly it reduces the underlying inflammation which may be making the joint swollen, hot and very painful; paracetamol does not do this. This combination of analgesic and anti-inflammatory effects makes NSAIDs particularly useful for treating the continuous pain associated with arthritis.

Aspirin, the original NSAID, has to be taken in much higher doses and for longer periods than you would take for a headache to relieve painful arthritic conditions. It should only be taken in these higher doses on the recommendation of a doctor. When taken in regular high dosage aspirin has about the same anti-inflammatory effect as other NSAIDs, but at these doses aspirin is likely to cause unwanted effects such as stomach irritation, gastric bleeding, nausea and ringing in the ears (tinnitus). Stomach upsets can be reduced by taking aspirin after meals or in one of the many other formulations such as dispersible, buffered or enteric-coated preparations. Tinnitus, deafness and dizziness are signs of mild overdosage and will be lessened by reducing the dose.

NSAIDs do not alter the progress of arthritic conditions but reduce inflammation and therefore pain by blocking prostaglandin production. Prostaglandins are body chemicals involved in the process of inflammation and the transmission of pain, in the body's immune response and in tissue damage. NSAIDs are therefore used to treat a variety of conditions involving prostag-landin activity, for example headaches, pain following surgery, period pains, backache and soft tissue injury (muscles, tendons and ligaments), strains and sprains.

All NSAIDs have similar anti-inflammatory activity, but there is considerable variation in how individuals respond to any one

NSAID. Your doctor may need to try several different NSAIDs before you find one that suits you. Most NSAIDs are rapidly absorbed and start to relieve symptoms during the first day of treatment but a sustained effect may not be seen for a week or more. However, you should not expect pain-relief 24 hours a day nor to take on activities that were previously restricted. Your doctor will want to give each treatment a fair trial, so three weeks may be needed to assess anti-inflammatory activity. NSAIDs are usually taken by mouth as tablets or capsules, but some are now produced in cream or gel form for applying to the skin to treat strains, sprains and bruising.

You should never take two NSAID preparations at the same time. This includes taking ibuprofen bought over the counter for pain relief at the same time as a prescribed NSAID.

The main differences between the NSAIDs are in the severity and frequency of unwanted effects, such as stomach upsets and diarrhoea. Occasionally bleeding and ulceration occur in the stomach or duodenum. Other unwanted effects include ankle swelling, headache, dizziness, vertigo and tinnitus. NSAIDs can cause hypersensitivity reactions such as asthma and skin rashes and should not be used if you are allergic to aspirin or have asthma.

NSAIDs should be used with caution by older people and par-ticularly by anyone who has poor kidney, liver or heart function. Many older people have some degree of kidney impairment, so an NSAID should always be used at the lowest possible dose for the shortest time to achieve an effect. If you are over 65 your doctor should avoid prescribing an NSAID for a long period if at all possible. If long-term treatment is necessary you should not have repeat prescriptions without regular check-ups. Your doctor should check your kidney function periodically if you are taking an NSAID for any length of time. You should not take an NSAID if you are pregnant.

Sometimes an NSAID can cause fluid to be retained in the body; one of the signs is ankle swelling. If you have heart failure this will aggravate the problem further and your doctor would not usually prescribe an NSAID under these circumstances. Fluid retention can also increase blood pressure and, if this is already raised, could possibly lead to a heart attack or stroke.

If you have an active peptic ulcer, you should not take NSAIDs because they upset the stomach and may aggravate an ulcer, caus-ing serious bleeding. If you have had a peptic ulcer, you should normally avoid NSAIDs, but some people with serious rheumatic diseases may need one to relieve swelling, stiffness and pain. Your doctor may then decide to prescribe an H2-receptor blocking drug, such as ranitidine (brand name Zantac) or misoprostol (Cytotec), to prevent further injury to the stomach lining.

NSAIDS AND ALLERGIC DISORDERS

NSAIDs may cause hypersensitivity reactions. If you develop skin rashes and wheezing after taking aspirin, you may also be allergic to any of the prescribed NSAIDs or ibuprofen bought over the counter Similarly, if you have asthma and your condition worsens while taking an NSAID, stop taking the medicine and seek medical help immediately. An NSAID applied to the skin can also trigger allergic reactions or asthma because some of the drug is absorbed into the body