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 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