Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
The NSAIDs comprise a large and chemically diverse group of drugs that possess analgesic, anti-inflammatory, and antipyretic properties. Pain and inflammation are common problems in patients with SLE, and NSAIDs are usually the drugs of choice for patients with mild SLE with little or no organ involvement. Patients with serious organ involvement may require more potent anti-inflammatory and immunosuppressive drugs.
Types of NSAIDs
There are as many as 70 NSAIDs on the market, and new ones are constantly becoming available. Some can be purchased as over-the-counter preparations, whereas larger doses of those drugs or other preparations are available only by prescription. For example, prescriptions are required for diclofenac sodium (Voltaren), indomethacin (Indocin), diflunisal (Dolobid), and nabumetone (Relafen).
Mechanism of Action and Use
The therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating joint pain and swelling and muscle pain. They may also be used to treat pleuritic chest pain. An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.
Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. In addition, patients may do well on one NSAID for a period of time, then, for some unknown reason, derive no benefit from it. Switching the patient to a different NSAID should produce the desired effects. Patients should use only one NSAID at any given time.
Gastrointestinal: Dyspepsia, heartburn, epigastric distress, and nausea; less frequently, vomiting, anorexia, abdominal pain, GI bleeding, and mucosal lesions. Misoprostol (Cytotec), a synthetic prostaglandin that inhibits gastric acid secretion, may be given to prevent GI intolerance. It prevents gastric ulcers and their associated GI bleeding in patients receiving NSAIDs.
Hepatic: Acute reversible hepatotoxicity.
Hematologic: Altered hemostasis through effects on platelet function.