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NSAIDs for Rheumatoid Arthritis

NSAIDs -- or nonsteroidal anti-inflammatory drugs -- are commonly used to treat rheumatoid arthritis (RA). NSAIDs help manage the chronic pain, inflammation, and swelling associated with RA.

NSAIDs do not slow RA progression. NSAIDs are usually used along with other RA medications, such as methotrexate or biologics. These more potent drugs also help prevent further joint damage.

Recommended Related to Rheumatoid Arthritis

Ask the Expert: I Have RA and My Husband Won't Help

In every issue of WebMD the Magazine, we ask our experts to answer readers' questions about a wide range of topics. In our May 2011 issue, a reader with rheumatoid arthritis asked WebMD's rheumatology expert, Scott Zashin, MD, why her husband doesn't help her more.

Read the Ask the Expert: I Have RA and My Husband Won't Help article > >

How Do NSAIDs Treat Rheumatoid Arthritis?

When you have pain from rheumatoid arthritis, the damaged tissue releases chemicals called prostaglandins, which are like hormones.

Prostaglandins send messages to trigger inflammation that results in pain and swelling. NSAIDs block prostaglandins by blocking Cox enzymes (specifically, Cox-1 and Cox-2 enzymes). This decreases inflammation and reduces pain and stiffness.

While prostaglandins trigger inflammation, they also send a few good messages as well, for example, protecting the stomach lining and kidneys. By blocking prostaglandins entirely, NSAIDs can sometimes cause stomach ulcers, bleeding, and even kidney damage.

NSAIDs vary in their strength and likelihood of causing side effects. It seems the more an NSAID blocks the Cox-1 enzyme, the greater the tendency is to cause stomach ulcers and promote bleeding.

What Are Some NSAIDS Used for Rheumatoid Arthritis?

  • Aspirin (Bufferin, Bayer)
  • Celecoxib (Celebrex)
  • Diclofenac (Cataflam, Voltaren)
  • Diflunisal (Dolobid)
  • Etodolac (Lodine)
  • Fenoprofen (Nalfon)
  • Flurbiprofen (Ansaid)
  • Ibuprofen (Advil, Motrin)
  • Indomethacin (Indocin)
  • Ketoprofen (Oruvail, Orudis)
  • Ketorolac (Toradol)
  • Meloxicam (Mobic)
  • Nabumetone (Relafen)
  • Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
  • Oxaprozin (Daypro)
  • Piroxicam (Feldene)
  • Salsalate (Amigesic)
  • Sulindac (Clinoril)
  • Tolmetin (Tolectin)

Arthrotec is an NSAID that combines diclofenac with another active ingredient, misoprostol, to help prevent stomach irritation.

Prevacid Naprapac combines naproxen with the acid blocker Prevacid to reduce the chance of developing stomach ulcers. Vimovo is a combination of naproxen and the acid blocker Nexium. 


What Is a Cox-2 Inhibitor?

Cox-2 inhibitors are a newer form of prescription NSAID and work similarly to older NSAIDs. However, Cox-2 inhibitors are less likely to cause stomach problems, such as ulcers.

Cox-2 inhibitors offer the same pain relief as standard NSAIDs but have a lower risk of stomach problems.

Celebrex is the only Cox-2 inhibitor.

Do All NSAIDs Increase Risk of Heart Attack and Stroke?

All prescription NSAIDs are linked to an increased risk of heart attack and stroke.

Doctors first became aware of the link between NSAIDs and heart disease and stroke with the Cox-2 inhibitor Vioxx. Vioxx was removed from the market because of the link with heart attacks and stroke.

Now, a strong black box warning is on all prescription NSAIDs to alert consumers of this increased risk.

While the actual risk of heart attack and stroke with NSAIDs is unknown, there are medical studies in progress to help find that answer. The risk is likely greatest for people with heart disease risk factors, such as high blood pressure, high cholesterol, diabetes, and smoking.

You and your doctor can decide if NSAIDs are right for you. Many people with rheumatoid arthritis take NSAIDs for relief of pain and swelling.

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