Using NSAIDs Safely and Effectively
Nonsteroidal antiinflammatory drugs (NSAIDs) still remain one of the most commonly used drugs for joint pain from osteoarthritis (OA). Changes have come about over the years to improve these drugs. Reducing side effects such as stomach bleeds and kidney problems has brought a whole new generation of NSAIDs to the market.
In this article, doctors from NYU Hospital for Joint Diseases in New York review current trends with NSAID use. Choosing the right NSAID for each patient is the first step. Acetaminophen (TylenolŪ) is still the first choice for mild OA. Tylenol is a pain reliever but not an NSAID.
When TylenolŪ is not effective, an NSAID may be needed to control pain and inflammation. Aspirin used to be the most popular NSAID. But aspirin use in some people can result in ulcers, GI bleeding, and kidney failure.
Scientists discovered that certain enzymes called cyclooxygenase (COX) were part of the problem. A new group of NSAIDs was developed to inhibit or stop one specific enzyme (COX-2). These drugs were called COX-2 inhibitors.
Over time it became apparent that some patients taking COX-2 inhibitors had higher rates of heart attack. Two of these drugs were removed from the market (Vioxx and Bextra). Celebrex is still available but no longer advertised.
The authors say that until a better product is developed, doctors should still use these drugs for patients with OA. All drugs come with some side effects. The goal is to benefit from the drug with minimal effects. Acetaminophen should be used first, then the lowest dose COX-2 inhibitor for as short a time as possible.
Patients with known GI problems who still need an NSAID can also take proton pump inhibitors (PPIs). Prilosec, Nexium, and Prevacid are examples of PPIs commonly used. These drugs help reduce acid in the stomach but must be used with caution as well. PPIs can also mask symptoms of serious GI disorders such as cancer. Patients should remain under a doctor's care when taking any of these drugs to manage side effects appropriately.
References: Jose U. Scher, MD, and Michael H. Pillinger, MD. Managing Osteoarthritis: NSAIDs Past, Present, and Future. In The Journal of Musculoskeletal Medicine. November 2006. Vol. 23. No. 11. Pp. 779-787.
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