Arthritis Arthritis Treatment

Treatments for Rheumatoid Arthritis: NSAIDs and Cox-2 Inhibitors

For many years, nonsteroidal inflammatory drugs (NSAIDs) have been the first choice of doctors to control the joint swelling and inflammation associated with rheumatoid arthritis (RA). Almost everyone with the condition has taken or is taking one of these drugs.

Although the medicines cannot cure the disease, NSAIDs have been successful at alleviating the inflammation associated with rheumatoid arthritis. The drugs appear to help pain, morning stiffness and range of motion in the joints. Also, they have been able to reduce the limitations on daily activities often caused by rheumatoid arthritis.

NSAIDs are available in a wide variety of strengths and formats. Less powerful strengths can be purchased over the counter, while more potent versions are sold only by prescription. They are available as oral tablets, capsules or liquids. Typical NSAIDs include ibuprofen (Advil®, Motrin®), naproxen (Anaprox®, Naprosyn®), tolmetin (Tolectin®), diclofenac (Voltaren®), nabumetone (Relafen®), indomethacin (Indocin®), ketoprofen (Orudis®, Oruvail®) and even aspirin. Your doctor can help you decide which NSAID is right for you and your condition.

How NSAIDs Work
NSAIDs work by preventing the body from producing prostaglandins. Prostaglandins are hormone-like substances that have been identified as a cause of pain, inflammation and fever in the body. They are produced within the body’s cells by cyclo-oxygenase (Cox) enzymes called Cox-1 and Cox-2.

Prostaglandins are important, because they are involved in the function of the platelets that cause blood to clot. They also aid in the production of the natural mucus lining that protects the stomach lining from the damaging effects of acid. Cox-1 and Cox-2 enzymes produce prostaglandins that promote inflammation, pain and fever. However, only the Cox-1 enzyme produces prostaglandins that support blood clotting platelets and protect the stomach.

Since NSAIDs block both Cox enzymes, they do more than just reduce the responses of inflammation, pain and fever. By also inhibiting the Cox-1 enzyme, there is evidence that NSAIDs may cause problems in the stomach, since it is the Cox-1 enzyme that protects the stomach lining.

NSAID Side Effects
Research shows that about 15 percent of patients on long-term NSAID treatment develop stomach ulcers. Many of these patients have no symptoms and are unaware of their ulcers. However, they are at risk for developing serious and potentially life-threatening ulcer complications, such as bleeding or perforations of the stomach.

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