NSAIDS: Arthritis Foundation

ARTHRITIS FOUNDATION OF VICTORIA
www.arthritisvic.org.au ... (Copy reviewed 2005)

Non-Steroidal Anti-Inflammatory Medications in the management of Arthritis

The following material is designed to help people who have been prescribed a NSAID to understand how to get the best results for their medication. While NSAIDs offer substantial relief from pain and inflammation, some patients are at increased risk of bleeding of developing gastric ulcers while taking NSAIDs.

Even though these patients may be at risk, the doctor may believe that a NSAID is still the best treatment. For such patients it is now possible to take another medication at the same time to reduce the risk of gastric ulcer developing. This medication, a prostaglandin analogue, is the only medicine approved for this use Australia. It reduces the risk of developing gastric ulcers without reducing the effect of the NSAID on pain and inflammation.

Your Questions Answered

Q: What advantages do other NSAIDs have over aspirin?

A: They are given in smaller, milligram doses and are usually effective and better tolerated than aspirin. Although aspirin can be purchased without a prescription, it can cause side effects when taken in large doses to treat inflammation. Anti-inflammatories need to be taken less often during a 24 hour period than most forms of aspirin.

Q: How does a doctor know which medication to prescribe?

A: The first step a doctor takes is to make an accurate diagnosis to determine the type of arthritis. As individuals can respond differently to the various drugs available, a doctor will select the treatment which should best suit each individual patient.

Q: How do the effects of anti-inflammatory drugs differ from those of analgesics such as paracetamol and codeine?

A: Paracetamol is often all that is needed in osteoarthritis. Analgesics reduce the sensation of pain by acting on the nervous system. Anti-inflammatories act to reduce some of the process of inflammation. This in turn reduces the resulting pain and stiffness which are common symptoms of osteoarthritis and rheumatoid arthritis.

Q: What are the possible side effects of NSAIDs?

A: Indigestion, nausea or heartburn may occur. A less common side effect is gastric ulcer. Patients with these or any other unusual symptoms should stop taking their medication and contact their doctor. The doctor may lower the dose or prescribe a different NSAID or another medication to reduce the risk of side effects.

Some patients are allergic to aspirin and NSAIDs. Serious breathing difficulties like asthma can occur if any NSAID is taken by a patients who has this problem. It is important to let the doctor or pharmacist know if you are ‘allergic’ to aspirin or NSAIDs, or if you suffer from asthma.

Occasionally NSAIDs can cause headaches or a sense of fuzziness. Also NSAIDs given in suppository form can sometimes be associated with local irritation. People known to have diminished local kidney function must be closely supervised by their doctor.

Q: Can anything be done to prevent the risk of bleeding or ulcers if the doctor feels the NSAID is still the best treatment?

A: These is a medication which reduces the risk of developing gastric ulcers without reducing the effect of the NSAID on pain and inflammation. Patients requiring NSAIDs who may benefit from this medication are those with a prior history of ulcers of gastrointestinal complications and older patients.

Q: Do the benefits of NSAIDs really outweigh the risks?

A: In most cases yes, but doctors need to constantly weigh the potential risks against the likely benefits for each individual.

Q: Is it safe to take other pain killing tablets bought from a pharmacy or supermarket as well as a NSAID?

A: Yes, but only after discussion with a doctor or pharmacist. It is important to know that taking aspirin with other anti-inflammatories should be avoided except under close medical supervision. The two can combine to produce side effects which otherwise would not occur.