Anti-Inflammatory Drugs for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease of the joints. It affects women of reproductive age, and even pregnancy complicated by RA is not uncommon. Most pregnant women find that RA tends to improve during pregnancy; it most often improves during the second and third trimesters. Treating RA during pregnancy is particularly challenging. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of therapy, despite reported adverse effects on both mothers and fetuses when they are used for long periods. Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis. During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength.

Treatment

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are also available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems, and liver damage.

Patients with rheumatic diseases, including rheumatoid arthritis and osteoarthritis, almost universally describe pain and stiffness as contributors to reduced health-related quality of life. Of the treatment options available, NSAIDs are the most widely used agents for symptomatic treatment. Of course, NSAIDs are effective anti-inflammatory and analgesic drugs by virtue of their ability to inhibit biosynthesis of prostaglandins at the level of the cyclooxygenase enzyme. However, many of the adverse effects of NSAIDs are also related to inhibition of prostaglandin production, making their use problematic in some patient populations. For clinician, understanding the biology of prostaglandin as it relates to gastrointestinal, renal, and cardiovascular physiology and the pharmacologic properties of specific NSAIDs is key to using these drugs safely. Recognition of co-morbid conditions and concomitant drugs that may increase the risk of NSAIDs in particular patients is very important. In patients with risk factors for NSAID toxicity, using the lowest dose of a drug with a short half-life only when it is needed is likely to be the safest treatment option. For those patients whose symptoms cannot be managed with intermittent treatment, using protective strategies is essential.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over-the-counter and by prescription. They are used to help ease arthritis pain and inflammation. NSAIDs include such drugs as ibuprofen, ketoprofen and naproxen sodium. For people who have had or are at risk of stomach ulcers, the doctor may prescribe celecoxib, a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach. These medicines can be taken by mouth or applied to the skin directly to a swollen joint. Most traditional NSAIDs inhibit both isoforms, albeit with some differences in the relative potency for COX-1 and COX-2. Some NSAIDs lack inhibition of platelet function, which is the operational definition of COX-2-selective NSAIDs. The pharmacologic properties, including chemical class, formulation, and drug half-life, of individual drugs may be equally important in determining the properties of NSAIDs. In light of the widespread use of NSAIDs for common diseases, which are likely to increase in prevalence with the aging of the population, it is really important to appreciate the potential events associated with NSAIDs to use them safely in patients with rheumatic diseases.

The pain and disability associated with rheumatoid arthritis can affect a person's professional work and family life. Depression and anxiety are very common, as are feelings of helplessness and low self-esteem. The degree to which rheumatoid arthritis affects your daily activities depends in part on how well you cope with the disease. Make sure to talk to your doctor or nurse about strategies for coping.