How To Take NSAIDS Safely

Non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain and reduce inflammation for many people with arthritis. They are usually the first-line treatment for axial spondyloarthritis (AxSpA).

Commonly used NSAIDs include aspirin, ibuprofen (Advil and Motrin), and naproxen (Aleve). These are purchased over-the-counter. Stronger NSAIDs like celecoxib (Celebrex) and diclofenac (Voltaren) must be prescribed. All NSAIDs block the production of chemicals that contribute to pain and inflammation.

NSAIDs can cause serious side-effects. It is important to follow your doctor’s directions about a safe intake level. This will depend on your specific health profile. Your doctor may want to monitor you for side effects.1

How are NSAIDs used to treat AxSpA?

Treatment for non-radiographic AxSpA (nr-AxSpA) focuses on relieving pain instead of stopping disease progression. This is usually done with physical therapy and NSAIDs. New classes of medication are changing this approach to treatment. But the initial therapy for nr-AxSpA is still NSAIDs.

NSAIDs reduce inflammation and relieve pain in early AxSpA.2 No single NSAID is ideal for every person. If one is not effective, your doctor may prescribe another.

Some NSAIDs work within a few hours, while others take weeks. In early AxSpA, NSAIDs may be taken on a regular basis. Once the disease is controlled, your doctor will likely recommend taking them only when needed.

According to the Assessment in Ankylosing Spondyloarthritis (ASAS) criteria, 35 percent of people experience improved inflammation and function when taking NSAIDs. So even though NSAIDs are very effective, many people need additional therapy.3

What are some side effects of NSAIDs?

Over-the-counter NSAIDs are meant for short-term use (less than 10 days for pain). But higher dosage or stronger NSAIDs may be prescribed to treat AxSpA. Ask your doctor about side effects for your specific medication. Some common side effects of NSAIDs are:

  • Dizziness and lightheadedness
  • Difficulty concentrating
  • Mild headaches
  • Heartburn
  • Stomach pain and feeling bloated
  • Nausea and vomiting
  • Diarrhea and/or constipation

Gastrointestinal symptoms may be prevented by taking the drug with food, milk, or antacids. If symptoms last more than a few days, call your doctor. They may stop or change the NSAID. Call your doctor right away if your side effects are more serious. These include:4

  • Bloody urine, vomit, or stools
  • Severe stomach pain
  • Jaundice
  • Blurred vision
  • Severe headache
  • Allergic reactions such as rashes, swelling, difficulty breathing, chest pain or flu-like symptoms

How should NSAIDs be used safely?

In general, the occasional NSAID will not cause problems. Using them as needed at a low dose will minimize harmful effects.

However, long-term NSAID use can increase the risk of heart attack, stroke, stomach ulcers, bleeding in the gastrointestinal tract, and kidney problems. These risks are higher for people who are older or who have high blood pressure. Taking blood thinners, diuretics, or multiple NSAIDs can also increase these risks.1,5

If a long treatment is required, your doctor may test you for kidney function and for ulcers or stomach bleeding. Here are more ways to lower your risk while taking long-term NSAIDs:

  • Ask your doctor about taking a proton-pump inhibitor (PPI) to reduce your chance of ulcers
  • Reduce heart risks with a healthy diet and regular exercise
  • Treat high blood pressure and diabetes
  • Avoid taking multiple medications with the same active ingredient at the same time

You should not take NSAIDs if you are taking warfarin or clopidogrel. These drugs can interact and cause complications. Certain medical conditions also increase the risk for side effects. Talk to your doctor before taking NSAIDs if you have:1,5

The bottom line is to communicate often with your doctor. Ask how to safely use NSAIDs given your specific health profile. Ensure they are watching for side effects. And inform them of any symptom changes. Never increase dosage or take additional medications without asking your doctor first.

Are there alternatives to NSAIDs for AxSpA?

Oral NSAIDs are not the only way to relieve pain. You can also try a topical version. This may relieve pain with fewer gastrointestinal side effects. You can also try acupuncture, biofeedback, physical therapy, or yoga.1

Exercise is also important. People with nr-AxSpA commonly feel better with movement. This is a feature of inflammatory back pain. Exercise also helps fatigue and emotional distress, which may accompany AxSpA.

NSAIDs and exercise may not provide relief if AxSpA progresses. In these cases, doctors may recommend TNF inhibitors, IL-17 inhibitors, or other recently approved medications.3

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