Non-steroidal Anti-Inflammatory Drugs (NSAIDs) for AxSpA Treatment

Reviewed by: HU Medical Review Board | Last Reviewed: May 2022 | Last updated: October 2022

Axial spondyloarthritis (AxSpA) is a chronic, progressive condition. There is no cure, but treatments are available to help you manage the condition. Rather than cure, the goals of treatment are to:1

  • Maximize quality of life
  • Prevent or slow progressive structural damage
  • Control symptoms and inflammation
  • Preserve mobility

Medicines can help to treat AxSpa spectrum conditions. There are different kinds of medicines, and what works for 1 person may not be effective for another. The first-line medicines often used are nonsteroidal anti-inflammatory drugs (NSAIDs).2

How do NSAIDs work?

NSAIDs stop prostaglandins from being made and released in the body. Prostaglandins are lipids involved in controlling the process of inflammation. NSAIDs also stop neutrophils from being activated. Neutrophils are a kind of white blood cell. When they are activated, they encourage inflammation. NSAIDs are also pain relievers, fever reducers, and can help prevent blood from clotting.3,4

There are both over-the-counter (OTC) NSAIDs and prescription NSAIDs. Your doctor will help determine which would be best for your pain and inflammation. Different doses may also be prescribed at different times based on the severity of your symptoms.

Examples of NSAIDs

There are many kinds of NSAIDs based on their chemical makeup. Examples of prescription NSAIDs include:5

  • Diclofenac potassium (Cataflam, Zipsor)
  • Diclofenac sodium (Dyloject, Voltaren XR)
  • Etodolac
  • Indomethacin (Indocin, Tivorbex)
  • Nabumetone
  • Sulindac
  • Tolmetin sodium
  • Meclofenamate sodium
  • Meloxicam (Mobic, Vivlodex)
  • Piroxicam (Feldene)
  • Fenoprofen calcium (Nalfon)
  • Flurbiprofen
  • Ibuprofen (Caldolor)
  • Ketoprofen
  • Naproxen (Naprosyn, EC-Naprosyn)
  • Naproxen sodium (Anaprox, Anaprox DS, Naprelan)
  • Oxaprozin (Daypro)
  • Celecoxib (Celebrex)

OTC NSAIDs include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve).

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking, especially if you take large doses of them or take them long-term. Common side effects of NSAIDs include:6

  • Gas
  • Bloating
  • Heartburn
  • Nausea and/or vomiting
  • Diarrhea and/or constipation

Many of these gastrointestinal (GI) side effects can be helped by taking NSAIDs with food, milk, or antacids. If these side effects last for more than a few days, especially if you are taking the drugs with food or milk, call your doctor.6

Other side effects may include:6

  • Dizziness or lightheadedness
  • Balance difficulties
  • Trouble concentrating
  • Headaches

Call your doctor right away if you experience any of the following:6

  • Black stools
  • Bloody or cloudy urine
  • Severe abdominal pain
  • Jaundice
  • Trouble urinating
  • Weight gain that is unexplained
  • Blurry vision
  • Change in strength on one side of the body
  • Fluid retention
  • Trouble breathing
  • Chest pain or heart palpitations
  • Flu-like symptoms

These are not all the possible side effects of NSAIDs. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with NSAIDs.

Other things to know

Do not combine an OTC NSAID with a prescription NSAID. People with certain medical or health conditions and those who are pregnant or breastfeeding should not take NSAIDs.

Non-aspirin NSAIDs may increase the risk of heart attack or stroke, especially if you have heart disease or have certain risk factors like high blood pressure or smoke cigarettes. Your risk can increase if you take high doses of NSAIDs.5

All NSAIDs can increase your risk of ulcers and GI bleeding.6 Talk with your doctor about whether you should take your NSAIDS daily or on an as-needed basis.

Before beginning treatment for AxSpA, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs, biologics, or other lines of medicine you currently use.

Additional treatment options

NSAIDs are the first-line treatment option for AxSpA spectrum conditions. However, they are not always sufficient to relieve symptoms and improve quality of life. If NSAIDs do not bring relief, there are other drug options that can be explored. Talk with your doctor about what NSAID options may work if others have not and what other drug options there are for you.

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