Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Reviewed by: HU Medical Review Board | Last Reviewed: January 2023

Axial spondyloarthritis (axSpA) is a condition that can worsen over time. There is no cure for AxSpA, but there are treatments that can help you feel better and manage your symptoms.1

Treatment for axSpA is aimed at maximizing your quality of life. Other treatment goals include:1

  • Preventing or slowing down bone, joint, and ligament damage
  • Controlling symptoms and inflammation
  • Preserving your ability to move around

It usually takes a combination of medicines and other supportive therapies to manage axSpA. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first drugs used to treat axSpA.1

How do NSAIDs work?

NSAIDs prevent your body from making some of the chemicals that lead to inflammation. They stop the enzyme cyclooxygenase (COX) from making certain chemicals, including prostaglandins. Prostaglandins cause inflammation, pain, and swelling when you are injured or sick.2,3

Prostaglandins are a key factor in axSpA pain. These chemicals are thought to be the major cause of pain and inflammation in enthesitis. Enthesitis is inflammation of the area where the joints and bones meet tendons and ligaments. It is often the first sign of axSpA.4,5

NSAIDs also decrease inflammation by:6

  • Preventing certain immune cells from clumping together
  • Affecting the growth and death of some cells

Examples of NSAIDs

There are many different types of NSAIDs. In the United States, more than 20 different NSAIDs are approved by the US Food and Drug Administration (FDA). Some NSAIDs are widely available over the counter (OTC) at drugstore pharmacies. Others are available only with a prescription from a doctor.2

OTC NSAIDs include:2,7

  • Aspirin (Bayer)
  • Ibuprofen (Motril, Advil)
  • Naproxen (Aleve)

Prescription NSAIDs include:2,7

  • Celecoxib (Celebrex®)
  • Diclofenac (Voltaren)
  • Diflunisal
  • Etodolac (Lodine)
  • Fenoprofen (Fenortho™, Nalfon®)
  • Flurbiprofen (Ansaid®)
  • Indomethacin (Indocin®)
  • Ketoprofen (Orudis®)
  • Ketorolac (Toradol®)
  • Mefenamic acid
  • Meloxicam (Mobic)
  • Nabumetone (Relafen®)
  • Oxaprozin (Daypro®)
  • Piroxicam (Feldene®)
  • Sulindac (Clinoril®)
  • Tolmetin (Tolectin®)

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. They also depend on how much you take and how often you take the drug. Common side effects of NSAIDs include:3,7

  • Stomach upset
  • Nausea
  • Vomiting
  • Heartburn
  • Bloating

NSAIDs can cause serious side effects in some people. Again, this is based on the type and amount of drug taken. Serious side effects may include:2,3,7

  • Stomach ulcers and bleeding
  • Kidney problems
  • Increased risk of heart and blood vessel disease
  • Allergic reactions

Call your doctor right away if you have any of the following:7

  • Black or bloody stools
  • Cloudy or bloody urine
  • Problems urinating
  • Yellowing of the skin, eyes, or mucus membranes
  • Severe belly pain
  • Unexplained weight gain
  • Blurry vision
  • Puffiness or swelling in the body
  • Problems breathing
  • Chest pain or feeling of heart “fluttering”
  • Flu-like symptoms

NSAIDs have a boxed warning, the strictest warning from the FDA. They have this warning because they increase your risk of heart attack, stroke, and serious gastrointestinal (GI) problems.8

These are not all the possible side effects of NSAIDs. Talk to your doctor about what to expect when taking NSAIDs. You also should call your doctor if you have any changes that concern you when taking NSAIDs.

Other things to know

Remember to always follow your doctor’s advice. Do not take more than the recommended dose for any drug. This will help you avoid potential side effects and complications. Taking NSAIDs with milk or food also may reduce stomach upset.7

If you are pregnant, you should not take NSAIDs after 20 weeks. Talk to your doctor about the risks versus the benefits of taking these drugs while you are pregnant or breastfeeding.3

NSAIDs can interact with other drugs. Before beginning treatment for axSpA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes OTC drugs.7

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