NSAIDs combat arthritis by interfering with the inflammatory process.
NSAIDs (nonsteroidal anti-inflammatory drugs) are a large group of drugs commonly used to treat arthritis because of their:
- analgesic (pain-killing) properties
- anti-inflammatory properties
- antipyretic (fever-reducing) properties
NSAID Categories
There are three types of NSAIDs:
- salicylates (both acetylated, such as aspirin, and nonacetylated)
- traditional NSAIDs
- COX-2 selective inhibitors
NSAIDs commonly used for arthritis include:
- Ansaid (generic name flurbiprofen)
- Arthrotec (generic name diclofenac with misoprostol)
- Aspirin (acetylsalicylic acid)
- Cataflam (generic name diclofenac potassium)
- Celebrex (generic name celecoxib)
- Clinoril (generic name sulindac)
- Daypro (generic name oxaprozin)
- Disalcid (generic name salsalate)
- Dolobid (generic name diflunisal)
- Feldene (generic name piroxicam)
- Ibuprofen (brand names include Motrin, Advil, Mediprin, Nuprin, Motrin IB)
- Indocin (generic name indomethacin)
- Ketoprofen (brands names include Orudis, Oruvail, Actron, Orudis KT)
- Lodine (generic name etodolac)
- Meclomen (generic name meclofenamate sodium)
- Mobic (generic name meloxicam)
- Nalfon (generic name fenoprofen)
- Naproxen (brand names include Naprosyn, Aleve, Naprelan, Anaprox)
- Ponstel (generic name mefanamic acid)
- Relafen (generic name nabumetone)
- Tolectin (generic name tolmetin sodium)
- Trilisate (generic name choline magnesium trisalicylate)
- Voltaren (generic name diclofenac sodium)
How NSAIDs Work
In simple terms, NSAIDs work by reducing inflammation. They do this by blocking a key enzyme of inflammation called cyclooxygenase, which converts arachidonic acid to prostaglandins and leukotrienes. Prostaglandins cause local inflammation. Therefore, by inhibiting cyclooxygenase, NSAIDs reduce inflammation.
A particular NSAID may work better for you than one you tried before -- or may not work at all. That's because of something referred to as pharmacokinetic differences -- the process by which a drug is absorbed, distributed, metabolized, and eliminated.
More on the Enzyme Cyclooxygenase
There are two forms of cyclooxygenase, known as COX-1 and COX-2. COX-1 is involved in maintaining healthy stomach and kidney tissue. COX-2 is the enzyme responsible for inflammation. Because traditional NSAIDs block both COX-1 and COX-2, they can have unwanted side effects, such as stomach irritation or decreased kidney function. That's why researchers developed NSAIDS that only block COX-2. These COX-2 selective inhibitors are the newest group of NSAIDs.
FDA Actions For All NSAIDs
In 2004, the manufacturer of the COX-2 selective inhibitor Vioxx voluntarily withdrew it from the market after studies showed long-term use could increase risk of heart attack and stroke. A subsequent review by the U.S. Food and Drug Administration led to the 2005 requirement that all non-aspirin NSAIDs carry a related warning. It is important to discuss these potential risks with your doctor. (The aftermath has left only one COX-2 inhibitor on the market -- Celebrex.)
