Facts About NSAIDs
- Pain and inflammation sometimes occur in a circadian rhythm (daily rhythmic cycle based on a 24 hour interval). Therefore, NSAIDs may be more effective at certain times.
- About 60% of patients will respond to any single NSAID. A trial period of three weeks should allow you enough time to know if the drug is working for you. Unfortunately, about 10% of rheumatoid arthritis patients will find NSAIDs don't work for them.
- NSAIDs can mask the signs and symptoms of infection.
- Adverse effects of NSAIDs which can occur at any time include kidney failure, liver dysfunction, bleeding, and gastric (stomach) ulceration.
- NSAIDs (particularly indomethacin) can interfere with medications used to control high blood pressure and cardiac failure (such as beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, or diuretics).
- Some research studies suggest long-term NSAID use might actually hasten joint cartilage loss, but more research is needed.
The Bottom Line
It can not be predicted which NSAID will best serve you. No single NSAID has been proven to be superior over the others for pain relief. Once an NSAID is selected, the dosage should be increased until pain is relieved or until the maximum tolerated dose has been reached. The patient response should be a guideline for selecting the proper dose, using the lowest dose possible to obtain pain relief. Always discuss the benefits and potential risks of NSAIDs with your doctor.
Sources:
The Duke University Medical Center Book of Arthritis, David S. Pisetsky, M.D., Ph.D. 1995.
New England Journal of Medicine, 324(24):1716-1725, 1991
