Arthritis Treatment: Non-Steroidal Anti-Inflammatory Drugs - Cons and Pros

One of the most common chronic ailments worldwide is arthritis. The term "arthritis" is derived from the Greek... "arthron" meaning joint, and "it is" meaning inflammation. It is used to refer to a group of more than 100 different conditions.

Arthritis remains the leading cause of disability in the United States.

One of the most common treatments used for arthritis are non-steroidal anti-inflammatory drugs (NSAIDS). These drugs reduce pain and inflammation. Their mechanism of action is through the blockade of enzymes called cyclooxygenase. Cyclooxygenase (there are two types- COX 1 and COX2) is key to the production of prostaglandins, hormone-like substances that have many physiologic effects. Some prostaglandins cause inflammation, some are responsible for mucus production to protect the lining of the stomach, some are responsible for normal functioning of the kidneys, and some are responsible for clotting.

As a result of these myriad actions, blockade of prostaglandins can also cause a multiplicity of effects and side effects.

Side effects of NSAIDS can limit their use and effectiveness. The most common side effect is gastrointestinal irritation and the development of ulcers in the stomach and small bowel. This side effect can be mitigated by using NSAID that selectively block COX 2 only since this is the type of cyclooxygenase that specifically channels inflammation and has less of an effect on mucus production in the stomach. Also using proton pump inhibitors- drugs that protect the stomach- along with an NSAID is another effective strategy.

Patients with kidney issues should not take NSAIDS since these drugs can significantly alter kidney function. NSAIDS also cause fluid retention.

Less common side effects include liver damage, bone marrow abnormalities, and allergic reactions.

The major concern is the increased risk of blood clots, strokes, and heart attacks associated with all NSAIDS regardless of whether they are COX-2 selective or not. These drugs should not be used in patients with recent coronary bypass. A major ongoing clinical trial, the PRECISION study, is seeking to answer the question as to whether some NSAIDS are riskier than others.

One option that can reduce the likelihood of NSAID side effect is to use topical (rub-on) NSAIDS. Examples are Pennsaid and Voltaren gel.

So what are NSAIDS good for? I'm going to stop beating up on them and talk about the potentially good things. Obviously, they are excellent analgesics and anti-inflammatory drugs.

In addition, there is accumulating data indicating that NSAIDS may be effective anti-cancer agents. One study published in Cancer Prevention Research showed that former smokers who took Celebrex, a COX-2 inhibitor had reduced levels of Ki-67, a marker of potential tumor growth. Other studies suggest NSAIDS may be protective against colon cancer. And the dermatology literature has suggested that low dose aspirin may reduce the risk of melanoma.