What is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic inflammatory disorder that happens to affect more than just the joints. In a few cases for certain individuals, this medical condition can lead to damage in a wider sense; for example, it could affect the other body systems, which could include the skin, heart, lungs, blood vessels, and eyes. This is an autoimmune disorder, and it occurs when the individual’s immune system erroneously starts attacking its own body’s tissues. This disease can affect the lining of the joints, which could then lead to painful swelling. This eventually results in erosion of the bones or bone deformity. The inflammation that happens to come along with this disease can impact the other parts of the body, as well. The treatment options have improved drastically over the ages, but if it is a severe case of rheumatoid arthritis, then it can lead to some forms of physical disability.
Why are Anti-inflammatory medications used for Rheumatoid Arthritis, and how do they work?
Prostaglandins come from the family of chemicals that are produced by the body cells and have a very vital role to play. This chemical helps to promote inflammation, which is very much necessary for healing. However, at the same time, it also results in pain and fever, and it also supports the function of blood clotting of platelets. It also helps to protect the lining of the stomach from any damaging effects of acid.
The prostaglandins are produced in the body’s cells by the enzyme called cyclooxygenase (COX). Prostaglandins are naturally occurring fatty acids that play an important role in pain and inflammation. Our body has two types of COX enzymes, COX-1 and COX-2. Both of these enzymes produce prostaglandins, which promote inflammation. However, it is COX-1 that produces prostaglandins that support the platelets and also protect the lining of the stomach. The anti-inflammatory drugs help to block the COX enzymes, which then reduces the production of prostaglandins throughout the body. As a result, the pain, fever, and inflammation are reduced. However, this can also lead to a reduction in the protection of the stomach lining and support of the platelets and blood clotting, thus causing side effects of ulcers and increased bleeding.
The anti-inflammatory drugs help to reduce the pain and swelling caused by the condition. The effect of the same starts working within a few hours of consumption of the drug. The doctor would provide better guidance on which dose should be taken and in what limit. The anti-inflammatory drugs come in tablets, as well as capsule form, and they should be taken orally shortly after having food. There are also anti-inflammatory creams or gels that are available and can be applied directly on the affected area.
The anti-inflammatory drug is not used to stop the progression of the disease. It is strategically used in combination with other medicines so as to help in the reduction of inflammation in certain cases.
List of Anti-Inflammatory Drugs
- celecoxib (Celebrex)
- piroxicam (Feldene)
- indomethacin (Indocin)
- meloxicam (Mobic Vivlodex)
- ketoprofen (Orudis, Ketoprofen ER, Oruvail, Actron)
- sulindac (Clinoril)
- diflunisal (Dolobid)
- nabumetone (Relafen)
- oxaprozin (Daypro)
- tolmetin (Tolmetin Sodium, Tolectin)
- salsalate (Disalcid)
- etodolac (Lodine)
- fenoprofen (Nalfon)
- flurbiprofen (Ansaid)
- ketorolac (Toradol)
- mefenamic acid (Ponstel)
There are 20 different types of anti-inflammatory drugs that are available with or without a prescription. Below are the common brands used to treat rheumatoid arthritis:
- Celecoxib (Celebrex)
- Diclofenac (Voltaren, Cataflam)
- Ibuprofen (Advil, Motrin)
- Ketoprofen (Orudis, Oruvail)
- Naproxen (Aleve)
Sulfasalazine is the type of drug that comes under the category of DMARD. This medicine works by modifying the underlying disease in a process to reduce inflammation, pain, and swelling in the joints and bones. It may take almost 12 weeks for the symptoms to start showing improvement. One should not take Sulfasalazine if the individual is known to have an allergy to salicylates, such as aspirin. Sulfasalazine is available in tablet form and is generally prescribed as Salazopyrin EN-Tabs. These tablets are coated in such a way so that they do not dissolve easily in the stomach. It should not be crushed, chewed, or broken. It should be taken as a whole with a glass of water. Usually, the doctor can start on the low dose, which can be a 500 mg tablet per day. This can be increased gradually over a period of about four to five weeks. The dose can later be adjusted as per the severity of the symptoms. The common side effects of Sulfasalazine are nausea, vomiting, pain in the stomach, headaches, and skin rashes. These side effects can arise in the first three months of the treatment, and if the dose is reduced, then these side effects also clear up. Intake of Sulfasalazine can affect the blood count or the liver. Hence, one who takes Sulfasalazine would be asked to keep a record of the blood tests.
Differences among Anti-Inflammatory drugs
The Anti-inflammatory drugs vary in their potency and duration of action. The more an NSAID blocks COX-1, the greater the tendency to cause ulcers in the stomach and lead to internal bleeding. One of the anti-inflammatory drugs called Celebrex blocks COX-2, but it has little effect on COX-1. Aspirin is one of the unique NSAIDs, not only because of its uses, but because it is the only NSAID that can inhibit the blood clotting for a prolonged period of time. Most of the anti-inflammatory medications effect the blood clotting for only a few hours. Ketorolac is one of the powerful anti-inflammatory drugs that is used for moderately severe acute pain and pain that may normally require narcotics. However, when compared to other anti-inflammatory drugs, ketorolac causes more ulcers if used frequently. Hence, doctors usually do not recommend it for more than five days at a time. Mostly, the anti-inflammatory drugs have a common mechanism of action; hence, individuals that do not respond to one type of anti-inflammatory may respond to another.
The reviews pertaining to the usage of this drug are fairly neutral. Some people have complained of the symptoms getting worse, even after the use of the drug, whereas some have recorded just mild changes in the symptoms. In a few cases, people have experienced fatigue that increases each day. It has been said that it takes a little longer for the symptoms to completely go away. A few of the individuals experienced certain side effects after the use of the drug in the initial weeks, but gradually it started to work just fine.
Choosing an Anti-Inflammatory Drug
The doctor can help to decide which one should be prescribed based on the severity of the medical condition and other factors. Before recommending any of the drugs, the doctor would take into account the below factors:
- Current medical condition
- Past medical history
- Any allergies or reactions to medicines
- Any other medicines currently being taken
- How well the kidney and liver would react to the medicine
- Any surgeries undergone in the past or present
- The overall plan and goals of the treatment
Inform the doctor, if you:
- are allergic to aspirin or any other pain reliever
- are addicted to alcohol
- have any disease related to the kidneys or liver
- have a medical condition related to the heart
- are taking in blood thinning medicines or have any kind of bleeding disorder
- have problems related to stomach ulcers
Aspirin taken in low doses and under the guidance of the doctor can help to protect the person from heart related conditions, such as heart attacks. There are certain kinds of anti-inflammatory drugs that can lead to a rise in the risk of heart disease and stroke. This mostly happens if the dosage is higher than recommended. These medicines tend to interfere with blood pressure medicines, thereby making them less effective. Anyone below the age of 18 years is strongly advised not to take aspirin, unless specifically advised by the doctor, since the intake can lead to a serious condition called Reye’s syndrome.
Various types of anti-inflammatory drugs are to be taken at different dosages, and the recommended dosage is always mentioned on the packaging label. However, the quantity that should be taken will depend on the severity of the illness and its symptoms. Also, it depends on how much one can tolerate. Hence, one should speak to the doctor about which drug should be taken and the correct dosage to use. Since NSAIDs are known to cause heart related problems, one should use them cautiously. Anti-inflammatory drugs are only suitable for acute pain and should not be used for chronic pain. Once the symptoms have been controlled with the help of the DMARD, the treatment of anti-inflammatory should be discontinued. Below are few of the doses pertaining to effective anti-inflammatory daily doses of some of the common NSAIDs that are used in the treatment of rheumatoid arthritis.
- Ibuprofen can be taken at 800mg three to four times daily
- Piroxicam can be taken at 20mg once daily
- Naproxen can be taken at 500mg two times on a daily basis
Each of the anti-inflammatory medicines has its own strength and can be taken at different intervals. The dosage quantity of over-the-counter medicines is often less than that of prescription medications. The work of anti-inflammatory drugs starts fairly quickly. Commonly, it would take a few hours to start showing improvement. The anti-inflammatory effects take some time as compared to the pain control, which mostly occurs quickly. One can see for themselves that the swelling starts to reduce after the consumption of these medicines. However, one should not mix up the over-the-counter anti-inflammatory medicines with the prescription-based medicines. They both have to be separately maintained. Also, one should not increase the dose much more than recommended, since it can lead to certain side effects for patients. Also, as previously mentioned, aspirin should not be given to children below the age of 18 years. Teens who have a virus should not take any medication that contains aspirin.
Side effects of Anti-Inflammatory drugs
Below are a few of the common side effects associated with anti-inflammatory drugs:
- Seizure attacks
- Low appetite
- Dizziness or drowsiness
Below are a few other side effects that are important to be immediately noted to the doctor:
- Damage to the kidneys
- Internal prolonged bleeding
- Liver failure
- Cramps in the muscles
- High blood pressure
- Problems in hearing
Anti-inflammatory drugs can tend to cause fluid retention, which ultimately leads to edema. This is mostly linked with swelling in the ankles.
The anti-inflammatory medications are known to reduce flow of blood to the kidneys, thus reducing the action of diuretics. They also decrease the elimination of lithium and methotrexate. Hence, the blood levels of these medications can increase, so the side effects may increase, as well. These drugs are also known to decrease the ability of clotting of blood, and hence they increase the chances of bleeding. When they are used with other medications, they can lead to an increase in the chances of bleeding. Hence, those individuals who take these drugs that reduce blood clotting should also avoid longer use of anti-inflammatory medications. The anti-inflammatory drugs are also known to increase blood pressure in patients. The usage of anti-inflammatory drugs leads to increases in the negative effect of cyclosporine on the functioning of the kidneys. Those individuals who are alcoholic or have more than three alcoholic beverages per day are at an increased risk of having ulcers in the stomach while taking the anti-inflammatory drugs. Thus, it is very much important to share all details with the doctor before they start the course of treatment.
- The anti-inflammatory drugs or NSAIDs are commonly used medicines for any kind of pain in adults.
- They are used as a common treatment by the doctor for chronic medical conditions, such as arthritis or lupus.
- The main work of anti-inflammatory drugs is to block the proteins that are called as enzymes. They help to make prostaglandins.