Rheumatoid Arthritis

Anti-inflammatory drugs and rheumatoid arthritis

Anti-inflammatory drugs are often called Non-Steroidal Anti-Inflammatory Drugs or NSAIDs for short. NSAIDs are helpful because they relieve pain and stiffness. They have no long-term effect on the disease. They are often taken in addition to simple painkillers. NSAIDs should be taken as directed as they vary in strength and should be eaten with food because they can cause stomach and digestive system problems, including ulcers.

There are many different non-steroidal anti-inflammatory drugs (NSAIDs), e.g. aspirin, ibuprofen, naproxen, indometacin, diclofenac and ketoprofen. The name non-steroidal anti-inflammatory means they reduce pain and stiffness due to inflammation of the joints, without using steroids. (See also Steroid tablets, injections and intravenous pulses.)

The 'coxibs', or COX-2-specific NSAIDs, are a family of drugs which perform the same function as standard NSAIDs in that they reduce inflammation, but they are less likely than standard NSAIDs to cause stomach upsets, heartburn and indigestion. Examples of coxibs include celecoxib (brand name Celebrex) and etoricoxib (Arcoxia).

NSAIDs can be bought over the counter in a pharmacy but stronger ones are prescribed by a doctor. 

Anti-inflammatories are often prescribed even before RA is the confirmed diagnosis and most people continue to take them regularly for many years. However, NSAIDs work differently for different people and so it may be necessary to try several types to find what is right for you and to minimise side effects. People described how their consultants gave them different ones to try to find the right one, or combination, at the right dose. Sometimes drugs can take a while to have their full effects so changing over to a new NSAID can make stiffness worse.

Different NSAIDs are taken in different quantities each day so it is important to follow instructions. Several people were unsure whether the drugs were working or not; one man took them regularly without knowing if he would be worse off if he didn't. One woman who took them three times a day found that after forgetting to take them at lunchtime it made no difference so she reduced her daily dosage.

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Some people found these drugs had little effect and that was when they needed additional drugs (see 'Disease Modifying Anti-Rheumatic Drugs' and 'Steroid tablets, injections and intravenous pulses'). 

One woman took an NSAID before exercise but later found that she no longer needed to. In contrast, other people who normally did take them everyday really noticed an increase in pain or stiffness or reduced mobility if they forgot to take them or tried to stop them. One young woman who had taken indometacin (Indocid) since she was a teenager felt it really helped her to get up and do things every day.

Getting the dose right can help a lot and some medication can be taken as a slow release tablet with its effects lasting about 14 hours. Several people were taking these: one taken at bedtime helped relieve early morning stiffness and lasted through part of the day. One woman found this, together with an additional standard tablet, helped her through her day.

Several people didn't like taking more NSAID tablets than they had to, because of possible side effects, so they tried to take the minimum they felt they needed each day. The fear of side effects or actually experiencing side effects meant some people had either changed the type of NSAID they were taking or they stopped them altogether. Some decided to put up with the stiffness because they wanted to enjoy their food and they didn't want a stomach ache. Side effects included stomach upsets and indigestion, although one woman accepted this was probably due to taking them on an empty stomach.

Some people are prescribed drugs to combat the side effects of NSAIDs including antacid indigestion tablets and others to reduce the long-term risk of stomach problems. One woman described the damage to her stomach lining and getting 'sore tummies' from time to time but took the additional drug, Lansoprazole regularly to try and stop them.
Three women had ulcers, one of them only discovered during a stay in hospital because it had caused no symptoms. One was the result of a now withdrawn anti-inflammatory drug, Opren. One man tried herbal remedies for several months to combat his stomach problems and indigestion but found they did not work, although eating a healthier diet had helped. He had also had four endoscopies, colonoscopies and an MRI scan to assess any damage to the digestive system as he had had some bleeding. (See 'Regular monitoring and other diagnostic tests').

Chest pains from diclofenac had been a worry for one older woman. For one woman with asthma, taking NSAID's meant she had more breathing problems and needed her inhaler more. She halved her NSAID dose because she found stopping them completely resulted in increased stiffness and pain.

One woman was on too high a dose of NSAID, had nausea and felt ''like a zombie'' but different specialists she saw took a year to realise that the anti-inflammatory tablets were causing the problems. The symptoms disappeared when she took a lower dose.
Hair loss (naproxen), urgency to urinate (slow release diclofenac) and headaches (indometacin) were also attributed to particular NSAIDs.
How long people endured side effects varied before approaching their doctor and some wished they had discussed it earlier rather than suffer them. One man had been advised to have blood tests every three months to check for any abnormalities caused by the NSAID.

A few people had used the newer Cox-2 inhibitors, particularly meloxicam (Mobic), rofecoxib (Vioxx) (now withdrawn) and celecoxib (Celebrex). People on meloxicam felt it worked for them and reduced stiffness but one had stopped due to side effects.
One woman used anti-inflammatory creams or gels to rub onto painful joints and she could use one, Movelat prescribed by her GP, on several joints.

Last reviewed August 2016.

Last updated August 2016.

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