You most likely have
taken a nonsteroidal anti-inflammatory drug (NSAID) – either
prescription or over-the-counter (OTC) – perhaps even before you
developed arthritis. At low doses, these drugs help a wide range of
problems, from muscle aches and headaches to minor pain and fever. At
higher prescription doses, NSAIDs help reduce joint inflammation. NSAIDs
fall into three basic categories: traditional NSAIDs, COX-2 inhibitors
and salicylates. All NSAIDs work by blocking prostaglandins
– hormone-like substances that contribute to pain, inflammation, fever
and muscle cramps. However, there are subtle differences between the
three types.
COX-2 Inhibitors
Like traditional NSAIDs, COX-2 inhibitors help reduce
pain and inflammation but are designed to be safer for the stomach. (See
" Side Effect Solutions")Digestive tract studies have shown less stomach
damage from COX-2 inhibitors compared to traditional NSAIDs; however,
COX-2s have not been used as long as other NSAIDs.
Studies to determine the
incidence of side effects and safety continue. In late 2004 and early
2005, two COX-2s, rofecoxib (Vioxx) and valdecoxib (Bextra),
were withdrawn from the market after several large studies showed
increased cardiovascular risks and, in the case of Bextra, risk
of a serious skin reaction. A long-term study to evaluate the
cardiovascular risks of Celebrex is currently underway. In the meantime,
the FDA has asked manufacturers of all NSAIDs to highlight warnings on
their labels in a black box and to provide consumers with medication
guides.
Salicylates
The original category of NSAIDs – the salicylates (suh-LIS-uh-lates)
– includes aspirin and is still preferred by many patients and doctors.
If you plan to take aspirin for more than occasional aches and pains,
consult your doctor. Frequent large doses, which can cause some serious
side effects, usually are needed to control arthritis pain and
inflammation. Your doctor can work with you to determine the best dosage
and help you prevent or manage side effects, including kidney problems
or gastrointestinal bleeding.
Your
doctor may prescribe a chemical variation referred to as a nonacetylated
salicylate, which is specially formulated to have fewer side effects, if
aspirin is too risky for you. Unfortunately, nonacetylated salicylates
lack aspirin’s beneficial protection against cardiovascular disease.
Therefore, if you’ve been advised to take low-dose (“baby”) aspirin to
prevent a heart attack or stroke and your doctor prescribes a
nonacetylated salicylate – or any other NSAID, for that matter – ask
about continuing your low-dose aspirin along with it.