Arthritis Arthritis Treatment

Treatments for Rheumatoid Arthritis: NSAIDs and Cox-2 Inhibitors

However, gastric problems aren’t the only side effects associated with NSAIDs. Some side effects are mild and go away on their own or go away after a reduction in dosage. Others are more serious and may require medical attention. They include an increased tendency to bleed, headaches and dizziness, a ringing in the ears, allergic reactions such as rashes, wheezing and throat swelling and liver or kidney problems. Additional problems that may arise include high blood pressure and swelling in the legs.

When NSAIDs are needed for prolonged periods, these side effects can be controlled with blood tests and regular monitoring by a physician. Gastric problems can be averted or at least kept to a minimum, by taking the drugs in low doses for brief periods. When NSAIDs are needed for longer periods of time, a variety of medicines may be recommended to prevent the gastric side effects. Antacids, for example, prevent the production of excess stomach acid. Drugs like sucralfate (Carafate®) help coat and protect the stomach. Medications like misoprostol (Cytotec®) help restore the lost mucus.

A New Class of NSAIDs: Cox-2 Inhibitors
A newer class of NSAIDs known as Cox-2 inhibitors (COXIBs) suppresses only Cox-2, the enzyme that is involved in the inflammation but not in the protection of the stomach. Because of this, Cox-2 inhibitors, such as celecoxib (Celebrex®), allegedly reduce the risk of the gastrointestinal complications associated with traditional NSAID therapy. Cox-2 inhibitors are more expensive than older NSAIDs, but they are not considered more effective at reducing the pain and inflammation of rheumatoid arthritis.

They also carry their own set of risks. In fact, in 2005, the makers of two Cox-2 inhibitors, rofecoxib (Vioxx®) and valdecoxib (Bextra®), voluntarily pulled the drugs from the market because of reports that they may increase the risk of heart attack, heart failure and stroke, especially in people who are known to already have heart disease. Studies have found that these drugs may also cause fluid retention and high blood pressure or that they may exacerbate an existing high blood pressure condition.

Now, Celebrex, the only Cox-2 inhibitor still available, carries a prominent “black box warning” on its packaging—the U.S. Food and Drug Administration’s strongest warning—that it may be linked to an increased risk of cardiovascular events.

In 2005, the FDA also announced new label requirements for prescription and nonprescription NSAIDs. Now, their packaging includes the same black box warning as the Cox-2 inhibitors. The warning highlights the increased risk of heart attack and stroke, as well as the potential for gastrointestinal bleeding. Manufacturers of Celebrex and all other prescription NSAIDs have since revised their labeling to include a medication guide for patients to ensure they use these drugs properly.

Take Precautions With NSAIDs
To ensure that NSAIDs are taken safely, patients should use them with a doctor’s supervision. They carry certain risks and may cause or worsen medical problems if taken at the same time as other medications or if certain health conditions are present. For example, individuals who are taking anticoagulants, such as warfarin sodium (Coumadin®), should be monitored for the potential of increased bleeding. A doctor’s supervision is also necessary because NSAIDs may cause fluid retention, which can decrease the effectiveness of high blood pressure medication and diuretics.

Many patients with rheumatoid arthritis take methotrexate, and its toxicity may increase when NSAIDs are used. Because corticosteroids and high doses of aspirin may increase the risk of developing peptic ulcers or gastrointestinal bleeding, a condition which can be aggravated by NSAID use, caution is advised. Some NSAIDs can also interfere with aspirin, which is sometimes taken to prevent heart disease.

People with certain health conditions should not take NSAIDs. Those conditions include an allergy to NSAIDs, peptic ulcer disease, bleeding disorders and kidney function impairment. Pregnant women are also told to avoid using NSAIDs during the last three months of their pregnancy.

Finally, patients should call their health professional if they experience severe stomach pain, bloody vomit, bloody or black tar-like stools, bloody or cloudy urine, unexplained bruising or bleeding, wheezing or breathing troubles, swelling in the face or around the eyes, severe rash or red, itchy skin. These conditions require immediate medical consultation.

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