Rheumatoid Arthritis: Pain Relief: How NSAIDs Work

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Friday, 18 April 2008

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Rheumatoid Arthritis: Pain Relief: How NSAIDs Work
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What Are the Side Effects from Standard NSAIDs?

Most people who use NSAIDs don't have any serious problems with them. But in some -- especially those who need pain relief regularly -- there can be a downside.

When you swallow a pill, it affects your whole system, not just the part that hurts. So while an NSAID may do a great job of easing your pain, it may also be having other effects -- some of them unwanted -- in other parts of your body.

Gastrointestinal Problems

The most common risk of standard NSAIDs is that they can cause ulcers and other problems in your esophagus, stomach, or small intestine.

Why? NSAIDs prevent the creation of prostaglandins, the hormone-like chemicals that cause swelling and increase pain. But that's not all that prostaglandins do. There are actually many different types of prostaglandins in your body.

One type of prostaglandin helps protect the lining of the stomach and GI tract. And the Cox-1 enzyme helps make this prostaglandin. Since regular NSAIDs block Cox-1 enzymes, they slow down the manufacture of this prostaglandin. This is why standard NSAIDs cause high rates of gastrointestinal problems. With its defenses down, your GI tract becomes irritated and damaged by normal gastric acids.

High Blood Pressure and Kidney Damage

How can NSAIDs affect your blood pressure? NSAIDs reduce the blood flow to the kidneys, which makes them work more slowly. When your kidneys are not working well, fluid builds up in your body. The more fluid in your bloodstream, the higher your blood pressure. It's that simple.

If you take NSAIDs in high doses, the reduced blood flow can permanently damage your kidneys. It can eventually lead to kidney failure and require dialysis.

Allergic Reactions

NSAIDs can also cause extreme allergic reactions, especially in people with asthma. Experts aren't sure why. Many specialists recommend that people who have asthma stay away from any NSAID, especially if they have sinus problems or nasal polyps.

How Are Cox-2 inhibitors Like Celebrex Different?

Cox-2 Inhibitors are a type of NSAID, and generally they work in similar ways. They are no better or worse at relieving pain. They have most of the same risks.

But there is a vital difference. Cox-2 inhibitors were specifically designed to avoid the gastrointestinal problems common to other NSAIDs.

Most NSAIDs affect levels of both Cox-1 and Cox-2 enzymes. Cox-2 inhibitors only block the Cox-2 enzyme. So these drugs don't affect the prostaglandins that protect the lining of your GI tract. Cox-2 inhibitors offer the same pain relief as standard NSAIDs, but a much lower risk of gastrointestinal problems.

What Are the Risks of Cox-2 Inhibitors?

In a normal body, the levels of Cox-1 and Cox-2 enzymes are naturally in balance. When you block one but not the other, unexpected things can happen.

It turns out that the Cox-1 enzymes also help make a chemical that encourages blood clotting and tightens the arteries. Normally, these nasty effects are kept in check by another chemical called prostacyclin. But prostacyclin is made, in part, with the help of Cox-2 enzymes -- the enzymes that drugs like Celebrex block.

Blocking only Cox-2 upsets the balance of these enzymes. Levels of prostacyclin go down, the influence of Cox-1 goes unchecked, and your risk of heart attacks and strokes goes up.

This is why Cox-2 inhibitors have been linked to an increased risk of heart attacks and strokes. The dangers were considered so high for the drug Vioxx that it was taken off the market. Bextra, another Cox-2 inhibitor, was also removed from the market partly because of the same risk.

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SOURCES: Byron Cryer, MD, spokesman, American Gastroenterological Association; associate professor of medicine, University of Texas Southwestern Medical Center, Dallas. Nieca Goldberg, MD, spokeswoman for the American Heart Association; chief of women's cardiac care, Lennox Hill Hospital, New York; author, Women Are Not Small Men: Lifesaving Strategies For Preventing And Healing Heart Disease In Women. John Klippel, MD, president and CEO, Arthritis Foundation, Atlanta. Scott Zashin, clinical assistant professor, University of Texas Southwestern Medical Center; author of Arthritis Without Pain. American College of Rheumatology web site. Arthritis Foundation web site. American Heart Association web site. American College of Gastroenterology web site. American Gastroenterological Association web site. American Academy of Family Physicians web site. American Academy of Allergy, Asthma, and Immunology web site.