NSAIDs — or nonsteroidal anti-inflammatory drugs — are commonly used to treat rheumatoid arthritis. They help manage the chronic pain, inflammation, and swelling that are characteristic of RA.
They do not slow down the disease. Most people with RA also take other types of medications, such as methotrexate or biologics, to help prevent further joint damage.
How Do NSAIDs Work?
They block your body’s “Cox” enzymes. This cuts down on inflammation and reduces pain and stiffness.
What Are Some NSAIDs Used for Rheumatoid Arthritis?
- Aspirin (Bufferin, Bayer)
- Celecoxib (Celebrex)
- Diclofenac (Cataflam, Voltaren)
- Diflunisal (Dolobid)
- Etodolac (Lodine)
- Fenoprofen (Nalfon)
- Flurbiprofen (Ansaid)
- Ibuprofen (Advil, Motrin)
- Indomethacin (Indocin)
- Ketoprofen (Oruvail, Orudis)
- Ketorolac (Toradol)
- Meloxicam (Mobic)
- Nabumetone (Relafen)
- Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- Piroxicam (Feldene)
- Salsalate (Amigesic)
- Sulindac (Clinoril)
- Tolmetin (Tolectin)
Arthrotec is an NSAID that combines diclofenac with another active ingredient, misoprostol, that helps prevent stomach irritation.
Prevacid Naprapac combines naproxen with the acid blocker Prevacid to lower your chances of getting stomach ulcers.
Vimovo is a combination of naproxen and the acid blocker Nexium.
Do All NSAIDs Raise the Risk of Heart Attack and Stroke?
All prescription NSAIDs are linked to a higher risk of heart attack and stroke. They carry a warning about that.
While the actual risk of a heart attack and stroke with NSAIDs is unknown, medical studies are in progress to help find that answer. The risk is likely greatest for people who have heart disease risk factors, such as high blood pressure, high cholesterol, diabetes, and smoking.
You and your doctor can weigh the risks and benefits.
What Are the Side Effects?
The most common ones include:
- Stomach problems, including pain, constipation, diarrhea, gas, nausea, and stomach ulcers
- Kidney problems
- Swelling in the legs
- Abnormal liver tests (blood tests)
- Easy bruising
- Ringing in the ears
NSAIDs may also raise blood pressure. If you have high BP, keep a close eye on your blood pressure. Let your doctor know if it goes up.
Most people take these meds with few to no side effects, though.
Is There a Serious Risk of Stomach Ulcers?
The chance of getting an ulcer or stomach bleeding rises even more if you also take corticosteroids (often called “steroids") for RA or blood thinners, or anticoagulants. Also, the longer you use NSAIDs, the greater the risk of stomach bleeding and ulcers.
Older adults, especially those who are over age 65, are more likely to get stomach bleeding and ulcers, as do those who drink alcohol and smoke cigarettes.
If you take NSAIDs to ease the inflammation, pain, and stiffness of RA, talk with your doctor about ways to protect your stomach. If you’re at high risk for stomach bleeding, you may need a strong stomach acid blocker to help prevent ulcers.
Can I Take NSAIDs if I Have High Blood Pressure?
Your doctor will check on that. NSAIDs can reduce blood flow to the kidneys, which may cause these organs not to work as well. This makes fluid build up in your body, which can raise your blood pressure.
So, if you take these meds, you will probably get a blood test from time to time to check how well your kidneys work.
Can I Be Allergic to NSAIDs?
They can cause allergies. Some people with asthma are sensitive to some NSAIDs. The drugs may worsen breathing, and many specialists recommend that people who have asthma not take certain NSAIDs. The risk may be greater in people with sinus problems or nasal polyps.
If you have asthma, make sure your arthritis doctor knows. Some NSAIDs may be safer for you.
Are There Special Precautions for Using These Meds for RA?
Use NSAIDs with caution if you have kidney or liver disease, heart failure, high blood pressure, diabetes, lupus, asthma, or ulcers.
Tell your doctor about all drugs and supplements you take. NSAIDs may interact with blood thinners, cyclosporine, lithium, or methotrexate. Let your doctor know if you’re sensitive to aspirin.
- American College of Rheumatology: “Information for Patients About NSAIDs."
- American Academy of Orthopaedic Surgeons: “What are NSAIDs?"
- Arthritis Foundation: “Studies Highlight the Risks and Health-Care Costs of NSAID Injury."
- American College of Gastroenterology: “The Dangers of Aspirin and NSAIDs."
- Arthritis Foundation: “Making Sense of NSAIDs: Side Effects."