Non-steroidal anti-inflammatory drugs (NSAIDs) are the mainstay of AS treatment 

NSAIDs reduce the pain and stiffness caused by inflammation of the joints without using steroids. They will have no long-term effect on your AS. They are often taken in addition to simple painkillers such as paracetamol.

There are many different NSAIDs available in the UK. Some commonly used NSAIDs include aspirin, ibuprofen, naproxen and diclofenac. Many are availble to buy over the counter but stronger NSAIDs are only available on prescription.

The coxibs, or COX-2-specific NSAIDs, are a group of drugs that also reduce inflammation, but they are less likely than standard NSAIDs to cause stomach upsets, heartburn and indigestion. Some commonly used coxibs in the UK include celecoxib (brand name Celebrex) and etoricoxib (Arcoxia). Currently these drugs are only available on prescription.

Taking NSAIDs

NSAIDs are usually taken as tablets or capsules but many are also available as a liquid suspension, a suppository, or as a topical cream or gel that you rub into the affected area.

Tablets or capsules should be taken with a full glass of liquid, with or shortly after food, and as directed by your doctor. Some NSAIDs are taken only once a day (especially those in a slow-release, sustained-release or retard preparation), while others are taken 2-4 times a day.

Your doctor will advise you about the correct dose to take. Usually a low dose is prescribed initially, and then increased if necessary.

Doctors have been advised to use the lowest effective dose for the shortest period of time for anyone who is prescribed any of the NSAIDs. This reduces the risk of side effects. It's important that you go back to your GP if the type and dose of NSAIDs that have been prescribed do not relieve your pain and stiffness after 2 weeks.

NSAIDs work quickly, usually within a few hours However it can take up to 2 weeks to get the full benefi.

Side-effects of NSAIDs

Possible side-effects of NSAIDs include:

  • stomach upsets
  • heartburn
  • indigestion
  • rashes
  • headaches
  • wheeziness
  • fluid retention

If you develop any new symptoms you should stop taking the drug and tell your doctor as soon as possible.

NSAIDs can damage the lining of the stomach and cause bleeding, especially if you are taking high doses or using them over a long period of time. They should only be used with caution and only continue to be used if they are controlling your symptoms. You should not take them if you have a history of indigestion or stomach ulcers. Drugs known as proton-pump inhibitors (PPIs) are commonly prescribed along with NSAIDs to help reduce the risk of side-effects on the stomach. Do discuss this with your doctor.

NSAIDs can slightly increase your risk of having a heart attack or stroke. This means doctors are unlikely to want to prescribe NSAIDs if you have:

  • heart disease
  • had a heart attack or stroke in the past
  • peripheral vascular disease (circulation problems in the limbs, usually in the legs)

You should not take etoricoxib (Arcoxia) if you have high blood pressure which is not under control.

Doctors have also been advised to be cautious about prescribing NSAIDs to people who have an increased risk of heart disease, including people with:

  • high blood pressure
  • high cholesterol levels (hyperlipidaemia)
  • diabetes
  • smokers

Further information regarding associations between NSAIDs, heart attacks and strokes is currently being researched.

Additionally, caution is required in the use of NSAIDs if you have:

  • asthma
  • problems with your digestive system including previous somach ulcers
  • hernia
  • kidney problems
  • circulatory problems

You should not take NSAIDs if you are allergic to aspirin. 

If you would like any further information about NSAIDs, or if you have any concerns about your treatment, you should discuss this with your doctor or pharmacist.

Last reviewed: March 2012

 

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