Rheumatoid Arthritis (cont.)
"First-line" medications
Acetylsalicylate (aspirin), naproxen (Naprosyn), ibuprofen (Advil, Medipren, Motrin), and etodolac (Lodine) are examples of
nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs
are medications that can reduce tissue inflammation, pain, and swelling. NSAIDs
are not cortisone. Aspirin, in doses higher than those used in treating headaches
and fever, is an effective anti-inflammatory medication for rheumatoid arthritis.
Aspirin has been used for joint problems since the ancient Egyptian era. The
newer NSAIDs are just as effective as aspirin in reducing inflammation and pain
and require fewer dosages per day. Patients' responses to different NSAID
medications vary. Therefore, it is not unusual for a doctor to try several NSAID
drugs in order to identify the most effective agent with the fewest side
effects. The most common side effects of aspirin and other NSAIDs include
stomach upset, abdominal pain, ulcers, and even gastrointestinal bleeding. In
order to reduce gastrointestinal side effects, NSAIDs are usually taken with food.
Additional medications are frequently recommended to protect the stomach from
the ulcer effects of NSAIDs. These
medications include antacids, sucralfate (Carafate), proton-pump inhibitors (Prevacid and others), and misoprostol (Cytotec). Newer NSAIDs include selective
Cox-2 inhibitors, such as celecoxib (Celebrex), which offer anti-inflammatory effects with less risk of stomach irritation and bleeding risk.
Corticosteroid medications can be
given orally or injected directly into tissues and joints. They are more potent
than NSAIDs in reducing inflammation and in restoring joint mobility and
function. Corticosteroids are useful for short periods during severe flares of
disease activity or when the disease is not responding to NSAIDs. However,
corticosteroids can have serious side effects, especially when given in high
doses for long periods of time. These side effects include weight gain, facial
puffiness, thinning of the skin and bone, easy bruising, cataracts, risk of infection, muscle wasting, and
destruction of
large joints, such as the hips. Corticosteroids also carry some increased risk of contracting infections. These side effects can be partially avoided by gradually tapering the doses of corticosteroids as the individual achieves improvement in symptoms. Abruptly discontinuing
corticosteroids can lead to flares of the disease or other symptoms of
corticosteroid withdrawal and is discouraged. Thinning of the bones due
to osteoporosis may be prevented by calcium and vitamin D supplements. For
further information on corticosteroids, please read the
article on prednisone.
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