Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
Nonsteroidal anti-inflammatory drugs (NSAIDs), including over-the-counter medications such as aspirin and ibuprofen as well as prescription products, help to decrease inflammation, joint pain and stiffness. Aspirin can help reduce pain, swelling and stiffness.
Prescription and nonprescription NSAIDs are effective for many people with psoriatic arthritis in controlling swelling, pain and morning stiffness, and in improving range of motion to joints. They can help reduce the limitations to daily activities often caused by arthritis. A partial list includes:
- Clinoril (sulindac)
- Daypro (oxaprozin)
- Feldene (piroxicam)
- Indocin (indomethacin)
- Lodine (etodolac)
- Meclomen (meclofenamate)
- Mobic (meloxicam)
- Motrin, Advil (ibuprofen)
- Aleve, Anaprox, Naprelan, Naprosyn (naproxen sodium)
- Orudis (ketoprofen)
- Relafen (nabumetone)
- Tolectin (tolmetin sodium)
- Voltaren, Arthrotec (diclofenac)
Which NSAID you use is a decision to be made between you and your doctor. Ask for a discussion of side effects. NSAIDs and aspirin generally do not significantly alter psoriasis skin lesions. NSAIDs or aspirin can be sufficient treatment for many people over time. Acetaminophen (Tylenol) may be added for pain relief; however, Tylenol does not relieve inflammation. A doctor considers stronger medications when NSAIDs and aspirin fail to work and progression of the disease is evident.
Some NSAIDs, when taken in high doses or over long periods of time, carry a risk of causing stomach problems, including ulcers and gastrointestinal bleeding. The risk depends on the strength of the NSAID and how long it is taken. Many people with psoriatic arthritis do not have problems with NSAID side effects.
NSAIDs called COX-2 inhibitors have proven to be less problematic for the stomach than other NSAIDs. The COX-2 inhibitor Celebrex has been approved for treating the symptoms of rheumatoid arthritis and osteoarthritis.
COX-2 inhibitors are not necessarily more effective at relieving pain and inflammation than regular NSAIDs. They are more expensive and have their own risks. People with psoriatic arthritis who are interested in trying a COX-2 inhibitor should talk to their doctor.
In spring 2005, the U.S. Food and Drug Administration (FDA) announced new label requirements for both prescription and non-prescription NSAIDS, including Celebrex. In 2004, Vioxx was voluntarily removed from the market by its manufacturer, following concerns about its risk-versus-benefit profile. Bextra, another COX-2, was also voluntarily removed.