Psoriatic Arthritis and NSAIDs: 7 Questions to Ask Your Doctor
Find out how nonsteroidal anti-inflammatory drugs work, and what you need to know before starting this common treatment.
If you’ve been diagnosed with?psoriatic arthritis, one of the first treatments your doctor is likely to try to ease your swollen, achy joints is a nonsteroidal anti-inflammatory drug (NSAID).
These medications, which are available both over the counter and by prescription, are effective for many people in controlling swelling, pain, and morning stiffness, and in improving range of motion in joints, according to the?National Psoriasis Foundation.
“For the average psoriatic arthritis patient, NSAIDs are the first-line treatment,” says?M. Elaine Husni, MD, MPH, the vice chair of rheumatology and the director of the arthritis and musculoskeletal center at the Cleveland Clinic in Ohio. “We usually use [them] for four to six weeks to see if we can get the patient’s symptoms under better control. For some people, stronger psoriatic arthritis drugs are not needed.”
NSAIDs?for Psoriatic Arthritis and How They Work
Some of these NSAIDs are also available in prescription strength. “For over-the-counter NSAIDs, we need to use doses in the range of 600 to 800 milligrams three times per day,” says?Olivia Ghaw, MD, an associate professor of medicine and rheumatology at Mount Sinai's Icahn School of Medicine in New York City. “That’s a lot of pills, so it often makes sense to switch to higher-strength NSAIDs, which are longer acting.”
Whether prescription or OTC, all NSAIDs work by blocking the actions of an enzyme in the body called cyclooxygenase (COX). COX has two functional types: COX-1 protects your stomach from acid, and COX-2 is involved in joint inflammation.
Most NSAIDs block the actions of COX-1 and COX-2, which is why they relieve joint pain but can also cause stomach upset.?Celebrex (celecoxib)?and?Mobic?are not as rough on the stomach, and both are widely used to block the action of COX-2.
NSAIDs have some advantages over steroids, which can also be used to ease psoriatic arthritis inflammation. ”Nonsteroidal anti-inflammatory drugs decrease inflammation in the joints and relieve pain with fewer side effects than steroids,” explains?Dr. Ghaw. ”Steroids suppress the?inflammation of psoriatic arthritis, but you can’t use them for long, and when you withdraw them, there can be a flare of psoriasis.”
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Potential Risks of Using NSAIDs for Psoriatic Arthritis
“Many people take NSAIDs for a headache or a pulled muscle, and for most people that sort of short-term use is fine — that’s why they’re offered over the counter,” says Dr. Husni.
But when someone takes NSAIDs every day, long-term, to treat psoriatic arthritis, there are different side effects that need to be considered, Husni notes.
For some people, NSAIDS can cause blood pressure to rise. “If you’re already prone to high blood pressure, you might not be a good candidate for an NSAID,” says Husni.
NSAIDs can also erode the stomach lining, so they should be avoided by people who are at risk of, or have a history of, peptic ulcers.
For people with a history of gastrointestinal bleeding or ulcers, doctors may prescribe an acid blocker along with the NSAID.
Questions to Ask Your Doctor Before Taking NSAIDs for Psoriatic Arthritis
The type of NSAID you use and the dosage involve decisions that you and your doctor make together. Here are some questions to consider asking:
- Do I have any health issues that will make it riskier for me to take NSAIDs? Raise any concerns you may have about your kidneys, liver, stomach, colon, lungs, or heart. If you are worried about high blood pressure or blood clots, ask about these potential complications, too.
- What are my chances of having an allergic reaction? If you've had problems with aspirin or have nasal polyps, your risk increases.
- Will NSAIDs interfere with any of my other medications? Some drugs that may be affected by NSAIDs include blood pressure medications, steroids, and blood thinners.
- How much alcohol can I drink while taking NSAIDs? Having more than two drinks a day may increase your risk of stomach problems.
- Will my age affect my risk of NSAID complications? People over age 65 are at greater risk from complications.
- Can I take NSAIDs if I am (or want to become) pregnant? Women who are still of childbearing age should ask about the risk of taking NSAIDs while pregnant or breastfeeding.
- Is there a generic NSAID available? Over-the-counter NSAIDs are not expensive, but some brand-name prescription NSAIDs may require preauthorization from your doctor for insurance coverage, and you may do just as well with a generic.
“It is important that you talk to your doctor — they know your history and they can customize your treatment,” says Husni. “There are tweaks we can make in how we deliver the medicine, and so it’s not just a yes or no decision.”
There are lots of considerations that go into prescribing NSAIDs in the safest and most effective way. Plus, Husni stresses that if these drugs are not right for you, there are other effective treatment options for psoriatic arthritis, including injectable and oral medications.
Additional reporting by Becky Upham.