Rheumatoid Arthritis and NSAIDs

These agents are the first-line treatment for most forms of arthritis. NSAIDs are among the commonly prescribed drugs, but some brands are available for over-the-counter use. NSAID's have antipyretic, analgesic and anti-inflammatory properties. There are currently 20 NSAIDs of different chemical groups available. Aspirin is one of the commonly used NSAID's for arthritis. It belongs to a group of drugs called salicylates. Aspirin has been in use for more than 100 years and it is the most extensively used drug in the world.Aspirin works by inactivating the enzyme called cyclooxygenase (COX) which is responsible for prostaglandin production. Oral forms of aspirin are available as caplets, gelcaps, tablets, chewables, enteric coated tablets, and extended-released forms.

NSAID's seem to beneficially affect several physiologic processes present in individuals with rheumatoid arthritis including prostaglandin production. Prostaglandin is a naturally-occurring chemical which is released when cells are injured or damaged. It sends messages to trigger inflammation. The nerve endings that sense pain are very sensitive to prostaglandin. When this chemical is released, the nerve endings respond to it by transmitting the pain and injury messages to the brain. Prostaglandins are generally increased in inflammatory conditions. NSAIDs work by blocking the enzyme that produce prostaglandin.

Read more details about NSAIDs.

Aspirin is used to relieve mild to moderate pain, reduce fever and inflammation. Aside from inflammatory conditions such as rheumatoid arthritis, aspirin is also helpful for treating or preventing heart attacks, angina and strokes because of its anti-platelet properties.

Adult: The usual adult dose for rheumatoid arthritis is 3 grams per day in divided doses.

Children: For treating patients with juvenile rheumatoid arthritis the usual doses are as follows:

For children 2 to 11 years or those who weigh less than or equal to 25 kg, the initial dose is 60 to 90 mg/kg daily in equally divided doses.

Maintenance dose is 80 to 100 mg/kg daily in equally divided doses; some patients may need higher dosages up to 130 mg/kg daily but the dose should not to exceed 5.4 g/day.

For 12 years or older or those who weigh more than 25 kg, the initial dose is 2.4 to 3.6 g/day taken by mouth in equally divided doses. Maintenance dose is 3.6 to 5.4 g/ daily in equally divided doses; higher dosages may be necessary in some cases.

Aspirin should be taken as prescribed by the doctor. It should not be used in larger or smaller amounts, or for longer than recommended. Aspirin must be taken with a full glass of water. Taking this medicine with food or milk can lessen stomach upset. The enteric-coated form is specially formulated to be gentle on the stomach, but it may also be taken food or milk. Do not crush, chew, break, or open an enteric-coated or extended-release forms. The pill should be swallowed whole. The enteric-coated aspirin tablets has a special coating to protect your stomach. Breaking the pill could damage its coating. The extended-release tablet is designed to release the medicine slowly in the body. Crushing or breaking this pill would cause too much of the drug to be released at one time.

Patients who develop signs of allergic reaction to aspirin should seek emergency care. Below are some of the signs to watch out for:

• hives
• difficulty breathing
• swelling of your face, lips, tongue, or throat.
• stomach discomfort or heartburn
• drowsiness
• headache

Serious side effects may occur with aspirin use. Patients are advised to stop using aspirin and contact the healthcare provider immediately if any of the following signs and symptoms occur:

• black, bloody, or tarry stools
• unusual bleeding or bruising
• coughing up blood or vomit that looks like coffee grounds
• severe nausea, vomiting, or stomach pain; * swelling, or pain lasting longer than 10 days
• ringing in the ears
• fever lasting longer than 3 days

It is important to inform your healthcare provider if you have any allergies or reactions to medicine, food preservatives, or dyes. Make sure to tell how the allergy usually affects you. This includes telling about the signs and symptoms of allergy that you usually experience such as rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other symptoms involved

Do not take any over-the-counter medication without checking with your doctor. Many over the counter medicines contain aspirin. Using this products while on aspirin therapy can be harmful. Read the label of any other medicine you are using to see if it contains aspirin.

Avoid taking an NSAID while you are taking aspirin. NSAIDs include ibuprofen (Motrin, Advil), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene), and others. Alcohol should be avoided while taking aspirin. Alcohol may increase one's risk of stomach bleeding.

If any of the conditions below applies to you, dose adjustment maybe needed or your doctor may request for some tests to find out if you can safely take aspirin.

• asthma or seasonal allergies
• nasal polyps
• gastric ulcers
• liver disease
• kidney disease
• a bleeding or blood clotting disorder
• heart disease
• high blood pressure

Aspirin should not be used by patients who have a recent history of stomach or intestinal bleeding; a bleeding disorder such as hemophilia; or an allergy to an NSAIDs.

Drug interactions

Taking aspirin with other drugs may produce undesirable adverse effect. These drugs include:

Heparin and other blood thinners. Administering aspirin with anticoagulants may increase the risk of bleeding and prolong bleeding time.

Antacids. These drugs may reduce the rate of aspirin absorption

Urine acidifiers. Drugs such as ascorbic acid, sodium phosphate, and ammonium chloride reduce the rate of excretion of salicylic acid by promoting its reabsorption.

Urine alkalinizers ( i.e. methotrexate). Urine alkalinizers increase aspirin's excretion rate.

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