How NSAIDs Control Your Arthritis Inflammation

NSAIDs serve two functions: reducing inflam­mation and relieving pain. For most of them, a relatively small dose is all that's needed to unleash their full pain-relieving power. Higher doses bring on the anti-inflammatory effect. As a general rule, then, if the drug controls your inflammation, it is doing all it can do to relieve your pain. But what happens if you are getting good control of your inflammation with the drug you're taking and yet you still have pain from time to time? Should you take more of the drug?

Most experts say no. An extra measure of the same medicine will not only fail to help you but it will raise your chances of suffering some adverse side effect; nor can you call in another NSAID to boost the power of the one you're taking. Since the NSAIDs are so similar to each other, using two together multiplies the risks of all side effects. Remember, too, that over-the-counter drugs such as aspirin and ibuprofen are also anti-inflammatory agents. Check with your doctor before you mix any of these with your prescription pills. Acetaminophen (Tylenol or Datril, for example), since it's not an anti-inflammatory, is a safer bet for added pain relief. Or your doctor may recommend a prescription painkiller for you to use from time to time.

One special category of drug fallout has not been mentioned yet, and that is the effect of the NSAIDs when used by pregnant or nursing women. If you are planning to have a baby, you'll want to discuss your medication with your obstetrician and make any necessary adjustments. If you have rheumatoid arthritis, you may find that your joint pain and inflammation all but vanish during pregnancy, anyway, perhaps because of the natural changes in hormone levels and the immune system that keep your body from rejecting the half-foreign cells of your baby.

Although the NSAIDs make up a group, or family, of drugs, some of them are more closely related than others. For example, Indomethacin and Sulindac make up one chemical class, called indoles, while Diflunisal and aspirin are part of another, called salicylates. Your doctor may use these class lists in trying to find the right NSAID for you. As the theory goes, if Indomethacin fails to help you, you probably wouldn't find much comfort in its classmates. That's the theory. In practice, however, the drugs continue to defy anybody's predictions. Often enough, the person who gets no comfort from Indomethacin goes on to have great success with Sulindac.

Of six chemical classes of NSAIDs, one has fallen far behind the others in popularity. This is the class containing phenylbutazone (Butazolidin) and oxyphenbutazone (Tandearil). Ciba-Geigy took Tandearil off the market, and put new restrictions on the use of Butazolidin at that time. Butazolidin is no longer recom­mended as an early choice, but only as a last resort if other NSAIDs fail, and it is not to be used on a long-term basis. In addition to the usual risks, Butazolidin has the potential to block the bone marrow's Ufe-sustaining production of new blood cells.