NSAIDs: old (and new) arthritis medicine standbys

Nonsteroidal anti-inflammatory drugs (also known as NSAIDs) such as aspirin and ibuprofen can help relieve the vexing symptoms of osteoarthritis, and are mainstays of rheumatoid arthritis treatment. Here's what you need to know.

Nonsteroidal anti-inflammatory drugs block the body's production of prostaglandins (chemicals that play a key role in causing the pain and swelling of inflammation). In addition to familiar over-the-counter brands, your doctor can draw from an extensive list of prescription variations, such as naproxen, many of which are stronger per dose or are timed-release so they can be taken fewer times a day.

However, a major drawback of these medications is that if they're taken regularly, these NSAIDs can cause nasty side-effects. These can include stomach irritation and even gastrointestinal bleeding.

Since 1999, Health Canada has approved the first of a new class of NSAIDs called COX-2 inhibitors. These drugs relieve inflammation as well as standard NSAIDs while posing less risk for causing gastrointestinal problems. These COX-2 inhibitors are useful for people over 65, who are especially susceptible to bleeding from using standard NSAIDs.

However, Health Canada has issued warnings about several of these drugs, and pulled at least two from the market since 2004, showing that these drugs are still a new solution and one about which new knowledge is still emerging.

Further, although NSAIDs counter inflammation, they don't prevent renegade synovial tissue from eroding cartilage and bone — the destructive process that inflammation sets in motion and that causes permanent joint damage. NSAIDs have also proven disappointing in studies involving fibromyalgia patients, though some may still benefit from them.

You'll find it on drugstore shelves next to ibuprofen and aspirin, but acetaminophen isn't known as an anti-inflammatory drug.

However, it is a good painkiller and, in moderate doses (up to two grams a day), can safely help arthritis patients to take lower doses of other NSAIDs to get relief. But, taken in full doses, acetaminophen can irritate the stomach too.

Remember this information to help you decide if NSAIDs are for you, and use it to start a conversation with your doctor about arthritis medication.