Anti-inflammatory drugs

Anatomy or system affected: All

Definition: Medicines used to relieve inflammation, pain, redness, and swelling; generally grouped into two categories: nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (steroid hormones that have an anti-inflammatory effect)

Indications and Procedures

Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve painful conditions such as arthritis, bursitis, gout, menstrual cramps, tendinitis, sprains, and strains. While some drugs are sold only with a doctor’s prescription, other drugs are sold over the counter. Some common NSAIDs, with the brand name in parentheses, are diclofenac (Voltaren), etodolac (Lodine), flurbiprofen (Ansaid), ibuprofen (Motrin, Advil, Rufen, Nuprin), nabumetone (Relafen), naproxen (Naprosyn or Aleve), and oxaprozin (Daypro). These drugs are sold as capsules, caplets, tablets, liquids, and suppositories.

Corticosteroids make up the second group of anti-inflammatory drugs that relieve inflammation and allergic reactions (and the itching, swelling, and redness that are associated with them, as well as with various skin conditions). They are similar to the natural hormone cortisone used in the treatment of arthritis. Corticosteroids are available in numerous forms, including inhalants, creams and ointments, and oral (systemic) medications. Common corticosteroids are beclomethasone (Beconase, Vancensase, Vanceril), betamethasone (Diprolene, Lotrisone), hydrocortisone, mometasone (Elocon), prednisone (Deltasone, Orasone), and triamcinolone (Azmacort, Nasacort).

Aspirin and NSAIDs are commonly used in the treatment of arthritis. Because high doses of aspirin are required to control joint inflammation, NSAIDs are effective for arthritis treatment and are useful for people who cannot tolerate the required dosage of aspirin. Individual responses to NSAIDs vary. These drugs tend to lose their effectiveness after prolonged use, and others may need to be substituted.

Uses and Complications

NSAIDs can cause some serious side effects, especially if they are taken for a long period of time, in large doses, or if several NSAIDs are taken together. Older persons who take NSAIDs are at risk of developing stomach problems. NSAIDs can also increase the possibility of bleeding after surgery or sensitivity to sunlight. The following persons should consult their physicians before taking NSAIDs: individuals who are taking other medications, women who are pregnant or who plan to become pregnant, women who are breast-feeding, and individuals with stomach or intestinal problems, liver disease, heart disease, high blood pressure, bleeding difficulties, diabetes, Parkinson’s disease, or epilepsy.

For most individuals who are prescribed these drugs, however, common side effects are mild and may include stomach pain or cramps, nausea, vomiting, indigestion, headache, and dizziness. It is also important to note that research has been used to identify new anti-inflammatory painkillers that produce fewer of these kinds of effects. One example is licofelone, an NSAID that is reported to be gentler on the stomach. Licofelone is classified as a COX/LOX inhibitor, where COX refers to the substance cyclooxygenase and LOX refers to the substance lipoxygenase.

For most individuals using these substances, serious side effects are rare. For some, however, they can be life-threatening. In fact, research has shown that some NSAIDs can increase the risk of strokes and heart attacks. According to a 2015 statement by the Food and Drug Administration (FDA), these issues can occur as early as the first week of NSAID use and can appear even in patients without existing heart disease or other risk factors for heart disease. These types of NSAIDs are COX inhibitors; they specifically work to inhibit COX-2, where the 2 represents a specific type of cyclooxygenase. Such risks underscore the need for medical consultation when using these drugs. Any feelings of tightness in the chest, irregular heartbeat, swelling, or fainting are reasons to discontinue taking NSAIDs and to consult a physician.

Corticosteroid therapy produces dramatic, immediate relief from pain, swelling, and inflammation due to arthritis. However, the beneficial effects tend to be temporary. Long-term use causes harmful reactions to corticosteroids; consequently, the advent of highly effective alternatives has led to less frequent use of steroids for arthritis. Also, small amounts of steroid may be injected into the inflamed joint.

Corticosteroids are a common treatment for persons suffering from more serious asthmatic conditions or when treatment with bronchodilators is not effective. Corticosteroids, which are not bronchodilators and do not open the airways, work to reduce inflammation and allow the lungs to function properly. They should be used regularly and for the complete course as prescribed to achieve full benefits. Inhaled corticosteroids may be sprayed, while oral corticosteroids are used largely in the prevention of asthma attacks. Inhaled corticosteroids may be sprayed into the nose for relief of stuffy nose, irritation, hay fever, or other allergies.

Ophthalmic anti-inflammatory medicines can be used to reduce problems that occur during or following eye surgery and soothe some eye inflammations; they can be obtained only with a doctor’s prescription. Corticosteroids also relieve inflammation of the temporal arteries, blood vessels that run along the temples. Inflammation here disrupts the blood supply and can result in blindness, loss of vision, strokes, and heart attacks.

Long-term use of corticosteroids causes a large number of serious side effects, including puffiness, weight gain, facial hair, reduced resistance to infection, gastrointestinal ulcers and bleeding, and diabetes. It may increase the risk of high blood pressure and osteoporosis, which is more likely to develop in older women. Corticosteroids can slow or stop growth in children and teenagers.

Individuals who have medical conditions such as allergies, diabetes, pregnancy, osteoporosis, glaucoma, infections, thyroid problems, liver disease, kidney disease, heart disease, or high blood pressure should discuss these conditions with their physician before taking corticosteroids.

If corticosteroids are used for a short time, serious side effects are rare. However, breathing problems or tightness in the chest, pain, rash, swelling, extreme tiredness, irregular heartbeat, or wounds that will not heal should be reported to the patient’s physician. Steroids should not be stopped abruptly without consulting a physician, especially if the steroids have been taken for a long time, as the body requires a weaning process to adapt.

Perspective and Prospects

The bark of the willow tree, which contains salicylates, was known in eighteenth-century England to reduce fever and aches, and in 1876 the first successful treatment of acute arthritis with sodium salicylate (aspirin) was reported. In the 1970s, pharmacologist John Vane amassed evidence of the effectiveness of NSAIDs.

The earliest demonstration of the importance of corticosteroids as anti-inflammatory agents occurred in the 1940s in regard to rheumatoid arthritis. The challenge of corticosteroid therapy lies in achieving the desired results with a minimum of side effects.

Bibliography

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