Psoriatic arthritis - causes, symptoms, diagnosis, treatment, pathology
Psoriatic Arthritis and NSAIDs: 5 Questions to Ask Your Doctor
Find out how these drugs work, and what you need to know before starting this common treatment.
By Chris Iliades, MD
Medically Reviewed by Sanjai Sinha, MD
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The goal of psoriatic arthritis treatment is to relieve the pain of stiff, swollen joints and prevent joint damage.
“Psoriatic arthritis is an inflammatory arthritis that falls under the same umbrella as rheumatoid arthritis. Joint symptoms usually follow psoriasis by about 10 years, and nonsteroidal anti-inflammatory drugs, or NSAIDs, are the first line of psoriatic arthritis treatment. For some people, stronger psoriatic arthritis drugs are not needed,” says M. Elaine Husni, MD, MPH, vice chair of rheumatology and director of the arthritis and musculoskeletal center at the Cleveland Clinic in Ohio.
"Nonsteroidal anti-inflammatory drugs decrease inflammation in the whole body, so they also decrease inflammation in the joints and relieve pain with less side effects than steroids,” says Olivia Ghaw, MD, rheumatologist at Mount Sinai Hospital and assistant professor of medicine and rheumatology at Mount Sinai's Icahn School of Medicine in New York City. "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."
How NSAIDs Work
NSAIDs include many common over-the-counter (OTC) drugs like aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve). 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 (mg) three times per day," says Dr. Ghaw. "That’s a lot of pills, so it often makes sense to switch to higher strength NSAIDs, which are longer acting. You can take 500 mg of Aleve twice daily, or 15 mg of Mobic (meloxicam) once daily.”
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. That’s why they relieve joint pain but also cause stomach upset. Celebrex (celecoxib) and Mobic are not as rough on the stomach, and both are widely used as COX-2 inhibitors.
“For psoriatic arthritis treatment, we usually begin with an NSAID for four to eight weeks,” says Dr. Husni. “Patients need to know what the side effects are, as well as the possible risks.”
“Both over-the-counter and prescription NSAIDs come with a warning that they may increase your risk of heart attack, stroke, and bleeding," says Husni.
Questions to Ask Your Doctor
Talk to your doctor and get answers before starting an NSAID for psoriatic arthritis treatment.
- Do I have any health issues that will increase my risk of problems? These can involve your kidneys, liver, stomach, colon, lungs, heart, blood pressure, or chance of blood clots.
- What are my chances of having an allergic reaction? If you've had problems with aspirin or nasal polyps, your risk increases.
- Will NSAIDs interfere with any of my other medications? Some medications that may be affected by NSAIDs include blood pressure meds, 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 risks of using NSAIDs? People over age 65 are at greater risk from complications.
Women who are still of childbearing age should ask about the risk of NSAIDs in pregnancy and while breastfeeding. If your doctor prescribes a prescription-strength NSAID, do not take an OTC NSAID along with it.
Over-the-counter NSAIDs are not expensive, but some prescription NSAIDs may require pre-authorization from your doctor if a generic version of the drug is not available.
The Arthritis Foundation’s Health Care Resources website will link you to sources to help explain out-of-pocket costs, copayments, and sources for financial assistance.
Millions of Americans have been using NSAIDs for more than 30 years to relieve pain and inflammation in both over-the-counter and prescription-strength forms. Although there are important side effects that you need to discuss with your doctor, these drugs have proven their value over time for psoriatic arthritis treatment.
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