Treating Psoriatic Arthritis with NSAIDs

02/14/2007

To prevent these gastric side effects, a variety of medicines may be recommended. Antacids, for example, prevent the production of excess stomach acid. Drugs such as sucralfate (Carafate®) help coat and protect the stomach, while medications like misoprostol (Cytotec®) help restore the lost mucus.

A Newer Class of NSAIDs

Newer classes of NSAIDs, known as COX-2 inhibitors or COXIBs, block only the COX-2 enzyme and are thereby able to reduce the risk of the gastrointestinal complications associated with traditional NSAID therapy. However, these drugs are more expensive than older NSAIDs, and, while considered just as effective at reducing the pain and inflammation of psoriatic arthritis, they carry their own set of risks.

Two of the three newer COX-2 inhibitors on the market were recently found to cause potentially serious side effects. In 2005, the makers of rofecoxib (Vioxx®) and valdecoxib (Bextra®) voluntarily pulled the drugs from the market because of reports that they may increase the risk of heart attack, heart failure and stroke, especially in people who are known to have heart disease. Celecoxib capsules (Celebrex®), the only COX-2 inhibitor still available, now carries a prominent "black box warning" on its packaging indicating that it may be linked to an increased risk of cardiovascular events. The black box is the strongest warning symbol used by the Food and Drug Administration (FDA).

All NSAIDs are Under Scrutiny

In the spring of 2005, the FDA also announced new label requirements for prescription and nonprescription NSAIDs. Their packaging now includes the same boxed warning as the COX-2 inhibitors. It highlights the increased risk of heart attack and stroke, as well as the potential for gastrointestinal bleeding. Manufacturers of Celebrex and all other prescription NSAIDs have since revised their labeling to include a medication guide for patients to ensure they use these drugs safely.

At the same time, the FDA also asked the manufacturers of over the counter NSAIDs to include a warning about potential skin reactions, a decision that is especially important to patients with psoriatic arthritis. Indomethacin, for example, has been shown to worsen psoriasis. However, when it is taken properly, adverse effects can be minimized, and the potential benefits it holds for patients with psoriatic arthritis is thought to outweigh its side effects.

Taking NSAIDs Safely

To ensure that NSAIDs are taken safely, a doctor's supervision is recommended, whether the medicines used are prescription or nonprescription. A doctor's supervision is important because NSAIDs can be contraindicated, meaning they should not be taken when a patient has a certain condition or is on a particular medication because more serious problems can occur. For example, individuals taking anticoagulants such as warfarin sodium tablets (Coumadin®) should be monitored for increased bleeding.

NSAIDs may cause fluid retention, which can decrease the effectiveness of high blood pressure medication and diuretics. They may also worsen conditions, such as high blood pressure, heart failure and kidney function, and may also cause liver impairment. Additionally, if two NSAIDs (such as aspirin and ibuprofen) are taken in conjunction with one another or at the same time as corticosteroids, they may increase a patient's risk of developing peptic ulcers or gastrointestinal bleeding. Some NSAIDS interfere with aspirin when taken to prevent heart disease.

For these reasons, people with allergies to NSAIDs, peptic ulcer disease, bleeding disorders, and kidney function impairment should not take NSAIDS. Pregnant women are also told to avoid using NSAIDs during the last 3 months of their pregnancy. Finally, patients should call their healthcare professional if they experience any of the following: severe stomach pain; vomiting, especially with blood; bloody or black, tarry stools; bloody or cloudy urine; unexplained bruising or bleeding; wheezing or breathing troubles; swelling in the face or around the eyes or severe rash or red, itchy skin.