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Understanding Ankylosing Spondylitis Medications (cont.)

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Drugs in this class include diclofenac (Cataflam, Voltaren), ibuprofen (Advil, Motrin), ketoprofen (Orudis), naproxen (Aleve, Naprosyn), piroxicam (Feldene), etodolac (Lodine), indomethacin (Indocin), oxaprozin (Daypro), nabumetone (Relafen), and meloxicam (Mobic).

How NSAIDs work: NSAIDs prevent the body from producing prostaglandins, which have been identified as a cause of pain and inflammation. NSAIDs prevent this by inhibiting the cyclooxygenase (COX) enzymes that are important in the formation of prostaglandins by cells. Several types of anti-inflammatory agents exist. Doctors recommend NSAIDs as the first type of medicine to try after they initially diagnose ankylosing spondylitis. Some of these drugs may be purchased without a prescription.

  • Who should not use these medications: People with the following conditions should not use NSAIDs:


    • Allergy to NSAIDs or aspirin


    • Peptic ulcer disease


    • Bleeding disorders


    • Kidney function impairment


    • Only certain NSAIDs should be used by people with conditions requiring treatment with blood thinners such as warfarin


  • Use: NSAIDs are taken as oral tablets, as capsules, or as a liquid suspension in various dosage regimens. Take them with food to decrease stomach irritation.


  • Drug or food interactions: NSAIDs may cause fluid retention, thereby decreasing the effectiveness of high blood pressure medications and diuretics (water pills). Phenytoin (Dilantin) or methotrexate (Rheumatrex) toxicity may increase when NSAIDs are used. Use with corticosteroids (for example, prednisone [Deltasone, Orasone]) or high doses of aspirin may increase the risk of developing peptic ulcers or gastrointestinal bleeding. Some NSAIDs interfere with the effects of aspirin taken to prevent heart disease.


  • Side effects: NSAIDs must be used with caution in people with a history of peptic ulcer disease. By inhibiting prostaglandin formation in the GI tract, these NSAIDs may predispose these people to gastropathy, which can lead to stomach erosions, ulcers, and bleeding. NSAIDs can cause fluid retention and worsen some conditions such as heart failure, high blood pressure, kidney impairment, or liver impairment. Ask your doctor prior to using NSAIDs in pregnancy. Seek medical attention if any of the following occur:


    • Severe stomach pain


    • Bloody vomit


    • 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


    • Severe rash or red itchy skin

A newer class of NSAIDs known as COX-2 inhibitors (or COXIBs, including Celebrex) reduces the risk of gastrointestinal complications and bleeding with NSAID therapy. However, the COX-2 inhibitors have been found to have their own potential, serious side effects, including an increased risk of heart attack, stroke, and heart failure. These risks may be present in varying degrees with all of the NSAIDs.

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