What Are NSAIDs?
Pain and inflammation are common in people with systemic lupus erythematosus (SLE). Sometimes these symptoms indicate serious organ involvement which may require powerful anti-inflammatory and immunosuppressive drugs, such as steroids (cortisone, prednisone).
At other times the inflammation is not as severe or does not affect major organs, and a less potent drug is indicated. In these cases, other milder anti-inflammatory and analgesic drugs can be used, especially a group of drugs called the non-steroidal anti-inflammatory drugs (NSAIDs).
While NSAIDs are not approved specifically for SLE by the Food and Drug Administration, they are approved for use in many musculoskeletal pain conditions such as arthritis and tendinitis, which also afflict people with lupus.
Types of NSAIDs
There are many different types of NSAIDs, available either by prescription or over the counter. Examples are listed in Table 1. Newer ones will be marketed over the next few years. Aspirin is anti-inflammatory when given in high doses; otherwise it is a pain killer such as tramedone (Ultram) or acetaminophen (Tylenol).
How do NSAIDs Work?
NSAIDs work primarily by preventing the formation of substances called prostaglandins. But there are two types of prostaglandins, and the body has problems when both types are inhibited.
- "Maintenance" prostaglandins are made regularly by the body.
- They are produced by an enzyme labeled cox-1.
- They play a role in maintaining normal function in several organ systems. Examples include:
- the protective lining of the stomach
- normal platelet function
- kidney blood flow.
- "Inflammatory" prostaglandins are produced by the body in response to an inflammatory stimulus.
- They are produced by an enzyme labeled cox-2.
- They play a role in causing inflammation and pain.
Traditional NSAIDs vs. Newer NSAIDs
Traditional NSAIDs-ibuprofen (Motrin, Advil), naproxen (Naprosyn, Alleve), and piroxicam (Feldene), to name a few-inhibit both cox-1 and cox-2 prostaglandins. Many of the undesirable side effects of using these non-selective NSAIDs result from inhibiting the cox-1 "maintenance" prostaglandins.
The beneficial effects of the newer NSAIDs result from inhibiting, or limiting, only the cox-2 "inflammatory " prostaglandins. These specific NSAIDs are effective for treatment of musculoskeletal pain and are without many of the side effects associated with the traditional agents.