Do NSAIDs influence the progress of diseases such as RA?
edited 29. Feb 2012, 08:05 in Chat to our Helpline Team archive
Hi - I wonder if you can explain why anti-inflammatories such as Naproxen - which I've just started taking for RA along with Methotrexate - don't actually halt the progress of the disease? If they reduce inflammation then surely that is also stopping the RA from doing damaging our joints because it's the inflammation that is the enemy here right? If not it would really help to know if they are only prescribed as pain relief - or if by not taking them during a flare we are doing ourselves more damage? I'm very confused on this point! Mat
scattered Member Posts: 326As I understand it NSAIDs treat the active inflammation by reducing swelling etc, but do nothing to stop the inflammatory process, which is the process that causes the damage. They're a bit like steroids: great at taking down the inflammation when it occurs but they do not prevent it occuring in the first place. Due to this they cannot prevent damage from happening as they are only treating visable symptoms not the disease process itself. Damage is caused by the autoimmune cells (take your pick which: TNF, B cells, Ilg 1 etc) attacking the joint. NSAIDs do not target these cells and stop them attacking the joint, they just treat the swelling that occurs as a consequence of the cells attacking the joint.
Like I said, that is how I understand it. Hopefully someone from helplines might be able to give you a better explanation!0
Thanks Scattered I think that's helped me to understand a bit more.
Basically I was prescribed Naproxen in the aftermath of a flare last weekend but felt myself getting fluid retention on it - similarly to what happened when I took Diclofenac. I don't mind taking these things if I think they are stopping the joints from becoming damaged during flares - or preventing flares even - but I would rather put up with pain than take too many pills as have quite a high threshold and don't like swelling up with odeoma.
But after the last flare a week ago my hands have actually changed shape a little more and my pinkies were both sticking out even more and this I found quite alarming so I wondered if I could maybe have stopped this kind of colateral damage by taking a NSAID in the first place. From what you are saying it would have been better to take them when I felt the flare coming on and that might have kept down the inflammation and lessened the damage to my fingers. Hope someone from the helpline might be able to confirm this? My GP prefers me not to take them regularly because he says they are more effective if taken week on week off so I am asking what purpose they actually will serve re flares and joint damage. Mat0
if my reply on your pain thread still leaves you with questions do come back.
all the best
Thanks Guy. I should explain that I live on an island (Orkney) so don't have a rheumy team or specialist nurse - just my GP who writes to the rheumatologist, who visits our local hospital every four months. This means I can only really get answers from my GP re my medication so I rely quite heavily on NRAS and Arthritis Care for information specific to RA.
You have answered my questions really. Thankfully to date I have RA quite mildly and it is only really my hands and wrists that are currently affected although it was an all over poly arthritis to begin with. I am thinking and hoping that after 11 weeks the Methotrexate is starting to take over from the NSAIDs because my hands are less swollen and my wrists much less painful and it feels wrong to take all this medication regularly when I'm only really experiencing the odd flare.
I was on max dose of ibuprofen for about 6 months, apart from when I was on a dose of Prednisolone so I think my body and brain are now rebelling against all this medication - and I only want to take things if they are strictly necessary.
I also asked this question out of curiosity because I have been told that inflammation is the enemy we need to get on top of and therefore wondered why NSAIDs are said to not make any difference to the progress of the disease, but I think I have understood it at last!
I also think pain is quite useful in stopping us from overusing the joints we have to rest and look after and I believe my pain threshold has adapted a lot so that what seemed really awful a year ago now seems quite manageable for the most part. It's the tiredness and the depression that are getting me down more than the pain and I don't think taking naproxen or steroids helps the systemic side of RA at all. My GP doesn't encourage me to take them regularly anymore anyway as he is concerned they will become ineffective if I take them too often so I'm only to use them if in pain. We do not get our ESR or CRP checked regularly in the practice I attend. I asked to have mine done a week ago and was told that my CRP is down to 13 but my ESR is still up at 40. I only see the rheumy once every five months for 15 mins maximum and am quite recently diagnosed so do forgive all the ramble please!
If you'd like us to send you a bit more information at any stage, just private message or email us your name and address and we'll put it in the post. You are always welcome to drop us a line or give us a call - we are happy to try to help.
all the best
Thanks Guy that's great to know! Mat0
I saw this thread just before I asked a similar question myself.
The helpful advice that Matilda got from the helpline team didn't show up in the public thread though, probably a policy thing.
So, if the inflammation which NSAIDs treat is only a symptom of the destructive activity in the joints, is there currently any drug available or being researched which does halt that specific damaging auto-immune response?
I suppose this would be considered the holy grail of Arthritis treatment and research but that doesn't necessarily mean it doesn't exist yet in some form.
Hi Mike - yes I kept this private not on the main public thread because I didn't want a huge ton of responses that we get if writing on the public forum.
The way I now understand it is that the Disease Modifying Drugs and Biologics (anti-tnfs) are the ones that actually can influence the progress of the disease whereas NSAIDs only take down the inflammation and lessen the pain they don't actually make a difference to the disease itself because it's systemic (only talking about the autoimmune diseases here not OA of course).
I have been on MTX (methotrexate) for 15 weeks now and am noticing a real difference now my dose has gone up - whereas the NSAIDs seemed to give me more side effects (fluid retention) so I just wanted to know whether they should be taken regularly to keep the RA at bay or whether they were just treating the symptoms. My GP then explained to keep them as ammunition for flares only now as MTX takes over. Couldn't understand why they weren't seen as being enough by themselves but now I understand it much better - hope you do too? Mat0
Thanks for the info Mat. I'll look into the 'anti-tnfs' stuff and hope to improve my education on the subject. Glad to hear that you're feeling better and more optimistic as a result of recent developments.
It is exactly as Mat48 said. However before you start looking into anti TNF's look into DMARDs- Disease-modifying antirheumatic drugs. As there is an order of drugs which the rhematologist will follow when prescribing for Inflamatory types of Arthritis. For more information feel free to have a look at our booklet called 'Drugs and Complimentary Therapies' : http://www.arthritiscare.org.uk/PublicationsandResources/Listedbytype/Booklets/main_content/DrugsCTbookletMarch11.pdf
If you have any further questions or wish to discuss anything feel free to give us a call on our free phone number.
That's very helpful and reassuring. This forum is just what I've been hoping to find.
PS HAPPY BIRTHDAY Mike!
Simona, You made my Day!
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