Are NSAIDs Worth the Side Effects?

Q:  Although I have painful arthritis, I choose not to take nonsteroidal anti-inflammatory drugs (NSAIDs) because of their side effects. Is it possible I am making my arthritis worse?

A:  There is no evidence that NSAIDs directly affect the progression of any form of arthritis. But that doesn't mean you should try to tough out the pain without them. NSAIDs bring relief to arthritis pain and inflammation, which can certainly make you feel better. And when you feel better, you can remain active and engage in exercise, which is important to the long-term health of your joints.

You don't mention which side effects concern you, but if you have had stomach upset or ulcers from NSAIDs in the past, you might want to speak to your doctor about a COX-2 inhibitors, such as celecoxib (Celebrex). These drugs are formulated to be safer for the stomach. You might also want to ask about combination products, such as Prevacid Naprapac, which pairs the stomach acid reducer naproxen (Naprosyn) and lansoprazole (Prevacid), or Arthrotec, which pairs the ulcer-preventing agent misoprostol (Cytotec) and the NSAID diclofenac sodium (Voltaren).

Another option is to increase your consumption of omega-3 fatty acids, which can act as an anti-inflammatory agent. You can get this by eating fish such as tuna, salmon, mackerel, sardines or trout. Otherwise, ask your doctor about supplementing with fish oil or flax seed oil, both of which contain omega-3 fatty acids. Side effects of these products generally are mild. If you are bothered mainly by joint pain and not inflammation, another good option is acetaminophen, which helps relieve arthritis pain and when used as directed has few, if any, side effects.

RONALD S. BENNETT, MD
Rheumatologist

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