Lupus Site - a guide for lupus patients and their families





What are NSAIDs?

Nonsteroidal Anti-Inflammatory Drugs.

The fever-lowering property of willow bark was known to the ancients & used by Hippocrates, Galen & Pliny.  The active salicylate ingredient was isolated in France in 1827, & acetylsalicylic acid (aspirin) specifically identified in 1899 in Germany. When Dr Marian Ropes founded the first lupus clinic in Boston in 1932, aspirin was the only real medication she had to work with.  For reasons that are still unclear, only one well-designed study has ever assessed the efficacy of aspirin in SLE.  Fortunately, it was a definitive one. In 1980, the National Institutes of Health proved beyond the shadow of a doubt that aspirin was helpful in SLE.

In the 1940s, pharmaceutical companies began their search for a better aspirin, & in 1952 came up with butazolidin. It was followed by indomethacin (Indocin) in 1965 & ibuprofen (Motrin) in 1974. Since then numerous NSAIDs have been introduced, all of which are more potent than aspirin, so fewer pills are needed to achieve the same effect.  However, very few of these drugs are superior to aspirin; they have more side effects & are expensive.

NSAIDs work by inhibiting the production of prostaglandins, substances that are mediators during the inflammatory process.

What NSAIDS are available?

Aspirin, Oxaprozin (Daypro), Naproxen (Naprosyn), Ibuprofen (Motrin, Advil), Diclofenac (Volterol, Arthrotec), Indomethacin (Indocin), Nabumetone (Relafen). There are many others available, & therefore if you find that one particular NSAID doesn't suit you, there are others to try.

What symptoms of Lupus can NSAIDS help?

They can relieve fevers, headaches, muscle aches, malaise, arthritis, & serositis.  They have no beneficial effect on skin, heart, lung, kidney, central nervous system, or blood involvement of SLE.

What are the side effects of NSAIDS?

NSAIDs can induce erosions in the stomach, & this may lead to bleeding ulcers, taking NSAIDs that have a sugar coating on them can help to reduce this risk, & also take them along with food.  If you suffer from an upset stomach, nausea, vomiting, heartburn, or blood in the stool or vomit, report it at once to your physician.

Other side effects include bloating & fluid retention, easy bruisability, diarrhoea, ringing in the ears, headaches, provocation of allergy or asthma attacks, & rashes.

NSAIDs prolong bleeding times, so should be discontinued at least a week before any surgery.

All patients taking NSAIDs should have complete blood counts taken, as well as liver & kidney blood chemistries, every 3-4 months.  An increase in liver enzymes to greater than 2.5 times normal mandates discontinuation of the NSAID so as to protect the body from liver failure.  Similarly, patients with lupus nephritis probably shouldn't take NSAIDs unless it is for a specific circumstance & under close medical supervision for a limited period & renal function is carefully monitored.




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