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NSAIDs and Lupus


NSAIDs are often used to reduce pain and inflammation in patients who have mild systemic lupus erythematosus (SLE). Many different types of NSAIDs exist, some of which you can buy without a doctor’s prescription. These are called “over-the-counter” drugs. Examples of over-the-counter NSAIDs include aspirin, Motrin® IB, Orudis KT®, and Aleve®. Tylenol® is not an NSAID and is not used to reduce the inflammation of lupus.

The NSAIDs comprise a large and chemically diverse group of drugs that possess analgesic, anti-inflammatory, and antipyretic properties. Pain and inflammation are common problems in patients with SLE, and NSAIDs are usually the drugs of choice for patients with mild SLE and little or no organ involvement. Patients with serious organ involvement may require more potent anti-inflammatory and immunosuppressive drugs.

Although all NSAIDs appear to work in the same way, there are differences among them. Not every NSAID has the same effect on every person. Also, you may find that one NSAID works well for a while, then for some unknown reason, it doesn’t work well any more. Your doctor will probably switch you to a different NSAID to get the same helpful effects you had with the first one.

Types of NSAIDS

There are more than two dozen different NSAIDs on the market, and many new ones are in development. Some can be purchased as over-the-counter preparations, whereas larger doses of those drugs or other preparations are available only by prescription. For example, prescriptions are required for diclofenac sodium (Voltaren®), indomethacin (Indocin®), diflunisal (Dolobid®), and nabumetone (Relafen®).

Mechanism of Action and Use

The therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating joint pain and swelling, as well as muscle pain. They may also be used to treat pleuritic chest pain. An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.

Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. In addition, patients may do well on one NSAID for a period of time, then, for some unknown reason, derive no benefit from it. Switching the patient to a different NSAID should produce the desired effects. Patients should use only one NSAID at any given time.

Possible Side Effects

These include upset stomach, headache, ringing in the ears, dizziness, rash, itching, easy bruising, fluid retention, and blood in the stool.

  • Gastrointestinal (GI): dyspepsia, heartburn, epigastric distress, and nausea; less frequently, vomiting, anorexia, abdominal pain, GI bleeding, and mucosal lesions. Misoprostol (Cytotec®), a synthetic prostaglandin that inhibits gastric acid secretion, may be given to prevent GI intolerance. It prevents gastric ulcers and their associated GI bleeding in patients receiving NSAIDs. Another product, Arthrotec®, combines misoprostol with the NSAID diclofenac sodium in a single pill.
  • Genitourinary: fluid retention, reduction in creatinine clearance, and acute tubular necrosis with renal failure
  • Hepatic: acute reversible hepatotoxicity
  • Cardiovascular: hypertension and moderate to severe noncardiogenic pulmonary edema. All NSAIDS now carry a warning that they may increase the risk of myocardial infarction.
  • Hematologic: altered hemostasis through effects on platelet function
  • Other: skin eruption, sensitivity reactions, tinnitus, and hearing loss

Precautions

  • You may use NSAIDs cautiously during pregnancy, but do not take them during the first 3 months of your pregnancy or just before delivery. NSAIDs appear in breast milk and should be used cautiously if you are breastfeeding.
  • Some patients taking NSAIDs become more sensitive to sunlight. Use sunblock and protective clothing; avoid exposure to sunlight.
  • Do not take more than the recommended dose.
  • Do not take NSAIDs with other drugs, including over-the-counter medications, without first checking with your nurse or doctor. Over-the-counter medications are medications that you can buy without a doctor’s prescription.
  • Recent studies of a couple of NSAIDs have suggested an increased risk of cardiovascular problems in people taking them on a long-term basis. As with any drug, it’s important to weigh the benefits against the potential risk of side effects.
  • Tell any nurse, doctor, or dentist who is taking care of you that you are taking NSAIDs for your lupus.
  • Since NSAIDs can cause stomach and intestinal upset and irritation, take them with food or after meals. You should also avoid alcoholic beverages, because alcohol can aggravate these stomach and intestinal problems. Check with your doctor for guidance on these issues.
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