Anti-inflammatory drugs

OA patients have been able to get pain relief from a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Some familiar medications in this class, which can be purchased without a prescription, are aspirin, ibuprofen (such as Motrin or Advil), and naproxen (such as Aleve). A prescription is needed for the NSAID Celebrex. These drugs not only reduce pain but block inflammation, a special benefit for arthritis patients.

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The medications do pose risks, however. Recently, prescription drugs Vioxx and Bextra, which are similar to Celebrex, were linked to a higher risk of heart attacks. The manufacturers, urged by the Food and Drug Administration, have stopped selling them. Celebrex is still available.

The FDA, after reviewing many studies of NSAIDs, announced two basic conclusions. First, all of these drugs raise the risk of heart trouble. But, second, it remains unclear just how much that risk is increased. Some studies implied a tiny rise or even none at all, while other studies pointed to a big jump. So rather than banning ibuprofen, naproxen, and Celebrex, the agency asked the drug manufacturers to add large warning labels about the heart risks.

Lower doses of these drugs appear to be safer, according to some recent research. This means OA patients should consult with their doctors about the safest effective dose. And people with high blood pressure or other heart disease risk factors should be watched carefully if they use these drugs for pain on a daily basis.

The heart isn't the only concern with NSAIDs. There are well-documented worries about stomach ulcers, even with Celebrex, which is supposed to be easier on the stomach. Patients can add a prescription drug called a proton-pump inhibitor, which protects the stomach. Some examples of these inhibitors are Nexium and Prilosec. Some come in generic versions, which are less expensive.

If a joint is severely inflamed, OA patients can get injections of cortisone, a steroid, directly into the joint. The injections relieve pain but don't stop the underlying cartilage degeneration; in fact, if repeated more than four times a year, they can make it worse.