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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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