The latest on NSAIDs

[Simba1992]

The risks with NSAIDs are quite well known to the public but new research has shown that the risks are more serious than we have thought.

escardio.org/The-ESC/Press-...

[medway-lady]

Actually, they do know as I'm not allowed them because of being on Rivaroxaban a blood medication. But surely it's about risk v benefit.

[Simba1992 in reply to medway-lady]

EULAR has actually quite recently come out with new recommendations concerning NSAIDs, after new reserch results. Many of us chronicly ill are still prescribed diclofenac for example by our doctors. Taking more risks than neccessary is something we can have a say in. Aspirin for example is very rarely prescribed to RA patients even though it has shown to have the least adverse effects and actually many bennefits that other NSAIDs do not have.

[Simba1992 in reply to Simba1992]

On the benefits of aspirin.

functionalps.com/blog/2012/...

[helixhelix in reply to Simba1992]

Only skimmed the article (he writes so badly that his stuff never appeals) but didn't see any mention of contraindications. As with everything there are pluses and minuses. For example I have been advised to avoid aspirin as my father died from an aortic aneurysm, and I have GERD.

[Simba1992 in reply to helixhelix]

We have genetic aneorysm in our family too. I have read reaserch where on the contrary aspirin therapy decreases the risk of cerebral aneurysm growth. Here is one link.

ncbi.nlm.nih.gov/pubmed/259...

[Simba1992 in reply to helixhelix]

I am sure you've already read everything there is to read on GERD, however I found this very interesting and it really applies to me. Thought I had too much acid but actually the other way around, which evidently seems to be the case in many AI patients.

raypeatforum.com/community/...

[nomoreheels]

As medway-lady correctly says it's risk versus benefit. This isn't aimed at RD/AS/PsA patients where NSAIDs are prescribed for a specific reason & most often form a treatment protocol so I don't think anyone here should overly concern themselves with this info. This excerpt from a EULAR recommendation ard.bmj.com/content/76/1/17 explains

C. The use of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and the Assessment of Spondyloarthritis International Society (ASAS).44 ,45

NSAIDs and corticosteroids are commonly used for the treatment of IJD and these agents effectively lower disease activity and inflammation. However, both treatment options have been associated with an increased CVD risk.46–48 As these medications are often indispensable in tackling disease activity in patients with IJD, the task force feels that their use should be evaluated on an individual patient level. Furthermore, lowering disease activity may have beneficial effects on the CVD risk. Therefore, the task force recommends to use NSAIDs and corticosteroids according to treatment-specific guidelines.

Our Rheumy & GP also have a useful tool for when we're prescribed NSAIDs on repeat, that is if they consider we're at particular risk qrisk.org/2017/

[Simba1992]

Choosing meds that have less risks is always a better alternative, was my point.

[medway-lady]

Asprin actually killed more people last year than Riveroxaban which is also dangerous. As I said it's about the benefit, (my hematologist told me that) all medications have risks and that's life. So is driving a car, getting a flight etc. I wonder how many worry themselves over so called risks but are not so informed about the benefits of medications. The benefit to me is staying active, pain-free and happy.

[Simba1992 in reply to medway-lady]

If you read the above link you would see that this is not so. I don't exactly know how many people died last year of NSAIDs, but it was a lot and aspirin was not the most dangerous. Ofcourse if you are taking huge doses which seldom is the case.

[Simba1992 in reply to Simba1992]

Here is a little more reading with real facts.

americannutritionassociatio...

[medway-lady in reply to Simba1992]

This is the problem just because it's on the internet does not mean it is a fact. I'm so sorry but not bothering to read it as I believe the hospital consultant who saved my life three years ago. RA can affect the blood, in fact, it does mine and aspirin is not without risks.

[medway-lady in reply to Simba1992]

Fact from the Telegraph "Daily aspirin behind more than 3,000 deaths a year, study suggest" again it's not fact but a suggestion.

[Needforname]

Interesting article. Thanks for sharing. I'm currently taking Oxycontin, Oxycodone, Cymbalta, Lyrica and Embrell for my RA. Im' also taking Ibuprofin for a tooth ache. I had a crown done to my tooth about 5 weeks ago. It has been causing a lot of pain, so the dentist has me taking Ibuprofin until we can see if the pain can subside before we have to pull it or do a root canal. I was taking about 1,600mg of Ibuprofin, but now I'm taking about 800mg. Not sure what else I can do because the pain is too much. Now that my insurance is dropping the Oxicontin, I can see why people resort to Heroin. The pain becomes too much while waiting for one of these RA drugs to work. I've tried Prednisone, Methotrexate, LDN, and now Embrell. Nothing works.

[Simba1992 in reply to Needforname]

Have you tried Tramadol? Taking NSAIDs for a short period is quite ok I can imagine but then also Naproxen seems to be the safest choice if aspirin is not strong enough sorry to hear that hard to find something that works. Hope you find something soon. Simba

[Needforname in reply to Simba1992]

Hey Simba1992. I tried Tramadol in the past. It didn't help with the pain, though it may help with the tooth pain. The ibuprofen helps with the tooth pain but of course does nothing for the RA body pain. I see my doctor tomorrow, so I'll ask her about the Naproxen and Tramadol. Thanks for the suggestion. You're full of helpful info

[Downtime]

I'm currently on 1600 mg Brufen Retard daily as well as 15mg Mxt weekly. The Brufen takes away the tendon pain and reduces residual inflammation. I really dont want to do this for the rest of my life but at the moment its risks versus benefit and benefit wins.....

[AgedCrone]

But how many people do we know who buy Ibruprofen in the supermarket, throw them down their throat like Smarties, & when you say "Hey don't do that"....they rattle off " Oh they must be safe they are just otc painkillers".

Like the people who save left over anti biotics for "next time"!

On here we have an educated informed approach to pills, sadly the general public do not!

[medway-lady in reply to AgedCrone]

Sorry Aged Crone but, the general public which we are part of unless you're a doctor mostly do know of risks in taking medication. That applies to Ibrufen, Paracetamol or Asprin as well as many other ones; worst is those who believe because it's sold in a health food store as a food it has some medicinal affect.

But there again for some If they think it works, it probably will, but Asprin is most definitely a no, no as if you have blood issues it is not harmless its dangerous.rous In fact having to take Rivaroxaban as it takes precedence over all other medications means no for Sulfonamide and many other medications which are devolved from or contain Asprin. Always take a doctors or RA nurses advice is the best thing.

[AgedCrone in reply to medway-lady]

The point I was trying to make is the Ostrich approach.Yes people read all the info...but an awful lot have the attitude of either " but that doesn't apply to me", or "it's only dangerous is only if you are really ill"!

You will see how the medical profession is trying to make people aware of how useful their pharmacist can be...but still I hear people say "l want to see a real doctor" when a pharmacist can probably help & will definitely refer you to your doctor if thinks it's outside his remit. Hence in the coming months GP's surgeries will be full of people of all ages with the common cold ....obviously if you have low immunity & are liable to chest infections you need to see a nurse or doctor, but not if you just have the sniffles.

Just got my letter for my Flu Jab......seems to come round quicker each year! That's old age for you!

[medway-lady in reply to AgedCrone]

Old age? I'm in denial. lol x

[Simba1992]

Cardiologist seem to recommend asperin too.

newsmax.com/Health/Headline...

[nomoreheels in reply to Simba1992]

Please be aware those who have already had or at risk of cardiac events are prescribed low dose aspirin as a blood thinner after cardio surgery can't take recommended doses of aspirin as pain relief. Also as anyone with asthma probably knows aspirin can cause breathing problems. As always take the advice of your Rheumy or GP, they're the ones who know what's best prescribed for your pain.

[Simba1992 in reply to nomoreheels]

Yes you are so right we come with so many different conditions that like with all meds the whole picture, not just symptoms, have to be assessed. The worrisome situation concerning perscription of meds today is that meds are too often prescribed without this assessment. Pills keep piling up as the patient goes from specialist to specialist.

[medway-lady in reply to nomoreheels]

Exactly so. nomoreheels x

It's the same for anyone whose had clots or embolisms and on medication ie Warfarin, Apixaban or Rivaroxaban. Yes, trust your doctor. I have an operation next week so very aware of the risks of blood ones at the moment, otherwise I just swallow and forget it. lol x Its Heparin which hurts, for a few days to minimise risk.

[nomoreheels in reply to medway-lady]

Omitted to add those, thanks ML. All the best for your op & speedy recovery too. x

[Hidden]

We should all be educated on our health conditions and the medications that we are prescribed. However, this really needs to come directly from our doctors and pharmacists. Ultimately, they are responsible for what they sign . A blanket statement is rarely helpful as we are all different and many have other comorbidities.

The information on NSAIDs has been known for a while. Unfortunately, things do change with new research. I had this discussion with my rheum nurse. When I was initially diagnosed with RA, I was told to take NSAIDs regularly and then use paracetamol and opiates PRN. I have since been advised to take the full daily dose of paracetamol and use opiates and NSAIDs PRN.

I stopped my naproxen around 6 weeks ago due to daily vomiting and low food intake. I have noticed I'm not as good in terms of symptoms without it and now I need to weigh up the pros and cons. I need to consider my quality of life, so it's easy to say "oh it's associated with risks" when it's your life that may be improved if you take this medication.

[Simba1992]

Hello Trashdoll,

Yes we are in an impossible situation in many ways Leaving the risk calculating only up to the doc who at the moment is treating us and who in fact may not have the needed knowledge, is in my view taking too big of a risk. We are lucky if we have a doc who is really interested in our perticular case and listens to us and help us to understand new research and the real effects of the meds. Like an insightful rheumatologist somewher stated that the RA patient needs to be the CEO of his/her disease.

[Simba1992 in reply to Simba1992]

Sorry😉 I meant crashdoll.

[Nana-8]

NSAIDS chew up my stomach. Cannot tolerate them.