These medications, which are available both over the counter and by prescription, are effective for many people in controlling swelling, pain, and morning stiffness, and in improving range of motion in joints, according to the National Psoriasis Foundation. “For the average psoriatic arthritis patient, NSAIDs are the first-line treatment,” says M. Elaine Husni, MD, MPH, the vice chair of rheumatology and the director of the arthritis and musculoskeletal center at the Cleveland Clinic in Ohio. “We usually use [them] for four to six weeks to see if we can get the patient’s symptoms under better control. For some people, stronger psoriatic arthritis drugs are not needed.” RELATED: 9 Myths About Psoriatic Arthritis Treatment, Debunked
NSAIDs for Psoriatic Arthritis and How They Work
NSAIDs include many common over-the-counter (OTC) drugs like aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). Some of these NSAIDs are also available in prescription strength. “For over-the-counter NSAIDs, we need to use doses in the range of 600 to 800 milligrams three times per day,” says Olivia Ghaw, MD, an associate professor of medicine and rheumatology at Mount Sinai’s Icahn School of Medicine in New York City. “That’s a lot of pills, so it often makes sense to switch to higher-strength NSAIDs, which are longer acting.” You may be fine taking 500 milligrams (mg) of Aleve twice daily, or 15 mg of Mobic (meloxicam) once daily, she says. Whether prescription or OTC, all NSAIDs work by blocking the actions of an enzyme in the body called cyclooxygenase (COX). COX has two functional types: COX-1 protects your stomach from acid, and COX-2 is involved in joint inflammation. NSAIDs have some advantages over steroids, which can also be used to ease psoriatic arthritis inflammation. ”Nonsteroidal anti-inflammatory drugs decrease inflammation in the joints and relieve pain with fewer side effects than steroids,” explains Dr. Ghaw. ”Steroids suppress the inflammation of psoriatic arthritis, but you can’t use them for long, and when you withdraw them, there can be a flare of psoriasis.” RELATED: Treatments for Psoriatic Arthritis
Potential Risks of Using NSAIDs for Psoriatic Arthritis
“Many people take NSAIDs for a headache or a pulled muscle, and for most people that sort of short-term use is fine — that’s why they’re offered over the counter,” says Dr. Husni. But when someone takes NSAIDs every day, long-term, to treat psoriatic arthritis, there are different side effects that need to be considered, Husni notes. For some people, NSAIDS can cause blood pressure to rise. “If you’re already prone to high blood pressure, you might not be a good candidate for an NSAID,” says Husni. NSAIDs can also erode the stomach lining, so they should be avoided by people who are at risk of, or have a history of, peptic ulcers. “Both over-the-counter and prescription NSAIDs come with a warning that they may increase your risk of heart attack, stroke, and [gastrointestinal and other types of] bleeding,” adds Husni. For people with a history of gastrointestinal bleeding or ulcers, doctors may prescribe an acid blocker along with the NSAID. RELATED: 3 Reasons You May Need to Change Your Psoriatic Arthritis Treatment
Questions to Ask Your Doctor Before Taking NSAIDs for Psoriatic Arthritis
The type of NSAID you use and the dosage involve decisions that you and your doctor make together. Here are some questions to consider asking: “It is important that you talk to your doctor — they know your history and they can customize your treatment,” says Husni. “There are tweaks we can make in how we deliver the medicine, and so it’s not just a yes or no decision.” There are lots of considerations that go into prescribing NSAIDs in the safest and most effective way. Plus, Husni stresses that if these drugs are not right for you, there are other effective treatment options for psoriatic arthritis, including injectable and oral medications. Additional reporting by Becky Upham.
