Acetaminophen, NSAIDs and Corticosteroids are Different

Category: Medications & Supplementation Published on Tuesday, 10 March 2015 Written by Yong Tsai, MD

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for people with arthritis to suppress the production of prostaglandins, a key chemical associated with inflammation. By decreasing prostaglandin production, the inflammatory substances that cause the pain, swelling, and redness commonly seen in arthritis can be reduced and controlled. With osteoarthritis, inflammation is very mild, therefore only a low dose, as in Advil, Aleve or other NSAIDS, may be needed to achieve optimal effects. However, because of the intense inflammation associated with rheumatoid and gouty, a higher prescribed dose is required.

However, not all prostaglandins are harmful, but offer beneficial elements to help protect the lining of our stomach. NSAIDs can reduce the amount of “bad” prostaglandins to control inflammation; the effects of the “beneficial” prostaglandins are also reduced. This, in turn, creates a risk of renal gastrointestinal (GI) complications such as impaired kidney function, ulcers, and stomach bleeding with the use of NSAIDs.

Acetaminophen (Tylenol) does not have the ability to inhibit prostaglandin and is therefore not effective for treating inflammation. Instead, it acts by blocking the brain’s perception of pain and can lower fever. Although Tylenol’s analgesic effect is similar to that of a low dose of NSAIDs, it does not produce the same side effects. It is a good drug to treat mild to moderate pain in osteoarthritis, particularly in patients with gastritis, peptic ulcers or kidney problems. But high dose of acetaminophen can cause liver damage. Patients who do not achieve satisfactory results from acetaminophen, can try low dose NSAIDs and even combine low dose NSAIDs with acetaminophen to achieve additive analgesic effects.

In 1948, E. C. Kendall and P.S. Hench discovered corticosteroid that was miraculously able to suppress inflammation, and reverse the symptoms of rheumatoid arthritis. Most inflammatory arthritis and autoimmune diseases were responsive to corticosteroids if they were given in an amount sufficient enough to cease the inflammation. Because of this immediate and powerful effect, it was considered a miracle drug. Since then, corticosteroids have been widely used to treat different autoimmune and inflammatory diseases and many lives have been saved due to their powerful anti-inflammatory effect.

However, over the years, unpleasant side effects caused by corticosteroids emerged and became worrisome. The most common side effects were weight gain, high blood pressure, thinning of the bones, increasing risk of diabetic, infection, poor sleep, cataracts and glaucoma.

Generally noted, the higher the dose of steroids and the longer they were prescribed, the greater the risk of side effects. Because of this, the medical pendulum swung in the opposite direction, from extreme euphoria to extreme pessimism. The fact is corticosteroids can be a miracle drug if it is used properly or work hand in hand with disease modifying anti-rheumatic drugs (DMARDs) or immunosuppressive agents.

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