Aspirin, Non-Aspirin NSAIDS, and Corticosteroids: See the Difference

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Category: Medications & Supplementation Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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In the 18th century, in England, an ingredient called Acetylsalicylic Acid was extracted from the bark of a willow tree and used to treat arthritic pain: the first arthritic wonder drug had been discovered, which we now know as aspirin.

Aspirin suppresses the production of inflammatory substances that cause pain, swelling, and redness, commonly seen in arthritis. Other drugs, such as “non-steroidal anti-inflammatory drugs” (NSAIDs), can mimic aspirin’s skill of inhibiting cycloxygenase, an enzyme that helps your body produce prostaglandins. By decreasing prostaglandin production, a key chemical in the role in inflammation, aspirin and NSAIDs can reduce the pain, swelling, and tenderness associated with arthritis.

However, not all prostaglandins are “bad”. They also play an important role in protecting the stomach lining, promoting the clotting of blood, regulating salt and fluid balance, and maintaining blood flow to the kidneys when function is impaired. Because aspirin and NSAIDs reduce the “bad” prostaglandins to control inflammation, the effects of the “good” prostaglandins” are also reduced, thus creating the risk of side effects such as stomach irritation, stomach bleeding, fluid retention or decreased kidney function.

Because aspirin and NSAIDs have two basic properties, to relieve pain (analgesic) and to alleviate inflammation (anti-inflammatory), their dose depends on what symptoms you have and how severe they are. For example, lower doses of aspirin and NSAIDs are sufficient to relieve pain, but higher doses are required to relieve inflammation. With osteoarthritis, inflammation is rare or very mild, therefore only a low dose, as in Advil or Aleve, may be needed to achieve optimal effects. However, because of the intense inflammation associated with rheumatoid, gouty and other inflammatory arthritis, a higher prescribed dose is required.

NSAID OR ASPIRIN?

A major benefit of NSAIDs versus aspirin is it’s higher potency and longer half-life. You may need to take less NSAIDs than you would aspirin, they are less toxic and they cause fewer gastrointestinal disturbances. Diclofenac (Voltaren), Ibuprofen (Motrin, Advil), Indomethacin (Indocin), Naproxen (Anaprox, Naprosyn), Sulindac (Clinoril), Piroxicm (Feldene) are all NSAIDs. Although all NSAIDs operate in basically the same way, their actions are not identical. Not everyone responds the same way to a particular NSAID. One may be more effective for you and you may need to try different ones before finding the one that is right for you.

STEROIDAL VS NON-STEROIDAL:

The word “non” is what distinguishes NSAIDs (non-steroidal) from corticosteroids (steroidal) such as Prednisone. They are both anti-inflammatory drugs, but corticosteroids are much more potent than NSAIDs. Their side effects are quite different and it is quite common that your doctor prescribe both corticosteroids and NSAIDs together, in hopes of keeping the corticosteroid dose as low as possible.

Because heartburn and stomach upset are common with a long term use of high doses of aspirin and NSAIDs, some patients may develop ulcers and GI bleeding, kidney function impairment in the elderly, tinitus or even deafness. Studies have shown that it is best to take aspirin and NSAIDs with food to help prevent stomach irritation and further research is being done to find relief for other side effects.

NEW DEVELOPMENTS:

In the early 1990s, while studying the anti-inflammatory effects of gluco-corticosteroids, scientists found that there are two types of enzymes involved in prostaglandin production: cyclooxygenas-1 (COX-1) associated with protecting the digestive system from its own erosive acids and cyclooxygenas-2 (COX-2) associated with pain and inflammation.

Celebrex and Vioxx, both COX-2 inhibitors, are in many ways similar to current non-steroidal anti-inflammatory drugs ( NSAIDs) and are formulated to be easier on the stomach. They are able to block only the pro-inflammatory prostaglandins, leaving those that help protect the stomach lining alone, which would prevent stomach ulcers and bleeding. As far as other side effects are concerned, such as water retention and aggravation of hypertension, the new COX-2s appear to be no different than the traditional NSAIDs.

COX-2s, like other NSAIDs, are not “super aspirins” or “magic anti-inflammatory drugs”. They do not have the ability to control the disease process of arthritis and they are used in conjunction with, rather than as a replacement of Prednisone or other disease modifying anti-rheumatic drugs such as Methotrexate (MTX). Neither provides protection against heart attack or stroke when taken on their own, like aspirin. Therefore, patients at risk of cardiovascular events should continue taking aspirin in addition to these drugs.

WHO SHOULD TAKE CELEBREX OR VIOXX?

Patients with a history of ulcerative complications and concomitant anti-coagulant therapy are at greatest risk GI disturbance during NSAID treatment and would most likely benefit from COX-2 specific agents.

However, people who are allergic to aspirin or other NSAIDs should not take either Celebrex or Vioxx. Furthermore, people allergic to sulfa drugs should not take Celebrex.

WHAT ABOUT ACETAMINOPHEN?

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 or aspirin 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, as it does not produce gastrointestinal disturbances.

WHAT’S THE VERDICT?

Well, as you can see, there are several medications that are available to treat different types of arthritis: aspirin, NSAIDs, corticosteroids, COX-2 inhibitors and acetaminophen. Their roles, dose and side effects may differ, but they can all help alleviate your symptoms, either alone or together. The key is to determine, with the help of your physician, which one, which dose and what regimen is best for you.

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