RE: a question about nsaids

[Guest guest]

Hi Sara

I'm hoping the following will answer your question. Jordan (5

systemic) has been on Indomethacin since Oct 2000. When we went to

the 1st ped rheumy he asked us if we thought it was working, when we

told him no, he told us he was going to leave him on it and see him

in a couple of months. To say the least, the man never saw us

again! He's now on mtx, zantac, folic acid & still with the

indomethacin. It's an anti-inflammatory, but it doesn't stop the

pain when it's used by itself. It also causes stomach problems which

is what the zantac is for. I found this info on nsaids, maybe it

will explain things for you.

Lori

NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are very well

tolerated, widely used and are often the initial therapy for common

inflammation, such as that which follows a muscle strain or sprain.

They can also be used to treat a high fever. They are called

nonsteroidal because they are not steroids, which treat inflammation

by suppressing the immune system (inflammation is one of the body's

healing responses to trauma). Instead, all NSAIDs treat inflammation

in a way similar to the mechanism of aspirin, the most well known

and oldest member of the class.

How They Work

NSAID drugs mainly inhibit the body's ability to synthesize

prostaglandins. Prostaglandins are a family of hormone-like

chemicals, some of which are made in response to cell injury. The

common mechanism of action for all NSAIDs is the inhibition of the

enzyme cyclooxgenase (COX). COX is necessary in the fomation of

prostaglandins. This enzyme actually has two known forms, COX-1 which

protects the stomach lining and intestine, and COX-2 that is involved

in making the prostaglandins that are important in the process of

inflammation.

Most NSAIDs currently available inhibit both COX-1 and 2. The stomach

irritation and ulcers that can occur with the use of these drugs

occur because of the COX-1 inhibition. COX-2 inhibitors stop the

formation of prostaglandins responsible for pain, fever and

inflammation. Recently, newer drugs (available in the U.S. by

prescription only) that inhibit only COX-2 have been approved by the

FDA for acute pain, rheumatoid arthritis, osteoarthritis, and

dysmenorrhea. Most people tolerate the nonspecific NSAIDs but a group

of people with gastric complaints will benefit from the new drugs.

COX inhibitors have been reported to have a protective effect against

colon cancer and Alzheimer's disease.

The general side effects of NSAIDs are similar among all the drugs in

this class. NSAIDs may upset your stomach and cause nausea and

vomiting. Stomach upset, nausea and vomiting can be avoided by taking

the medication with a little food or milk. Long-term or extensive

ingestion of NSAIDs can result in the drugs having toxicity to the

kidneys and also to the lining of the stomach, possibly causing

ulcers.

If you have asthma, heart problems, are on Coumadin® (NSAIDs have

a 'blood thinning' effect) or any other medications both prescription

and OTC, ask your doctor or pharmacist first if it is safe for you to

take an NSAID.

OTC and Prescription NSAIDs

Some NSAIDs are currently available over the counter at pharmacies.

The other NSAIDs listed below require a prescription from your doctor

(U.S.).

Common OTC names include:

ibuprofen (Advil®)

naproxen (Aleve® or Naprosyn®)

aspirin (Bayer®)

acetaminophen (Tylenol®) a non-opiod analgesic {not technically an

NSAID}

Rx (prescription) names include:

celecoxib --Celebrex®

diclofenac -- Voltaren®

etodolac --Lodine®

fenoprofen -- Nalfon®

indomethacin -- Indocin®

ketoprofen - Orudis®, Oruvail®

ketoralac --Toradol®

oxaprozin -- Daypro®

nabumetone -- Relafen®

sulindac -- Clinoril®

tolmetin -- Tolectin®

rofecoxib -- Vioxx®

> I am hoping you all can give me some insight on this one please.

how

> many people use nsaids for jra and does it always help in the pain?

> my daughter takes that type of med but find that it does nothing

for

> the pain what so ever, it does not seem to help lessen the degree

of

> pain, I am wondering why? does this happen with jra? any help would

> be appreciated. thank you. Sara

[Guest guest]

Dear Sara,

My daughter Kate is on high doses of Ibuprofen (Enbrel and Prilosec too)

and sometimes I think the Ibuprofen doesn't help much either. Alot of it

depends on how bad her flair is and the weather also can wreak havoc

with her. There are some days it seems to help alot and other days it

doesn't seem to help much. She was on Naprosyn but had to be pulled

because of side effects--so she's been on the Ibuprofen for 2 years now

and I don't know if she is building a tolerance for it or what. We can't

go any higher on the doses as she's maxed out on it according to weight,

height etc...How old is your child and what kind of jra ? Are you on any

other meds? Kate has severe polyarticular (dx. at age 3--now 6 1/2) I do

know with this jra that things can and do change frequently and

sometimes meds need to be changed or added when they're not working

well. Hope I could help some. Keep us posted as we've all " been there,

done that! " lol!

[Guest guest]

Hi, Sara - My son takes Celebrex. It is supposed to help with the pain. It

did help at first,(he is pauci with his ankle being the main joint involved

at first) but that didn't last long. He is now up to 800 mgs a day and still

has pain, with his back now involved. He has less pain sometimes in his

ankle than before he was diagnosed and started on the drug. Since he was

still having so much pain he was placed on Sulfasalazine, a DMARD, which is

slow acting so we have had no real results yet. I just spoke with the rhuemy

Mon. and she said that the nsaid is a pain reliever. I don't know. I guess

it is supposed to help with the inflammation which in turn should lessen the

pain but I agree it does not always seem to. I hope this info helps you a

bit. Michele

a question about nsaids

I am hoping you all can give me some insight on this one please. how

many people use nsaids for jra and does it always help in the pain?

my daughter takes that type of med but find that it does nothing for

the pain what so ever, it does not seem to help lessen the degree of

pain, I am wondering why? does this happen with jra? any help would

be appreciated. thank you. Sara

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[Guest guest]

Hi Sara,

NSAIDs are often the first-line treatment for many children with JRA.

Some respond really well to them. There are quite a few on the market so

if one doesn't work well enough, after a couple weeks, it might be

worthwhile to ask the doctor about possibly trying a different one. My

son takes Indomethacin ... but he also takes a bunch of other meds to

treat his systemic JRA.

What type of JRA does your daughter have? How long has she had it? What

types of symptoms does she have and which parts of her body have been

affected? Is she seen by a pediatric rheumatologist?

While NSAIDs can and do sometimes help with pain and inflammation, there

are other meds that may be more beneficial in that instead of just

treating these symptoms, they can actually alter the course of the

disease and possibly prevent serious damage to joints by working on the

underlying mechanisms of inflammation. This line of meds is known as

DMARDs, disease modifying anti-rheumatic drugs.

If your daughter's symptoms of pain, stiffness and inflammation persist

for several weeks despite being treated with NSAIDs, it may be time to

talk with her doctor about DMARDs.

Hope this helps,

Georgina

sarasdesigns@... wrote:

>

> I am hoping you all can give me some insight on this one please. how

> many people use nsaids for jra and does it always help in the pain?

> my daughter takes that type of med but find that it does nothing for

> the pain what so ever, it does not seem to help lessen the degree of

> pain, I am wondering why? does this happen with jra? any help would

> be appreciated. thank you. Sara

[Guest guest]

Thank you all for your replies, it helps clear up a lot of questions

for me. Kim is 16, started with 1 ankle pain about approx 5 years

ago, which we thought was just a sprain or something due to sports.

But as time went on it spread to bilat ankles, bilat knees and now

she has problems in her wrists. She does not have the swelling but a

constant pain (worse some days than others) a feverish feeling in her

wrist occurs once in a while also. She sees a ped rheumatologist in

AIDupont, who tested her, she had a positive ANA with a titer of

320,although her sed rate was normal, last time she tested. She has

tried relafen, now tometin which does nothing for the pain. I have

noticed her immune system is weakened as she has gotten numerous

strep throat infections and painful swollen glands,and she's always

tired. The nurse pract told me that she should be getting some relief

from the nsaids, that most of people with this problem do get relief

from that type of medication. She has had MRIs which showed a bone

marrow problem (bone marrow edema) that was so severe the doctor said

he had never seen joints like that before. I feel like there should

be more I could do for her like vitamins or something, My husband and

I feel pretty helpless and confused in this situation. Thank you for

all the helpful information.

Sara