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NSAIDS, Non-Steroidal Anti-Inflammatory Drugs

NSAIDs, or non-steroidal anti-inflammatory drugs, are some of the oldest and most widely used medications for pain and inflammation. They may be used as a first-line treatment to help relieve the symptoms of ankylosing spondylitis (AS).1 In addition to AS, NSAIDs are used for a variety of conditions such as headaches, muscle aches, and other arthritis conditions.

Many NSAIDs are readily available over-the-counter, and as such, don’t need a prescription. However, higher strength NSAIDs that may be needed to help relieve pain and inflammation of AS are only available with a prescription. Higher doses and long-term use of NSAIDs may cause side effects, including side effects which may cause stomach or intestinal issues. Although NSAIDs are very effective for relieving pain and inflammation, they are not the best choice for all people.1

NSAIDs start to work quickly on pain, within a few hours of taking the medicine. The anti-inflammatory effects of NSAIDs take longer to realize.2 People with AS may have to try more than one NSAID to find relief from their symptoms. Treatment guidelines suggest daily use for most patients, although each individual should discuss with their doctor what is best for them. If NSAIDs fail to relieve symptoms, other treatments like TNF (tumor necrosis factor) inhibitors may be used.3

Over-the-counter NSAIDs

NSAIDs available over-the-counter include:

  • Aspirin (available as Bayer®, Bufferin®, Ecotrin®, Excedrin®)
  • Ibuprofen (available as Advil®, Motrin IB®, Nuprin®)
  • Naproxen (available as Aleve® and Naprosyn®)

Prescription NSAIDs

NSAIDs available by prescription for AS include:

  • Voltaren (diclofenac)
  • Celebrex® (celecoxib)
  • Indocin (indomethacin)
  • Mobic (meloxicam)
  • Arthrotec (diclofenac and misoprostol)

How do NSAIDs work?

NSAIDs work by blocking chemicals in the body called cyclo-oxygenase (COX) enzymes that cause inflammation. By blocking these enzymes, NSAIDs decrease inflammation, pain, and fever. Some NSAIDs, like ibuprofen, block two of these enzymes, COX-1 and COX-2. Celebrex and Mobic, prescription NSAIDs, target COX-2 and are also known as a COX-2 inhibitors. COX-2’s generally do not cause as many gastrointestinal side effects. Different NSAIDs may have similar effectiveness, but some people respond better to one NSAID than another. 2,4

What are the possible side effects of NSAIDs?

NSAIDs can cause unwanted side effects. Possible side effects of NSAIDs are stomach ulcers, stomach upset, high blood pressure, fluid retention (causing swelling around the lower legs, feet, ankles, and hands), kidney problems, heart problems, and rashes. Long-term use of NSAIDs has been associated with a slightly higher incidence of heart attacks and strokes. Although side effects can occur at any time, the risk of side effects increases with higher dosages and with a longer duration of treatment. Patients should discuss the risks and benefits with their doctor, as well as any additional precautions to avoid side effects.2,4

Other things to know about NSAIDs

People who have heart disease should not take an NSAID, including over-the-counter NSAIDs, without first talking to their doctor. Some NSAIDs may interfere with medicines prescribed to patients with heart disease.1

NSAIDs should not be used during pregnancy unless prescribed by a doctor. Women who are planning to become pregnant or breastfeeding should also talk to their doctor before taking NSAIDs.1

Patients with the following conditions should talk to their doctor before using NSAIDs: decreased kidney or liver function, hepatitis, ulcer, gastritis, low platelet count, Crohn’s disease, ulcerative colitis, asthma or other chronic lung disease, reflux disease, indigestion, hiatal hernia, high blood pressure, congestive heart failure, past stroke or heart attack, allergies to NSAIDs, use of blood thinners, use of corticosteroids, are 65 years of age or older, or alcohol consumption of more than seven alcoholic drinks per week or more than two a day.1

Written by: Emily Downward | Last reviewed: February 2019
  1. Medications used to treat ankylosing spondylitis. Spondylitis Association of America. Available at https://www.spondylitis.org/Medications. Accessed 1/15/19.
  2. NSAIDs (nonsteroidal anti-inflammatory drugs). American College of Rheumatology. Available at https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/NSAIDs. Accessed 1/15/19.
  3. Ward MM, Deodhar A, Akl EA, et al. American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network 2015 Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol. 2015;68(2):282-98.
  4. What are NSAIDs? American Academy of Orthopaedic Surgeons. Available at https://orthoinfo.aaos.org/en/treatment/what-are-nsaids/. Accessed 1/15/19.