The NSAIDs comprise a large and chemically diverse group of drugs that possess analgesic, anti-inflammatory, and antipyretic properties. Pain and inflammation are common problems in patients with SLE, and NSAIDs are usually the drugs of choice for patients with mild SLE and little or no organ involvement. Patients with serious organ involvement may require more potent anti-inflammatory and immunosuppressive drugs.

Types of NSAIDS

There are more than two dozen different NSAIDs on the market, and many new ones are in development. Some can be purchased as over-the-counter preparations, whereas larger doses of those drugs or other preparations are available only by prescription. For example, prescriptions are required for diclofenac sodium (Voltaren®), indomethacin (Indocin®), diflunisal (Dolobid®), and nabumetone (Relafen®).

*Brand names included in this book are provided as examples only; their inclusion does not mean that these products are endorsed by NIH or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Mechanism of Action and Use

The therapeutic effects of NSAIDs stem from their ability to inhibit the release of prostaglandins and leukotrienes, which are responsible for producing inflammation and pain. NSAIDs are very useful in treating joint pain and swelling, as well as muscle pain. They may also be used to treat pleuritic chest pain. An NSAID may be the only drug needed to treat a mild flare; more active disease may require additional medications.

Although all NSAIDs appear to work in the same way, not every one has the same effect on every person. In addition, patients may do well on one NSAID for a period of time, then, for some unknown reason, derive no benefit from it. Switching the patient to a different NSAID should produce the desired effects. Patients should use only one NSAID at any given time.

Side/Adverse Effects

Gastrointestinal (GI): dyspepsia, heartburn, epigastric distress, and nausea; less frequently, vomiting, anorexia, abdominal pain, GI bleeding, and mucosal lesions. Misoprostol (Cytotec®), a synthetic prostaglandin that inhibits gastric acid secretion, may be given to prevent GI intolerance. It prevents gastric ulcers and their associated GI bleeding in patients receiving NSAIDs. Another product, Arthrotec®, combines misoprostol with the NSAID diclofenac sodium in a single pill.

Genitourinary: fluid retention, reduction in creatinine clearance, and acute tubular necrosis with renal failure

Hepatic: acute reversible hepatotoxicity

Cardiovascular: hypertension and moderate to severe noncardiogenic pulmonary edema. All NSAIDS now carry a warning that they may increase the risk of myocardial infarction.

Hematologic: altered hemostasis through effects on platelet function

Other: skin eruption, sensitivity reactions, tinnitus, and hearing loss

Pregnancy and Lactation

NSAIDs should be avoided after the first trimester. NSAIDs appear in breast milk and should be used cautiously by breast-feeding mothers.

Considerations for Health Professionals Assessment: History: allergy to salicylates or other NSAIDs, cardiovascular dysfunction, hypertension, peptic ulcer, GI bleeding or other bleeding disorders, impaired hepatic or renal function, pregnancy, and lactation Laboratory data: hepatic and renal studies, complete blood count (CBC), clotting times, urinalysis, serum electrolytes, and stool for occult blood Physical: all body systems to determine baseline data and alterations in function, skin color, lesions, edema, hearing, orientation, reflexes, temperature, pulse, respirations, and blood pressure Evaluation: therapeutic response, including decreased inflammation and adverse effects Administration: with food or milk (to decrease gastric irritation) Teaching points: See Patient Information Sheet on Nonsteroidal Anti- Inflammatory Drugs (NSAIDs).

Source: National Institutes of Health, U.S.Dept of Health and Human Services