What is the role of NSAIDS in the treatment of rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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NSAIDs interfere with prostaglandin synthesis through inhibition of the enzyme cyclooxygenase (COX), thus reducing swelling and pain. However, they do not retard joint destruction and thus are not sufficient to treat RA when used alone. Like corticosteroids, NSAIDs can be reduced in dose or discontinued with successful DMARD therapy.

The several dozen NSAIDs are available can be classified into several different groups of compounds. Commonly used NSAIDs include ibuprofen, naproxen, ketoprofen, piroxicam, and diclofenac.

In the early 1990s, a second isoform of COX was discovered (COX-2). COX-1 has a protective role, particularly in the stomach, whereas COX-2 is strongly upregulated during inflammation. Traditional NSAIDs are nonselective COX inhibitors, inhibiting both COX-1 and COX-2. Several coxibs (selective COX-2 inhibitors) were developed that had a significant preference for COX-2 over COX-1. Currently, however, only one COX-2 inhibitor remains on the US market—namely, celecoxib.

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