Arthur Weinstein, MD
Professor of Medicine and Chief
Division of Rheumatic Diseases and Immunology
New York Medical College
Valhalla, NY
Although all NSAIDS appear to work in the same way, there are differences between them. The beneficial effects and side effects of individual NSAIDS can vary from patient to patient. Side effects experienced by one patient may not be noted by someone else taking the same drug. Likewise, benefits experienced by one person may not be experienced by another.
As a general rule, NSAIDS are most useful in treating joint pain, muscle pain, and joint swelling experienced by individuals with lupus. Occasionally, they can be used to treat the chest pain caused by pleurisy. When used for treatment of a mild flare, an NSAID may be the only drug needed. More active disease may require additional medications. Although there is no absolute reason not to use NSAIDS during pregnancy, it is best to avoid using these medications in the first few months after conception and before delivery.
NSAIDS commonly cause dyspepsia, a burning, bloated feeling in the pit of the stomach. In some patients, stomach inflammation (gastritis) or gastric ulcers may occur. This can cause bleeding, either obvious and painful or hidden and painless. This loss of blood may lead to anemia. To help protect the stomach, NSAIDS should always be taken with food or directly after a meal. Some patients may need additional medications to control their stomach symptoms. Some may tolerate one kind of NSAID, but have gastric irritation with others. A person on long term NSAID therapy should have a blood count periodically to insure that anemia from gastric bleeding is not occurring. Patients with a history of gastric (stomach) or duodenal (intestinal) ulcers should tell their physician before starting on NSAIDS. Furthermore, any individual who will not accept blood products for religious or other reasons, should inform their doctor of this prior to starting therapy with NSAIDS.
Symptoms of headache or drowsiness are usually mild, but if severe, the medicine may have to be stopped.
NSAIDS affect the function of platelets, a type of blood cell important in normal blood clotting. Although aspirin has the greatest effect, all NSAIDS have some effect on platelet function. If the function of these cells is impaired, it will take longer for blood to clot and bruising can occur more readily. Some patients are very susceptible and experience easy bruising. If severe, the medication should be discontinued.
In older patients or in lupus patients who already have kidney or blood pressure problems, commonly seen side effects include: fluid retention, high blood pressure and reduced kidney function. In young, otherwise healthy people, these side effects are not common. Patients with lupus nephritis often have some reduction in kidney function. Therefore, NSAID use in this type of SLE may cause further deterioration in kidney function and should be closely supervised.
Patients with asthma may notice a worsening of their asthmatic symptoms when they use aspirin or other NSAIDS. If this occurs, these drugs should not be used.
Severe headache with neck stiffness is a rare side effect seen almost exclusively in people with lupus. It is important because it mimics meningitis.
Hives and other skin rashes, although uncommon, occur with these medications and may require the discontinuation of the NSAID. Photosensitive skin rashes, which could mimic a flare of SLE, also rarely occur with some NSAIDS.
While NSAIDS are widely used with good results and without problems, individuals with lupus and their prescribing doctors need to pay special attention to the potential side effects. Since drug side effects and symptoms of increased lupus activity may be identical, it is important to alert a physician if any of these symptoms occur. For example: fluid retention, headache or rash may be side effects, but they also may occur when the disease activity increases. In any case, notify your doctor when any side effect occurs so therapy can be adjusted. The majority of NSAID-related side effects are reversible once the drug is stopped. Some side effects are seen initially or only in the blood. Therefore, with continued NSAID use regular blood counts, including tests of liver and kidney function, should be monitored every 3-4 months.