Inflammation
is controlled by many different chemicals which are released from different
cells. These chemicals control or contribute to different aspects
of the inflammatory response. It is a highly complicated reaction to
defend the body. When the need for defence has gone (ie the bacteria
has been killed or the tissue has healed) the inflammation usually subsides.
However,
sometimes the body fails to recognize when the danger period has passed
and then chronic inflammation occurs. In conditions like ankylosing
spondylitis there is continued inflammation and yet there is no remaining
bacteria or damage.
Anti-inflammatory
medication such as NSAIDs block the production of some of the chemicals
which lead to the swelling, heat, and pain of inflammation. They do
not act on all of the possible inflammatory pathways but they do reduce
the main and most common chemicals involved in this process. Thus, they
do reduce pain and many aspects of inflammation.
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What
effect do NSAIDs have in ankylosing spondylitis ?
As with
all general forms of inflammation, these drugs will reduce the pain,
stiffness in the area and improve the ability of the affected region
to function. Over the short term they act to reduce the symptoms of
ankylosing spondylitis. However, some symptoms such as fatigue will
not be helped by NSAIDs.
By reducing
symptoms, NSAIDs can help people with AS maintain activity, exercise,
and continue to perform at work and home. Exercise will have a
pain relieving effect, maintain function, and perhaps modify the process
of formation of bone between the joints.
Thus, NSAIDs
have a role in improving quality of life through reducing pain and stiffness,
improving function and allowing a person to exercise. It is through
exercise that long term function can be maintained.
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What
effects do NSAIDs not have in ankylosing spondylitis ?
NSAIDs
are not specific drugs developed especially for ankylosing spondylitis.
They target the general and most common inflammatory chemicals. However,
there are many different chemicals used in the body to give different
inflammatory responses (ie an allergy is accompanied by itching but
damage is accompanied by pain). The inflammation leading to AS-specific
changes, such as the laying down of calcium between the joints, may
be controlled by different chemicals than those found in the general
inflammatory response. There is no evidence that NSAIDs act on the specific
chemical which leads to specific AS changes. However, exercise has been
shown to modify the pain, improve function and maintain flexibility
in the long term. Thus, NSAIDs can help a person exercise and it is
through movement that the long term changes in AS can be modified.
What
will happen to my AS if I do not take NSAIDs ?
NSAIDs
can have side effects such as gastro-intestinal bleeding, diarrhea or
nausea.  Therefore,
some people feel that if they can cope with the pain and stiffness of
AS and if NSAIDs don’t directly affect the course of AS, perhaps
they should not take these drugs.
General
advice is that a person should try the NSAID for at least 3 weeks to
evaluate how much benefit they feel from the medication. They should
then try a period of time without the NSAID and monitor the difference.
If the person can continue to exercise and remain active and can live
with the level of pain and stiffness they experience then perhaps they
should not take the NSAID regularly.
However,
if quality of life is affected for example a normal day’s work
is difficult and exercise is impossible without the NSAID then it is
better to take the medication. Side effects such as bleeding or ulcers
in the gut occurs in 4/100 people per year in those who take them regularly
for years. Therefore, if the medication does greatly improve quality
of life and allows the person to exercise, then a 4% risk per year (where
96 people in 100 do not have these side effects) is worthwhile. Eighty
percent of people with AS take NSAIDs and report that they do help to
relieve symptoms.
In
summary
Thus, in
summary remaining mobile is an important way of modifying the AS. If
the NSAID helps the person to continue to be active then it will have
a role in controlling the AS. However, if the person can cope with the
AS and is active without the need for the NSAID then there is no need
to take this medication.
Reference:
Miceli-Richard
C, Dougados M. NSAIDs in ankylosing spondylitis. Clin Exp Rheumatol
2002; 20 (Suppl . 28): S65-S66.
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NSAIDs
stands for non-steroidal anti-inflammatory drugs which are analgesics
or pain-killers. They include medications such as aspirin, ibuprofen,
indomethacin, diclofenac, naproxen and phenylbutazone.
