Psoriatic Arthritis and NSAIDs: What You Need to Know

Find out how nonsteroidal anti-inflammatory drugs work, and what you need to know before starting this common treatment.

NSAIDs on a blue background
NSAIDs, whether over-the-counter or prescription, are a common treatment for psoriatic arthritis pain and inflammation.Getty Images

If you’ve been diagnosed with?psoriatic arthritis, one of the first treatments your doctor is likely to try to ease your swollen, achy joints is a nonsteroidal anti-inflammatory drug (NSAID).

These medications, which are available both over the counter and by prescription, are effective for many people in controlling swelling, pain, and morning stiffness, and in improving range of motion in joints.

“For the average?psoriatic arthritis?patient, NSAIDs are the first-line treatment,” says?M. Elaine Husni, MD, MPH, the vice chair of rheumatology and the director of the arthritis and musculoskeletal center at Cleveland Clinic in Ohio. “We usually use [them] for four to six weeks to see if we can get the patient’s symptoms under better control. For some people, stronger psoriatic arthritis drugs are not needed.”

There are some instances in which NSAIDs won’t be used; if a patient has kidney disease, significant heart disease, or are on other blood thinners, NSAIDs are contraindicated, notes Olivia Ghaw, MD, an associate professor of medicine and rheumatology at Mount Sinai's Icahn School of Medicine in New York City.

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NSAIDs?for Psoriatic Arthritis

NSAIDs include many common over-the-counter (OTC) drugs like?aspirin,?ibuprofen (Advil, Motrin), and?naproxen (Aleve).

Some of these NSAIDs are also available in prescription strength. Other prescription NSAIDs include meloxicam?(Mobic) and celecoxib?(Celebrex). “For over-the-counter NSAIDs, we need to use doses in the range of 600 to 800 milligrams (mg) three times per day,” says Dr. Ghaw. “That’s a lot of pills, so it often makes sense to switch to higher-strength NSAIDs.” There are higher doses and there are other NSAIDs (by prescription) that are longer acting and don’t require three doses a day, she adds.

You may be fine taking 500 mg of?Aleve?twice daily, or 15 mg of?Mobic once daily, she says.

How NSAIDs Work

Whether prescription or OTC, NSAIDs work by blocking the actions of an enzyme in the body called cyclooxygenase (COX). COX has two functional types: COX-1 protects your stomach from acid, and COX-2 is involved in joint inflammation.

Most NSAIDs block the actions of COX-1 and COX-2, which is why they relieve joint pain but can also cause stomach upset.?Celebrex (celecoxib)?and?Mobic?are not as rough on the stomach, and both are widely used to block the action of COX-2.

NSAIDs work like corticosteroids, which have been used to ease psoriatic arthritis inflammation, but with fewer side effects.

”Steroids suppress the?inflammation of psoriatic arthritis, but you can’t use them for long, and when you withdraw them, there can be a flare of?psoriasis,” says Dr. Ghaw. She also adds that PsA often responds better to NSAIDs than to low or moderate doses of steroids.

While NSAIDs relieve pain and inflammation in cases of mild psoriatic arthritis, they do not treat the underlying cause of the inflammation, nor do they slow the progression of the disease, unlike other medications such as disease-modifying antirheumatic drugs (DMARDs) and biologics.

?Depending on the severity of the psoriatic arthritis, a patient may switch to certain oral DMARDs, such as methotrexate or sulfasalazine before trying biologic drugs, notes Ghaw.

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Potential Risks of NSAIDs?for Psoriatic Arthritis

“Many people take NSAIDs for a headache or a pulled muscle, and for most people that sort of short-term use is fine — that’s why they’re offered over the counter,” says Dr. Husni.

But when someone takes prescription NSAIDs to?treat psoriatic arthritis, the dosage is usually higher and they’re taken more frequently, Husni notes. So you “need more monitoring on prescription NSAIDs and you should always take the lowest dosage for your symptoms in the shortest duration.”

Doctors should take a good medical history and use caution for patients on blood thinners, those who have hypertension or renal disease, a history of peptic ulcer disease, or are 65 and older, says Husni.

For some people, NSAIDS can cause blood pressure to rise. “If you’re already prone to?high blood pressure, you might not be a good candidate for an NSAID,” says Husni.

NSAIDs can also erode the stomach lining, so they should be avoided by people who are at risk of, or have a history of,?peptic ulcers.

“Both over-the-counter and?prescription NSAIDs?come with a warning that they may increase your?risk of heart attack, stroke, and [gastrointestinal?and other types of] bleeding,” adds Husni.

For people with a history of gastrointestinal bleeding or?ulcers, doctors may prescribe an acid blocker along with the NSAID.

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What to Know Before Taking NSAIDs for Psoriatic Arthritis

The type of NSAID you use and the dosage involve decisions that you and your doctor make together. Here are some questions to consider asking.

  1. Contraindications:?Do I have health issues that make it riskier for me to take NSAIDs??Raise any concerns you may have about your kidneys, liver, stomach, colon, lungs, or heart. If you are worried about high blood pressure or blood clots, ask about these potential complications, too.
  2. Allergic reactions:?What are my chances of having an?allergic reaction??If you've had problems with?aspirin?or have?nasal polyps, your risk increases.

  3. Drug interactions:?Will NSAIDs interfere with any of my other medications??Some drugs that may be affected by NSAIDs include blood pressure medications, steroids, and?blood thinners.
  4. Alcohol and NSAIDs: Can I drink alcohol while taking NSAIDs??More than two drinks a day may increase your risk of?stomach problems.
  5. The effect of age on risk:?Will my age affect my risk of NSAID complications??People over age 65 are at greater risk from complications.
  6. Pregnancy: Can I take NSAIDs if I am (or want to become) pregnant??Women who are still of childbearing age should ask about the risk of taking NSAIDs while pregnant or breastfeeding.
  7. Generics vs. brand-name drugs:?Is there a generic NSAID available??Over-the-counter NSAIDs are not expensive, but some brand-name prescription NSAIDs may require preauthorization from your doctor for insurance coverage, and you may do just as well with a generic.

“It is important that you talk to your doctor — they know your history and they can customize your treatment,” says Husni. “There are tweaks we can make in how we deliver the medicine, and so it’s not just a yes or no decision.”

There are lots of considerations that go into prescribing NSAIDs in the safest and most effective way. Plus, if these drugs are not right or are not working for you, there are other effective?treatment options for psoriatic arthritis, including injectable and oral medications. Sometimes, Husni adds, you may use NSAIDs along with these other medications.

Additional reporting by?Becky Upham and Deborah Shapiro.

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  2. NSAIDs. Arthritis Foundation.
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  4. Medication for Psoriatic Arthritis. NYU Langone Health.
  5. Aspirin Allergy: What Are the Symptoms. Mayo Clinic. March 5, 2022.
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