Which NSAIDs are Right for Your Arthritis?

Mar 18, 2021 | Arthritis, Treatments

If you have arthritis, especially an inflammatory type arthritis, your doctor has probably prescribed an NSAID as part of your treatment plan to manage your symptoms. Not only are they some of the most effective medications for relieving pain, but they’re also relatively inexpensive. Most of them can even be found over the counter at your local drug store or pharmacy. In fact, you probably have some in your medicine cabinet right now.

However, not all NSAIDs are created equal. While they all work similarly to reduce pain and inflammation, people respond to certain ones better than others. Moreover, depending on your health condition, some NSAIDs can have adverse side effects, including blood thinning, increased in blood pressure, gastrointestinal bleeding from stomach ulcers and kidney problems.

Below we explain how NSAIDs work, the different kinds, side effects, and which one may be right for you.

What are NSAIDs and How Do They Work?

NSAIDs are nonsteroidal anti-inflammatory drugs. They reduce inflammation in your body without the use of steroids.

Please understand that steroids aren’t necessarily bad. In fact, they inhibit the same exact hormones that control inflammation, which we call prostaglandins. At Arthritis Relief & Vascular Centers, we inject a corticosteroid directly into patients’ joints to relieve inflammation at the source, which in turn reduces pain.

NSAIDs, on the other hand, usually come in pill form (but can also come in a topical cream) and prevent prostaglandins from ever being created. We call these active substances COX-1 and COX-2.

COX-1 and COX-2 regulate the release of prostaglandin and therefore control your body’s inflammatory response. NSAIDs work by reducing or inhibiting one or both of these, which results in you feeling less pain, swelling and inflammation. Some NSAIDs, like Ibuprofen, can even reduce your fever — we refer to this as antipyretic.

It’s important to note that NSAIDs cannot cure arthritis. Unfortunately, nothing can cure arthritis — yet. However, NSAIDs, in combination with other treatments, are excellent at treating many of the symptoms of arthritis. Many people who have arthritis can benefit from this medication, and many achieve long-term improvement of symptoms.

Different Types of NSAIDs Used to Treat Arthritis

Have you ever wondered what’s the difference between Aleve, ibuprofen and aspirin? Aren’t they all the same? Actually, yes! They’re within the same “class” of NSAIDs. However, each has its own side effects. Let’s break them down.

More than 20 different kinds of NSAIDs exist, but they all fit within the following three categories:

  • Non-Selective NSAIDs
  • Selective COX-1 Inhibitors
  • Selective COX-2 Inhibitors

Each has its own benefits and drawbacks. So while we give you a high-level overview of them below, it’s always best to consult your physician before taking any form of NSAID due to the associated risks.

Non-Selective NSAIDs

These are your over-the-counter aspirins, ibuprofens (Advil), and naproxens (Aleve). But they also can be prescribed, such as piroxicam (Feldene). This class of NSAIDs is called non-selective because these drugs prevent both COX-1 and COX-2 from being released into your body.


  • Reduces inflammation
  • Reduces fever
  • Reduces pain

Side Effects:

  • Prevents blood from clumping (especially aspirin); you can bleed more easily
  • Can negatively affect the kidneys and stomach
  • Can cause your bronchial tubes to spasm
  • Can cause skin rashes
  • Can interact with medications

Non-selective NSAIDs are effective at treating short-term pain and inflammation caused by arthritis. However, because they affect both COX inhibitors, the side effects can be pretty adverse.

Selective COX-1 Inhibitors

These types of NSAIDs — which include low-dose aspirin, ketoprofen, and flurbiprofen among others — inhibit only COX-1. These medications are not only effective at treating arthritis, but they can also prevent heart attacks in people at risk of a heart attack or stroke (specifically low-dose aspirin).

However, arthritis doctors tend to be more cautious about COX-1 inhibitors due to their effects on the gastrointestinal tract and cardiovascular system. That said, while blood-thinning might be an adverse side effect for arthritis patients, cardiologists consider it beneficial for patients with certain heart conditions.


  • Reduces inflammation
  • Reduces fever
  • Reduces pain
  • Prevents blood from coagulating

Side Effects:

  • Can cause prolonged bleeding
  • Adversely affects the stomach lining
  • Can increase the risk for gastrointestinal bleeding
  • Can increase the risk for stomach ulcers
  • Can interact with medications

Selective COX-2 Inhibitors

Arthritis specialists tend to prefer this class of NSAID because COX-2 inhibitors have fewer physical symptoms than we mentioned above. In fact, COX-2 inhibitors were actually created to reduce the side effects of the other two classes.

While COX-2 inhibitors tend to create fewer stomach and kidney issues, they can have the opposite effect of COX-1 in that they can promote the blood to coagulate and clot.


  • Reduces inflammation
  • Reduces fever
  • Reduces pain
  • Less likely to cause stomach and kidney problems

Side Effects:

  • Increases blood clotting
  • Can interact with medications

Caution: NSAIDs are Part of the Triple Whammy

NSAIDs are one of three drugs doctors refer to as the “triple whammy” — diuretics, NSAIDs and ACE inhibitors (for controlling blood pressure). These three, in combination with one another, can cause severe side effects, including renal (kidney) failure, which can be fatal.

If you are considering adding NSAIDs to your arthritis treatment regimen, we strongly advise you to consult with your arthritis specialist or doctor to go over the pros and cons based on your unique medical history.

Which NSAID is Right for You?

If you and your doctor decide that NSAIDs are right for you, they may want to start you on a lower dose that is sold over-the-counter. They’ll then work with you to determine whether you should continue with OTC medication, prescribe something stronger, or recommend a different treatment option.

At Arthritis Relief & Vascular Centers, we offer a variety of treatment options, from corticosteroid injections and gel shots to regenerative medicine treatments and more. We can help kick your pain to the curb — for good.

Call (855) 910-9195 now to schedule an appointment with one of our Pain Management Physicians.



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