The Role of NSAIDs in Managing Inflammatory Conditions

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The Role of NSAIDs in Managing Inflammatory Conditions

Viral Patel
Viral Patel

Galt Pharmaceuticals Medical Affairs Fellow, 2024-2025

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medication used to treat various inflammatory conditions due to their analgesic, antipyretic, and anti-inflammatory properties. NSAIDs main mechanism of action is the inhibition of the enzyme cyclooxygenase (COX). This enzyme is crucial for the synthesis of prostaglandins which are involved in various inflammatory processes.1

Key inflammatory conditions treated with NSAIDs include:

  1. Rheumatoid Arthritis (RA)
    1. Rheumatoid arthritis is a systemic autoimmune disease characterized by inflammatory arthritis and extra-articular involvement. It is a chronic inflammatory disorder caused in many cases by the interaction between genes and environmental factors.2
    2. NSAIDs are commonly used to manage pain and inflammation in RA. They provide symptomatic relief but do not alter the disease course.3
  1. Osteoarthritis (OA)
    1. Osteoarthritis is the most common form of arthritis in the world. OA is degenerative joint disease characterized by the breakdown of cartilage and the underlying bone, causing pain, stiffness, and limited movement.4
    2. NSAIDs are effective in reducing pain and improving function in patients with OA.
  1. Acute gout
    1. Gout is one of the most common causes of chronic inflammatory arthritis in the United States. Gout is characterized by monohydrate crystals deposited in tissue.5
    2. NSAIDs are first-line treatment for acute gout flares, providing significant pain relief and reduction in inflammation in affected joints.6
  1. Ankylosing Spondylitis (AS)
    1. Ankylosing spondylitis is a chronic, inflammatory disease of the axial spine. Chronic back pain and progressive spinal stiffness are the most common features of this disease.7
    2. NSAIDs are recommended as first-line therapy for reducing pain and stiffness in AS. Continuous NSAID treatment is often advised for persistently active disease per the American College of Rheumatology.8
  1. Primary dysmenorrhea
    1. Primary dysmenorrhea is defined as cramping pain in the lower abdomen occurring just before or during menstruation, in the absence of other diseases.9
    2. NSAIDs have been shown to be effective agents in managing pain associated with primary dysmenorrhea.10

The dosage and duration of NSAID therapy should be tailored to the individual patient’s needs, balancing efficacy with the risk of adverse effects, particularly gastrointestinal, renal and cardiovascular complications.

References

  1. Ghlichloo I, Gerriets V. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547742/
  2. Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/
  3. Braun J, Baraliakos X, Westhoff T. Nonsteroidal anti-inflammatory drugs and cardiovascular risk – a matter of indication. Semin Arthritis Rheum. 2020;50(2):285-288. doi:10.1016/j.semarthrit.2019.07.012
  4. Sen R, Hurley JA. Osteoarthritis. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482326/
  5. Fenando A, Rednam M, Gujarathi R, et al. Gout. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546606/
  6. van Durme CM, Wechalekar MD, Landewé RB, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev. 2021;12(12):CD010120. Published 2021 Dec 9. doi:10.1002/14651858.CD010120.pub3
  7. Wenker KJ, Quint JM. Ankylosing Spondylitis. [Updated 2023 Jun 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470173/
  8. Poddubnyy D, van der Heijde D. Therapeutic controversies in spondyloarthritis: nonsteroidal anti-inflammatory drugs. Rheum Dis Clin North Am. 2012;38(3):601-611. doi:10.1016/j.rdc.2012.08.005
  9. Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999;60(2):489-496.
  10. Itani R, Soubra L, Karout S, Rahme D, Karout L, Khojah HMJ. Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates. Korean J Fam Med. 2022;43(2):101-108. doi:10.4082/kjfm.21.0103

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