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Which Conventional Arthritis Pain Medications Can Make Arthritis Worse?
My First Arthritis Healing Breakthrough
About the Author
Arthritis Treatments That Didn’t Work for Me
 I used an electric scooter for years because of my arthritis. I am now completely healed. Before I tell you what treatments worked, I will briefly tell you what treatments didn’t work for me and what I learned from this.
What didn’t work for me was arthritis pain medication treatment.
I was initially treated with Non Steroidal Anti Inflammatory Drugs, also known by the acronym NSAIDs. The particular ones I took included Aspirin, ibuprofen, Voltarin, Indomethacin, Naproxen (Naprosyn, Naprelan*), Naproxen sodium (Aleve, Anaprox) and Piroxicam (Feldene). They all caused me severe stomach pain, some worse than others. Because of the stomach pain I was given an anti ulcer drug called Cytotec (misoprostol). Unfortunately, Cytotec can cause uterine contractions. It gave me such bad menstrual cramps that I eventually stopped taking it.
When those medications didn’t work, I was told the only other alternative was to put me on antidepressants. I didn’t want to go on them but my doctor said she would stop treating me if I didn’t. The rationalization was that antidepressants would raise my threshold for pain, thus allowing me to sleep better. So I first went on one of the tricyclics, but it gave me such a bad case of cotton mouth, that my doctor switched me over to the rather famous serotonin reuptake inhibitor, Prozac.
Unfortunately I didn’t need Prozac and at half the normal therapeutic dose I started having overdose symptoms. I would feel fine one moment, and then with no warning I would suddenly be so exhausted I could hardly control my arms or legs. If I was standing I would drop to the ground. If I was driving it was all I could do not to crash the car in that moment. My doctor dismissed these symptoms for several months. It wasn’t until I saw the supervising psychologist that I was told I was experiencing classic Prozac overdose symptoms. Within a few weeks of stopping the Prozac, those problems disappeared. Through our mutual frustration with this process, I no longer had a workable relationship with this doctor.
In retrospect, that was an empowering moment for me, because my doctor really didn’t have anything more to offer me. It was ultimately much better for my health to seek out answers that aren’t part of the training that MDs receive. Their answer just weren’t working for me.
I did see another doctor a few months later when my arthritis was so bad I could hardly function. At that time I was given the corticosteroid prednisone. It helped me through a hard period, but like all anti-inflammatories, it only provided temporary relief of my symptoms. It did nothing to correct the underlying problem.
This doctor also wanted me to try a drug whose brand name is Plaquenil®. Its chemical name is hydroxychloroquine and it is an anti-malarial. No one knows why it relieves arthritis symptoms, but it does. I was reluctant to take this medication because it can damage the eyes. I went as far as to have reference pictures of my eyes taken by an optometrist, so we could stop the medication if we started seeing damage. I didn’t want to do anything that would cause permanent damage to my eyesight.
At the same time my doctor was also suggesting I take methotrexate, which is a chemotherapy agent.
Luckily, I started finding non-drug alternatives to eliminate my arthritis, and eliminated the need for any of these drugs.
Why Conventional Treatments for Arthritis Seldom Work
Conventional arthritis pain medications suppress symptoms, but they do nothing to correct the underlying causes of arthritis.
Arthritis is caused by certain systems in the body going out of balance. The digestive system, the elimination system, and the immune system are the big three that are involved.
Conventional treatments consist of pain medication and surgery options that do nothing to bring these systems back into balance. At best they suppress symptoms. At worst they also disrupt the immune system or some other system so badly that it can be hard to know which is worse: the untreated arthritis or the treatment side effects.
Good Reasons for Arthritis Pain Medications
That being said, there are good reasons for using arthritis pain medications. The first is pain relief. Anyone who has ever been in pain knows how valuable that is. The second is to slow or stop ongoing joint damage.
But it is still important to be clear that pain relief and slowing damage are not the same as a cure.
Four Classes of Arthritis Pain Medications
There are four classes of medications used to treat arthritis: NSAIDS, analgesics, corticosteroids, and DMARDs. I will talk about the advantages and disadvantages of each.
1. NSAIDS
There are two kinds of NSAIDs: conventional and COX-II inhibitors. They are the most commonly used medications to treat arthritis pain. They reduce inflammation and relieve pain. Some NSAIDs, like aspirin and ibuprofen, are available over the counter.
Like many medications, however, too much of a good thing can be bad. When taken over an extended time period, like over weeks or months, conventional NSAIDs can cause stomach damage.
In fact, research studies has shown that conventional NSAIDs almost always cause acute lesions in the mucosal lining of the stomach and upper part of the small intestine (called the duodenum). You can even have these stomach and intestinal lesions without knowing it. According to one study only 50 percent of patients with these lesions have upper abdominal discomfort(1) .
If you have been using conventional NSAIDs for a long time, the biochemical damage, which results in increased intestinal permeability, may take months to heal even after you stop taking the drugs (2). In a study at Karolinska Hospital in Stockholm, Sweden, intestinal permeability increased in every single rheumatoid arthritis patient treated with conventional NSAIDs (3).
“So why is that a big deal?” you may ask. “Who cares about a little stomach damage as long as my arthritis is under better control?”
The reason to care is that increased intestinal permeability, also known as leaky gut syndrome, can cause also sorts of problems, including making arthritis worse.
Let me take a moment to clarify. Leaky gut syndrome is when a large number of food particles pass either totally undigested or partially undigested into the bloodstream. All people, even very healthy people, have some undigested food that leaks into their bloodstream. However, when high levels of food start leaking into the bloodstream, that is when we start seeing problems like arthritis and food sensitivities (4).
So that is the problem with conventional NSAIDS.
There are also NSAIDs called COX-II inhibitors.
You may remember when COX-II inhibitors first came to market in 1998. They were promoted for not causing stomach problems. Unfortunately, the COX-II inhibitor, Vioxx, was pulled off the market in Sept of 2004. The COX-II inhibitor, Bextra, was pulled off the market April of 2005. This is because they increase the risk of dying from a stoke or heart attack.
The one COX-II inhibitor still on the market is Celebrex. There is some debate over the safety of using Celebrex long term (18 months or more). One New Zealand study of actual patient outcomes found it no safer than Vioxx.
Examples of NSAIDs
Aspirin (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin)
Choline and magnesium salicylates (CMT, Tricosal, Trilisate)
Choline salicylate (Arthropan)
Celecoxib (Celebrex)
Diclofenac potassium (Cataflam)
Diclofenac sodium (Voltren, Voltaren XR)
Diclofenac sodium with misoprostol (Arthrotec)
Diflunisal (Dolobid)
Etodolac (Lodine, Lodine XL)
Fenoprofen calcium (Nalfon)
Flurbiprofen (Ansaid)
Ibuprofen (Advil, Motrin, Motrin IB, Nuprin)
Indomethacin (Indocin, Indocin SR)
Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
Magnesium salicylate (Arthritab, Bayer Select, Doan's Pills, Magan, Mobidin, Mobogesic)
Meclofenamate sodium (Meclomen)
Mefenamic acid (Ponstel)
Meloxicam (Mobic)
Nabumetone (Relafen)
Naproxen (Naprosyn, Naprelan*)
Naproxen sodium (Aleve, Anaprox)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Rofecoxib (Vioxx)
Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic, Salflex, Salsitab)
Sodium salicylate (various generics)
Sulindac (Clinoril)
Tolmetin sodium (Tolectin)
Valdecoxib (Bextra)
2. Analgesics
So what medication choices are left for someone with arthritis? Many people turn to an analgesic. The most popular is the old over the counter standby acetaminophen which is know in some parts of the world as Paracetamol and is also marketed under the brand name Tylenol.
Unlike the NSAIDS, an analgesic like acetaminophen does nothing to reduce inflammation. All it will do for arthritis is block the pain. It will give you short term pain relief, but will do nothing to heal your arthritis.
In fact, acetaminophen can actually make it harder for your body to heal joint damage. Sulfate is required for maintaining the structure of the glycosaminioglycans within joints. Lack of sulfate can impair joint repair. The human body processes acetaminophen using a reaction called sulfation. High doses of acetaminophen saturate the sulfation pathway, effectively keeping this enzyme system busy doing something other than repairing your joints.
So like NSAIDS, it is useful for short term pain relief, but problematic when used over a long period of time.
The final two classes of arthritis drugs are corticosteroids and DMARDs.
3. Corticosteroids
The three most common oral corticosteroids are prednisone (brand name Orasone), prednisoline (Prelone), and methylprednisolone (Medrol). They all have similar side effects.
Prednisone is probably the most famous of the cortiosteroidals. Prednisone is a feel good medication, at least initially. Often people who get a prednisone injection into a joint, feel like a miracle has occurred. Unfortunately the relief tends to be temporary and if you repeat the treatment to often, it will cause osteoporosis.
It may also decrease your ability to fight infection and may prevent you from developing symptoms if you get an infection. It can be a nightmare to be on on-going oral doses. It can cause swelling, weight gain, redistribution of fat, thin fragile skin, osteoporosis, loss of contact with reality and many other serious side effects.
Because of the problems with repeated or ongoing use, where prednisone is most useful for arthritis is in disrupting a period of high inflammation and pain.
4. DMARDs
DMARDs stands for disease modifying anti rheumatic drugs.
DMARDs used to not be used for arthritis except as a last resort. Now they are sometimes used much earlier because when used aggressively they are effective in slowing joint damage.
But their effectiveness at stopping joint damage comes at a price. They are toxic. Some can cause birth defects. Others can suppress the creation of blood cells. Others suppress the immune system, increasing the risk of infections. Some can damage the eye. Some can cause cancer. Some are hard on the liver or kidneys.
Instead of restoring the body to balance, they throw the body even further out of balance, but in a way that can interrupt the on going damage caused by arthritis. That can be valuable, but it should not be mistaken for a cure.
DMARDs include methotrexate, sulfasalazine, leflunomide (Arava™), gold salts, d-penicillamine, the Tumor necrosis factor (TNF) inhibitors:etanercept (Enbrel™), infliximab (Remicade™), and adalimumab (Humira™); anakinra (Kineret™), the antimalarials, and the cytotoxic agents: cyclosporin A, cyclophosphamide and azathioprine.
Methotrexate is a chemotherapy agent. It can cause myelosuppression, although not usually at the low doses used for arthritis patients. Myelosuppression which is a reduction in the ability of the bone marrow to produce blood cells.
Sulfasalazine can cause mild gastrointestinal problems. Is often used as an alternative to methotrexate for patients with liver disease. Its mechanism of action against arthritis is unknown.
Leflunomide (Arava™). Its mechanism of action is not fully understood. It can cause diarrhea and birth defects.
Gold Salts. Intramuscular gold salts were, until the 1990's, the most often used DMARD agents. They are rarely used now due to side effects and very slow onset of action. Their mechanism of action is unknown.
D-Penicillamine. d-Penicillamine is also a relatively toxic drug and is, like injectable gold, prescribed primarily for patients with persistent aggressive disease who have failed to achieve remission with less toxic agents.
Tumor necrosis factor (TNF) inhibitors.
There are currently three TNF inhibitors FDA approved in the treatment of RA: Etanercept (Enbrel™) , Infliximab (Remicade™) and adalimumab (Humira™).
The long-term safety of these agents is still relatively unknown. Side effects include increased risk for serious and opportunistic infections.
Soluble Interleukin–1 (IL–1) Receptor Therapy.
Anakinra (Kineret™) is a human recombinant IL–1 receptor antagonist (hu rIL-1ra) is approved by the FDA for the treatment of RA. Anakinra has no major side effects but it must be injected everyday, about the same time of day.
AntiMalarials.
Antimalarials such as hydroxychloroquine (brand name Plaquinil) and chloroquine are often effective remittive agents for the treatment of rheumatoid arthritis, particularly mild to moderate disease. Their mechanism of action is unknown. Both can damage the eyes. Chloroquine is no longer recommended because of its greater toxicity to the eye.
Cytotoxic Agents.
The most commonly used cytotoxic drugs are azathioprine (Imuran), cyclophosphamide (Cytoxan) and cyclosporin A. These agents have high potential toxicity, so are used only as a last resort.
Azathioprine is a purine analog that can cause severe bone marrow suppression particularly in patients with renal insufficiency or when used concomitantly with allopurinol or ACE inhibitors.
Cyclophosphamide is an alkylating agent with serious toxicities including bone marrow suppression, hemorrhagic cystitis, premature ovarian failure, infection and secondary malignancy particularly an increased risk of bladder cancer.
Cyclosporine is an immunosuppressive agent approved for use in preventing renal and liver allograft rejection. Cyclosporine inhibits T cell function by inhibiting transcription of interleukin-2. Its main toxicity is increased risk of infection and renal insufficiency.
Which Conventional Arthritis Pain Medications Can Make Arthritis Worse?
There are four classes of medications commonly used for arthritis: NSAIDs, analgesics, corticosteroids and DMARDs. Two of these four classes can make arthritis worse.
When taken over a long period of time, the stomach damaging effects of conventional NSAIDs can make arthritis worse. Conventional NSAIDs include over the counter remedies like aspirin and ibuprofen and many prescription arthritis drugs. There are about 2 dozen that prescription arthritis drugs that fall in this category.
The pain killer acetaminophen, which is in Tylenol, makes it harder for the body to repair joint damage.
Corticosteroids like prednisone, give temporary relief when injected into a joint, but when used too frequently, they cause osteoporosis. Same thing with oral doses. If you stay on them too long or at too high a dose, it causes osteoporosis. Although osteoporosis is different than arthritis, when it occurs at a joint, it can cause structural damage to that joint.
The final class DMARDs are the only class besides the corticosteroids that don’t seem to make arthritis worse. However, most of the medications in this class are toxic. They will suppress arthritis, many through unknown mechanisms, but they don’t rebuild health. They just disrupt joint destruction.
My First Arthritis Healing Breakthrough
My first breakthrough came in January 1993 during my first juice fast. Three days into my first fast I was pain-free for the first time in the 4½ years since I had developed arthritis. The fatigue vanished. I could move around freely without bringing on pain and inflammation. I could think more clearly than I had in years. It reminded me of the verse in the Bible where the healed were commanded to pick up their beds and walk. Suddenly, after years of crippling illness, I could finally pick up and walk. Fasting had done what arthritis drugs had not. Fasting stopped the inflammation and gave me the boost I needed to get well.
For more information on this and the other 8 breakthroughs (including anti-inflammatory foods and spices) that allowed me to completely heal my arthritis read my book Conquering Arthritis.
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The book, Conquering Arthritis plus 3 recipes!
Enjoy the anti-inflammatory effects of ginger and turmeric without the unfortunate side effects associated with arthritis drugs.
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→Now you know about drug medications, what about topical ones?
About the Author
Author Barbara Allan completely cured herself of her arthritis. Now she helps others do the same. To find out more, visit her page.
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| Author, Barbara Allan, before healing her arthritis |
Author, Barbara Allan, after healing her arthritis |
Notes
(1) P. Bertschinger, G. F. Zala and M. Fried, “Effect of Nonsteroidal Antirheumatic Agents on the Gastrointestinal Tract: Clinical Aspects and Pathophysiology, Schweiz Med Wochenschr. 126(37) (1996):1566-8.
(2) I. Bjarnason and T. J. Peters, “Influence of Anti-Rheumatic Drugs on Gut Permeability and on the Gut Associated Lymphoid Tissue,” Baillieres Clin. Rheumatol. 10(1) (1996):165-76.
(3) Hans Oman et al., “Increased Intestinal Permeability to Polysucrose in NSAID-Treated Patients,” Eur J of Gastroenterol Hepatol 4(3) (1992):235-240.
(4) Charlotte Cunningham-Rundles, M.D., Ph.D., “Dietary Antigens and Immunologic Disease in Humans,” Rheum Dis Clin North Amer 17(2) (1991):287-307.
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