NSAIDs with a pronounced analgesic effect. What is treated and how non-steroidal anti-inflammatory drugs work: classification, list. The most frequently used

Their mechanism of action is based on the blocking of certain enzymes (COX, cyclooxygenase), they are responsible for the production of prostaglandins - chemicals that contribute to inflammation, fever, pain.

The word "non-steroidal", which is contained in the name of the group of drugs, emphasizes the fact that the drugs in this group are not synthetic analogues of steroid hormones - powerful hormonal anti-inflammatory drugs.

The most famous representatives of NSAIDs: aspirin, ibuprofen, diclofenac.

How do NSAIDs work?

If analgesics fight directly with pain, then NSAIDs reduce both the most unpleasant symptoms of the disease: both pain and inflammation. Most drugs in this group are non-selective inhibitors of the cyclooxygenase enzyme, inhibiting the action of both of its isoforms (varieties) - COX-1 and COX-2.

Cyclooxygenase is responsible for the production of prostaglandins and thromboxane from arachidonic acid, which in turn is obtained from cell membrane phospholipids by the enzyme phospholipase A2. Prostaglandins, among other functions, are mediators and regulators in the development of inflammation. This mechanism was discovered by John Wayne, who later received the Nobel Prize for his discovery.

When are these drugs prescribed?

As a rule, NSAIDs are used to treat acute or chronic inflammation accompanied by pain. Non-steroidal anti-inflammatory drugs have gained particular popularity for the treatment of joints.

We list the diseases for which these drugs are prescribed:

• acute gout;
• dysmenorrhea (menstrual pain);
• bone pain caused by metastases;
• postoperative pain;
• fever (increased body temperature);
• intestinal obstruction;
• renal colic;
• moderate pain due to inflammation or soft tissue injury;
• osteochondrosis;
• lower back pain;
• headache;
• migraine;
• arthrosis;
• rheumatoid arthritis;
• pain in Parkinson's disease.

NSAIDs are contraindicated in erosive and ulcerative lesions of the gastrointestinal tract, especially in the acute stage, severe violations of the liver and kidneys, cytopenias, individual intolerance, pregnancy. Should be used with caution in patients with bronchial asthma, as well as in persons who have previously had adverse reactions when taking any other NSAIDs.

List of Common NSAIDs for Joint Treatment

We list the most well-known and effective NSAIDs that are used to treat joints and other diseases when an anti-inflammatory and antipyretic effect is needed:

Some drugs are weaker, not so aggressive, others are designed for acute arthrosis, when urgent intervention is required to stop dangerous processes in the body.

What is the advantage of new generation NSAIDs

Adverse reactions are noted with long-term use of NSAIDs (for example, in the treatment of osteochondrosis) and consist in damage to the mucous membrane of the stomach and duodenum with the formation of ulcers and bleeding. This lack of non-selective NSAIDs has led to the development of new generation drugs that block only COX-2 (an inflammatory enzyme) and do not affect the work of COX-1 (protection enzyme).

Thus, new generation drugs are practically devoid of ulcerogenic side effects (damage to the mucous membrane of the digestive tract) associated with long-term use of non-selective NSAIDs, but increase the risk of thrombotic complications.

Of the shortcomings of new generation drugs, only their high price can be noted, which makes it inaccessible to many people.

New generation NSAIDs: list and prices

What it is? New generation non-steroidal anti-inflammatory drugs act much more selectively, they inhibit COX-2 to a greater extent, while COX-1 remains practically untouched. This explains the rather high efficiency of the drug, which is combined with a minimum number of side effects.

List of popular and effective non-steroidal anti-inflammatory drugs of the new generation:

1. Movalis. It has an antipyretic, well-marked analgesic and anti-inflammatory effect. The main advantage of this remedy is that, with regular medical supervision, it can be taken for a fairly long period of time. Meloxicam is available as a solution for intramuscular injection, in tablets, suppositories and ointments. Meloxicam (Movalis) tablets are very convenient in that they are long-acting, and it is enough to take one tablet during the day. Movalis, which contains 20 tablets of 15 mg, costs a rub.
2. Ksefokam. A drug based on Lornoxicam. Its distinguishing feature is the fact that it has a high ability to relieve pain. According to this parameter, it corresponds to morphine, but it is not addictive and does not have an opiate-like effect on the central nervous system. Ksefokam, which contains 30 tablets of 4 mg, costs a rub.
3. Celecoxib. This drug greatly alleviates the patient's condition with osteochondrosis, arthrosis and other diseases, relieves pain well and effectively fights inflammation. Side effects on the digestive system from celecoxib are minimal or absent at all. Price, rub.
4. Nimesulide. It has been used with great success in the treatment of vertebrogenic back pain, arthritis, etc. Removes inflammation, hyperemia, normalizes temperature. The use of nimesulide quickly leads to a reduction in pain and improved mobility. It is also used as an ointment for application to the problem area. Nimesulide, which contains 20 tablets of 100 mg, costs a rub.

Therefore, in cases where long-term use of non-steroidal anti-inflammatory drugs is not required, old-generation drugs are used. However, in some cases this is simply a forced situation, since few can afford a course of treatment with such a drug.

Classification

How are NSAIDs classified and what are they? By chemical origin, these drugs come with acidic and non-acidic derivatives.

1. Oxicams - piroxicam, meloxicam;
2. NSAIDs based on indoacetic acid - indomethacin, etodolac, sulindac;
3. Based on propionic acid - ketoprofen, ibuprofen;
4. Salicipates (based on salicylic acid) - aspirin, diflunisal;
5. Derivatives of phenylacetic acid - diclofenac, aceclofenac;
6. Pyrazolidines (pyrazolonic acid) - analgin, metamizole sodium, phenylbutazone.

Also, non-steroidal drugs differ in type and intensity of exposure - analgesic, anti-inflammatory, combined.

Effectiveness of medium doses

According to the strength of the anti-inflammatory effect of medium doses, NSAIDs can be arranged in the following sequence (the strongest ones are at the top):

According to the analgesic effect of medium doses, NSAIDs can be arranged in the following sequence:

As a rule, the above medicines are used for acute and chronic diseases accompanied by pain and inflammation. Most often, non-steroidal anti-inflammatory drugs are prescribed to relieve pain and treat joints: arthritis, arthrosis, injuries, etc.

Not infrequently, NSAIDs are used for pain relief for headaches and migraines, dysmenorrhea, postoperative pain, renal colic, etc. Due to the inhibitory effect on the synthesis of prostaglandins, these drugs also have an antipyretic effect.

What dosage to choose?

Any new drug for this patient should be prescribed first at the lowest dose. With good tolerance after 2-3 days, the daily dose is increased.

Therapeutic doses of NSAIDs are in a wide range, and in recent years there has been a tendency to increase single and daily doses of drugs characterized by the best tolerance (naproxen, ibuprofen), while maintaining restrictions on the maximum doses of aspirin, indomethacin, phenylbutazone, piroxicam. In some patients, the therapeutic effect is achieved only when using very high doses of NSAIDs.

Side effects

Long-term use of high doses of anti-inflammatory drugs can cause:

1. Violation of the nervous system - mood changes, disorientation, dizziness, apathy, tinnitus, headache, blurred vision;
2. Changes in the work of the heart and blood vessels - palpitations, increased blood pressure, swelling.
3. Gastritis, ulcer, perforation, gastrointestinal bleeding, dyspeptic disorders, changes in liver function with an increase in liver enzymes;
4. Allergic reactions - angioedema, erythema, urticaria, bullous dermatitis, bronchial asthma, anaphylactic shock;
5. Renal failure, impaired urination.

Treatment with NSAIDs should be carried out for the shortest possible time and at the lowest effective doses.

Use during pregnancy

It is not recommended to use drugs of the NSAID group during pregnancy, especially in the third trimester. Although no direct teratogenic effects have been identified, it is believed that NSAIDs can cause premature closure of the ductus arteriosus (Botalla) and renal complications in the fetus. There are also reports of premature births. Despite this, aspirin in combination with heparin has been successfully used in pregnant women with antiphospholipid syndrome.

According to the latest data from Canadian researchers, the use of NSAIDs before 20 weeks of gestation was associated with an increased risk of miscarriage (miscarriage). According to the results of the study, the risk of miscarriage increased by 2.4 times, regardless of the dose of the drug taken.

Movalis

The leader among non-steroidal anti-inflammatory drugs can be called Movalis, which has an extended period of action and is approved for long-term use.

It has a pronounced anti-inflammatory effect, which allows it to be taken in osteoarthritis, ankylosing spondylitis, rheumatoid arthritis. It is not devoid of analgesic, antipyretic properties, protects cartilage tissue. It is used for toothache, headache.

Determination of dosage, method of administration (tablets, injections, suppositories) depends on the severity, type of disease.

Celecoxib

A specific COX-2 inhibitor with a pronounced anti-inflammatory and analgesic effect. When used in therapeutic doses, it practically does not have a negative effect on the mucosa of the gastrointestinal tract, since it has a very low degree of affinity for COX-1, therefore, it does not cause a violation of the synthesis of constitutional prostaglandins.

As a rule, celecoxib is taken at a dosage of mg per day in 1-2 doses. The maximum daily dose is 400 mg.

Indomethacin

Refers to the most effective means of non-hormonal action. In arthritis, indomethacin relieves pain, reduces swelling of the joints and has a strong anti-inflammatory effect.

The price of the drug, regardless of the form of release (tablets, ointments, gels, rectal suppositories) is quite low, the maximum cost of tablets is 50 rubles per pack. When using the drug, you must be careful, as it has a long list of side effects.

In pharmacology, indomethacin is produced under the names Indovazin, Indovis EU, Metindol, Indotard, Indocollir.

Ibuprofen

Ibuprofen combines relative safety and the ability to effectively reduce fever and pain, so preparations based on it are sold without a prescription. As an antipyretic, ibuprofen is also used for newborns. It has been proven to reduce fever better than other non-steroidal anti-inflammatory drugs.

In addition, ibuprofen is one of the most popular over-the-counter analgesics. As an anti-inflammatory drug, it is not prescribed so often, however, the drug is quite popular in rheumatology: it is used to treat rheumatoid arthritis, osteoarthritis and other joint diseases.

The most popular brand names for ibuprofen include Ibuprom, Nurofen, MIG 200 and MIG 400.

Diclofenac

Perhaps one of the most popular NSAIDs, created back in the 60s. Release form - tablets, capsules, injection, suppositories, gel. In this remedy for the treatment of joints, both high analgesic activity and high anti-inflammatory properties are well combined.

Produced under the names Voltaren, Naklofen, Ortofen, Diklak, Diklonak P, Wurdon, Olfen, Dolex, Dicloberl, Klodifen and others.

Ketoprofen

In addition to the drugs listed above, the group of drugs of the first type, non-selective NSAIDs, i.e. COX-1, includes a drug such as ketoprofen. By the strength of its action, it is close to ibuprofen, and is available in the form of tablets, gel, aerosol, cream, solutions for external use and injection, rectal suppositories (suppositories).

You can buy this tool under the trade names Artrum, Febrofid, Ketonal, OKI, Artrozilen, Fastum, Bystrum, Flamax, Flexen and others.

Aspirin

Acetylsalicylic acid reduces the ability of blood cells to stick together and form blood clots. When taking Aspirin, the blood thins, and the vessels expand, which leads to relief of a person's condition with headaches and intracranial pressure. The action of the drug reduces the energy supply in the focus of inflammation and leads to the attenuation of this process.4

Aspirin is contraindicated for children under 15 years of age, since a complication is possible in the form of an extremely severe Reye's syndrome, in which 80% of patients die. The remaining 20% ​​of surviving babies may be susceptible to epilepsy and mental retardation.

Alternative drugs: chondroprotectors

Quite often, chondroprotectors are prescribed for the treatment of joints. People often do not understand the difference between NSAIDs and chondroprotectors. NSAIDs quickly relieve pain, but at the same time have a lot of side effects. And chondroprotectors protect cartilage tissue, but they need to be taken in courses.

The composition of the most effective chondroprotectors includes 2 substances - glucosamine and chondroitin.

The best anti-inflammatory for the respiratory system

In most infectious and inflammatory diseases of the respiratory system and ENT organs, non-steroidal anti-inflammatory drugs are widely used as symptomatic therapy. They are prescribed to reduce fever, suppress inflammation and reduce pain.

Varieties of NSAIDs

To date, there are more than 25 different drugs belonging to the group of non-steroidal anti-inflammatory drugs. Classification by chemical structure is considered of little use for comparative evaluation of drug efficacy and safety. Of greatest interest are drugs that have a pronounced antipyretic and anti-inflammatory effect and have a low rate of adverse reactions.

List of anti-inflammatory drugs that can be prescribed for diseases of the respiratory system and ENT organs:

Only the attending physician knows which anti-inflammatory tablets, capsules, powder, mixture or syrup will be effective in each case.

Application features

All non-steroidal anti-inflammatory drugs have similar principles of action, the use of which leads to the elimination of the inflammatory process, fever and pain. In pulmonology and otolaryngology, NSAIDs are preferred, which have more pronounced antipyretic and anti-inflammatory properties. I would like to note that due to the high risk of adverse reactions, the combined use of several NSAIDs at once is highly undesirable. At the same time, their therapeutic effect is not enhanced, but the negative impact on the body, in particular, on the digestive system, sharply increases.

In case of serious problems with the gastrointestinal tract (for example, peptic ulcer), it is better to use modern selective NSAIDs of the new generation, which have a much lower likelihood of side effects. Despite the possibility of obtaining these drugs without a prescription, the dosage and duration of the therapeutic course must be agreed with your doctor. During treatment, the use of alcoholic beverages should be excluded.

Paracetamol

Paracetamol effectively copes with the main clinical symptoms of colds. Taking it in the appropriate dosage makes it possible to quickly bring down the high temperature, relieve malaise and fatigue, relieve pain, etc. The main advantages of the drug:

• Recommended for use by the World Health Organization.
• Fast antipyretic effect.
• Fairly well tolerated by most patients.
• Low risk of adverse reactions.
• Compared to other similar anti-inflammatory drugs, the cost is relatively low, making it accessible to all segments of the population.

Paracetamol has its own characteristics of use. It can be used in the form of tablets, powder, rectal suppositories, injections, etc. Ingestion or rectal administration of the drug allows you to achieve more effective results. The interval between applications should be at least 4 hours. The average duration of treatment is 5-7 days. A longer therapeutic course with this antipyretic is not recommended. Usually, the clinical manifestations of colds begin to pass on the 2-3rd day. In case of a significant deterioration in the condition, you should immediately consult a doctor.

If the patient has an allergy to the components of the drug or severe problems with the kidneys and liver, Paracetamol should not be prescribed. The development of the following pathological conditions is referred to as side effects:

• anemia.
• Reducing the number of platelets.
• Renal colic.
• Glomerulonephritis.
• Allergic manifestations (itching, redness of the skin, various rashes, etc.).

In an attempt to achieve a speedy result, some patients ignore the instructions in the official instructions for use, and take a dosage of an anti-inflammatory drug that exceeds the maximum recommended. With an overdose of Paracetamol, the following symptoms are possible:

• The appearance of pallor, nausea, vomiting and pain in the abdomen.
• In case of failure to provide timely assistance and taking too large a dose of the drug, the kidneys and liver are affected. Arrhythmia, pancreatitis, and serious disorders of the central nervous system may develop.

If severe clinical manifestations of an overdose are noted, it is necessary to prescribe Methionine or N-acetylcysteine, which are effective antidotes (antidote). In addition, when using Paracetamol, drug interactions with other drugs should be taken into account. For example, simultaneous use with indirect anticoagulants (coumarin derivatives) increases the effect of the latter. The antipyretic effect is significantly reduced when combined with barbiturates.

A qualified specialist (pharmacist or doctor) will help you choose the best non-steroidal anti-inflammatory drug.

Panadol Extra

Panadol Extra is considered to be a combined NSAID preparation, which contains not only paracetamol, but also caffeine as active substances. Both components reinforce each other's action. Paracetamol relieves pain and relieves fever. Caffeine has a stimulating effect on the central nervous system. In addition, by increasing the level of paracetamol concentration in the brain by increasing the permeability of the blood-brain barrier, caffeine increases the analgesic effect of the drug.

Panadol Extra helps to alleviate the condition of colds, acute tonsillitis, laryngopharyngitis and other infectious and inflammatory pathologies of the respiratory system and ENT organs. Most adults and children tolerate this anti-inflammatory drug fairly well. As a rule, there are no special problems with suction and excretion of the drug. Panadol Extra is not prescribed to patients who have hypersensitivity to active substances. In rare cases, side effects occur, which can manifest as:

• Jumps in blood pressure.
• Functional disorders of the liver.
• Allergic reactions (redness, rashes, itching, etc.).

Read the official instructions for the features of use and recommended dosage. It should only be noted that 8 tablets is the maximum that an adult patient can take per day. Given the pharmacological properties of the drug, the interval between doses should be at least 4 hours. Tablets from the inflammatory process Panadol Extra cost about 45 rubles per pack.

Coldrex

In acute infectious diseases of the upper respiratory tract, Coldrex can be used. It is a complex anti-inflammatory drug, consisting of:

Given the multicomponent composition, Coldrex has a very diverse pharmacological effect:

1. The presence of paracetamol causes the normalization of temperature, the removal of pain and the elimination of the inflammatory process.
2. Ascorbic acid strengthens the local immunity of the respiratory tract.
3. Phenylephrine is responsible for the narrowing of peripheral vessels and preventing the growth of edema of the affected tissues.
4. Terpinhydrate enhances bronchial secretion and facilitates expectoration of sputum.
5. Caffeine potentiates the analgesic effect of paracetamol.

Coldrex has several varieties, each of which is selected individually, taking into account the severity of the clinical signs of the disease. There are such contraindications to its use:

• Allergy to the active ingredients of the drug.
• Severe disorders of the liver and kidneys.
• Diseases of the circulatory system.
• Increased blood pressure.
• Diabetes.
• Cardiovascular pathology (for example, arrhythmias, heart attack, etc.).
• Increased hormonal activity of the thyroid gland.
• Children whose age is less than 6 years.

The therapeutic course should be no more than 5 days. Dosage and frequency of use are detailed in the official instructions. During treatment, drug interactions with other drugs must be taken into account. It is strongly not recommended to combine with drugs from the group of antidepressants, beta-blockers, etc. Adverse reactions are rarely recorded. In general, the drug is well tolerated. When used for the treatment of children, it is better to first consult with your doctor. The cost of packing Coldrex tablets ranges from 160 rubles.

The list of NSAID drugs (tablets, capsules, etc.) is constantly updated and supplemented with new drugs that have more pronounced therapeutic effects and less toxic properties.

Fervex

Another representative of the combined non-steroidal anti-inflammatory drugs is Fervex, which today is successfully used for most colds of the upper respiratory tract. How the pharmacological action of the drug is realized:

• The analgesic and antipyretic effect is characteristic of paracetamol.
• Strengthening local immunity and tissue repair provides ascorbic acid.
• The antihistamine effect is given by pheniramine, which helps to reduce the production of mucus in the nasal cavity, improve breathing through the nose, eliminate sneezing, lacrimation, etc.

Despite the fact that Fervex is considered a fairly safe medicine, not all patients can use it. In the following pathological conditions and diseases, this drug should not be used:

Children can use Fervex, starting from the age of 15. Use with extreme caution when:

• Functional insufficiency of the liver.
• Angle-closure glaucoma.
• Congenital disorders of bilirubin metabolism (for example, Gilbert's syndrome).
• Viral hepatitis.
• In old age.

At the recommended dosage, the drug is well tolerated. However, nausea, pain in the abdomen, itching, redness of the skin, rashes and other allergic reactions may occur. Unjustified prolonged use or a significant excess of the recommended dosage increases the risk of developing serious disorders of the kidneys and liver. In case of side effects, stop taking the medicine and contact a specialist for professional medical help.

The anti-inflammatory drug has its own characteristics of use. The contents of the Fervex sachet are dissolved in warm water (200 ml) and drunk completely. The recommended dosage is up to three times a day. The next appointment should be no earlier than 4 hours later. With functional disorders of the kidneys and liver, increase the interval between applications to 8 hours. The therapeutic course is up to five days. To reduce the temperature can be used within 3 days. Fervex is produced by the French company UPSA. You can buy it at a price of 360 rubles per package, which contains 8 sachets.

A complete list of modern anti-inflammatory drugs can be found in the Pharmaceutical Directory.

Aspirin-S

To date, Aspirin-C is considered one of the most popular drugs for the symptomatic treatment of infectious and inflammatory diseases of the respiratory system. Having in its composition acetylsalicylic and ascorbic acids, it is able to effectively eliminate the main clinical manifestations of colds (fever, headaches, malaise, etc.). The effectiveness of the drug has been proven by numerous scientific studies.

Aspirin-C comes in the form of effervescent tablets that can be quickly dissolved in water. This form is very convenient for most patients with colds. Especially with severe sore throats, when the use of conventional tablets or hot drinks provokes a very unpleasant sensation. In addition, it has long been established that ascorbic acid is destroyed at high temperatures. By dissolving it in cool water, we retain all the pharmacological properties of vitamin C. The absorption of the drug occurs quickly enough, which ensures the immediate onset of the therapeutic effect. It is also worth noting that acetylsalicylic acid is completely soluble in water without the formation of sediment, reducing the likelihood of various kinds of side effects.

However, uncontrolled long-term use of the drug can lead to the development of a number of adverse events:

• Vertigo.
• Headaches.
• Nausea.
• Vomiting.
• Breathing problems.
• Drowsiness.
• Lethargy.
• Increased bleeding.
• Allergies (itching, rashes, skin redness, etc.).

In case of an overdose of Aspirin-C, it is necessary to control the acid-base balance in the body. If necessary, special solutions are introduced to normalize the condition (for example, sodium bicarbonate or citrate). The therapeutic measures taken should be aimed at enhancing the excretion of acetylsalicylic acid and its metabolites.

It should be noted that in children with a suspected viral infection, drugs that contain acetylsalicylic acid are not used, since the likelihood of developing a more severe pathology, such as Reye's syndrome, increases. It is manifested by prolonged vomiting, damage to the central nervous system and enlargement of the liver.

Before surgery, it is better to refrain from taking Aspirin-C, which affects the blood clotting system. Also, acetylsalicylic acid slows down the process of excretion of uric acid from the body. Patients suffering from gout may experience a new attack during treatment with this drug. Aspirin-C is a prohibited drug during pregnancy. In the early stages, it often provokes congenital malformations in the fetus, in the later stages it inhibits labor activity.

The Swiss pharmaceutical company Bayer Consumer Care AG is one of the main manufacturers of Aspirin-C effervescent tablets. The cost of a package of medicine (10 pcs.) Is approximately 250 rubles.

Ibuprofen

Complex therapy of infectious and inflammatory diseases of the respiratory system and ENT organs may include Ibuprofen. It is currently considered one of the most commonly prescribed non-steroidal anti-inflammatory drugs for fever and pain. It is widely used not only in therapeutic, but also pediatric practice. Being a very safe and effective antipyretic, it is allowed for sale without a doctor's prescription.

If there are appropriate indications, it can be used to treat children from the first days of life, both in stationary and laboratory conditions. Babies are recommended to use Ibuprofen in the form of rectal suppositories, which have a number of advantages over other forms of drug release:

• Simplicity and painlessness of introduction.
• There is no need for additional special tools.
• The integrity of the skin is not violated.
• There is no risk of infection.
• Intestinal fullness does not affect the absorption and effectiveness of the drug.
• Low incidence of allergic reactions.

Most patients do not experience any side effects during treatment with Ibuprofen. However, in rare cases, undesirable effects are still possible, which manifest themselves in the form of:

• Decreased appetite.
• Nausea.
• Vomiting.
• Headache.
• Drowsiness.
• nervousness.
• Hearing and vision disorders.
• Increase in blood pressure.
• Rapid heartbeat.
• Labored breathing.
• Edema syndrome.
• Kidney dysfunction.
• Allergies (rashes, itching, redness of the skin, Quincke's edema, etc.).

It is worth noting that the list of contraindications for the use of Ibuprofen is quite long, so we recommend that you read it in the official instructions for the drug. During therapy, it is desirable to use the minimum effective dosage of non-steroidal anti-inflammatory drugs in order to reduce the risk of adverse reactions. It is also preferable to stick to short courses of treatment. If the drug is ineffective or the condition worsens, you should immediately visit your doctor. Particular attention should be paid to the state of the digestive system, which is very sensitive to nonsteroidal drug therapy. Today, Ibuprofen is available under various trade names:

These drugs are produced by both foreign and domestic pharmaceutical companies. The cost of the medicine will depend not only on the form of release, but also on the amount of the active substance. For example, a package of Ibuprofen tablets from the Russian pharmaceutical company Sintez costs about 40 rubles.

Non-steroidal anti-inflammatory drugs are available without a prescription, but this does not mean that you should neglect the advice of a specialist before using them.

Some doctors may recommend Nise for infectious and inflammatory diseases of the upper and lower respiratory tract, which are accompanied by fever and pain. This modern non-steroidal anti-inflammatory agent contains the active substance nimesulide. It must be taken with severe symptoms of the disease. For example, Nise is able to bring down the temperature in 10-12 hours. He can also relieve headaches, fatigue, weakness, malaise, aching muscles and joints. However, in the absence of a sufficient therapeutic effect for 3-4 days, you should visit your doctor and adjust the course of treatment.

During the period of bearing a baby, the drug can not be used categorically. It has been established that nimesulide adversely affects the growth and development of the fetus. In addition, the active substance can penetrate into breast milk, so during treatment it is necessary to switch to artificial feeding. With proper observance of all recommendations for the use of the drug specified in the instructions, adverse reactions are practically not observed. In rare cases, the appearance of:

• Nausea, vomiting, diarrhea and other dyspeptic disorders.
• Headache, drowsiness, irritability.
• Increased blood pressure, breathing problems.
• Changes in the main blood parameters (for example, anemia, a decrease in the number of platelets, etc.).
• Reversible functional problems with the functioning of the kidneys and liver.
• Rash, itching, erythema, redness of the skin and other allergic reactions.

With extreme caution, Nise should be taken by patients who have problems with the digestive system, in particular, peptic ulcer. It is recommended to use short therapeutic courses, which in most cases successfully cope with the main symptoms of colds. Foreign pharmaceutical companies mainly specialize in the release of Nise, so often the price will be slightly higher compared to domestic analogues of the drug. A pack of Indian-made tablets (20 pcs.) Will cost about 180 rubles.

When choosing an effective non-steroidal anti-inflammatory drug, never neglect the opinion of a specialist.

What are the best non-steroidal anti-inflammatory drugs?

Anti-inflammatory drugs for joints are the main treatment for diseases of cartilage and connective tissue. They slow down the progression of the disease, help fight exacerbations, relieve painful symptoms. The scheme of taking the drug can be different - they are taken in courses, or as needed to alleviate the condition. Nonsteroidal anti-inflammatory drugs (NSAIDs) are produced in various dosage forms - ointments and gels for topical use, tablets and capsules, as well as injectable preparations for intraarticular administration.

Anti-inflammatory drugs (NSAIDs) - the principle of action

This group of drugs is very extensive, but they are all united by a common principle of action. The essence of this process is that non-steroidal anti-inflammatory drugs for the treatment of joints interfere with the mechanism of the formation of the inflammatory process. The enzyme cyclooxygenase is responsible for the synthesis of so-called inflammatory mediators. It is she who is inhibited by drugs from the NSAID group, interrupting the chain of development of the inflammatory reaction. They prevent pain, fever and local swelling.

But there is another important feature of the action of non-steroidal anti-inflammatory drugs. There are two types of cyclooxygenase enzyme. One of them (COX-1) is involved in the synthesis of inflammatory mediators, and the second (COX-2) is involved in the synthesis of the protective layer of the stomach wall. NSAIDs act on both types of this enzyme, causing both of them to be inhibited. This explains the side effect common to these drugs, which consists in damage to the mucous membrane of the digestive organs.

According to their effect on COX-2 drugs are divided into selective and non-selective. The development of new NSAIDs aims to increase the selectivity of their effect on COX-1 and eliminate the effect on COX-2. Currently, a new generation of NSAIDs has been developed, which have almost complete selectivity.

The three main therapeutic effects of drugs in this group are anti-inflammatory, antipyretic and analgesic. In diseases of the joints, it is the anti-inflammatory effect that comes to the fore, and the analgesic effect is no less significant. The antipyretic effect is less important and practically does not manifest itself in the new generation of anti-inflammatory non-steroidal drugs that are used to treat joint diseases.

Classification of anti-inflammatory drugs

Taking into account the peculiarities of the structure of the active substance, all NSAIDs can be divided into several groups:

Non-selective NSAIDs (affect mainly COX-1)

These include the following tools:

Non-selective NSAIDs (equally affecting COX-1 and COX-2).

• Lornoxicam;
• Xefocam;
• Lorakam.

Selective NSAIDs (inhibit COX-2)

• Celecoxib;
• Meloxicam;
• Nimesulide;
• Rofecoxib.

Some of these drugs have a strong anti-inflammatory effect, others are more antipyretic (Aspirin, Ibuprofen) or analgesic (Ketorolac) effect.

Indications for the use of NSAIDs

knee arthritis is one of the causes

In diseases of the joints, nonsteroidal drugs are prescribed according to several schemes, depending on the dosage form and stage of the disease. The list of diseases for which NSAIDs are prescribed is quite long - these are arthritis of various etiologies, including autoimmune, most arthrosis, the recovery period after injuries of the joints and muscular apparatus.

With exacerbation of chronic diseases of the joints, non-steroidal anti-inflammatory drugs are used in a complex manner. They are prescribed in the form of a course of tablets and ointments, in a serious condition, the treatment is supplemented by intra-articular injections. Outside of exacerbation and in acute conditions, they are used as needed if symptoms of inflammation of the joints occur.

Side effects

Non-steroidal anti-inflammatory drugs have many side effects, so be sure to read the instructions before taking them. The most common side effects are:

• provocation of a stomach or duodenal ulcer,
• dyspepsia,
• dysfunction of the nervous system,
• allergic reactions

They are especially pronounced in medicines in tablets, suppositories and solutions for intramuscular injections. Local remedies (ointments and intra-articular injections) do not have such an effect.

Another common group of side effects is the effect on the hematopoietic system. NSAIDs have a blood-thinning effect, and this effect must be taken into account when taking these drugs so as not to harm your health. A more dangerous effect on the blood system is expressed in the inhibition of hematopoietic processes. It is manifested by a gradual decrease in the number of formed elements in the blood - first anemia develops, then - thrombocytopenia, subsequently - pancytopenia.

In addition, there are other side effects caused by the chemical characteristics of the drugs, they are indicated in the instructions for use. Due to the large number of side effects, you should consult your doctor before taking NSAIDs for the treatment of joints.

Contraindications

Contraindications to the use of NSAIDs in diseases of the joints stem from their side effects and relate primarily to tablet forms. They are not prescribed to patients during an exacerbation of diseases of the gastrointestinal tract, as well as to patients with diseases of the blood system - anemia of various origins, clotting disorders, leukemia and leukemia.

NSAIDs should not be administered simultaneously with drugs that reduce blood clotting (heparin), and it is also not recommended to take the same drug in different dosage forms - this leads to increased side effects. First of all, this applies to drugs containing ibuprofen and diclofenac.

In addition, it is possible to develop an allergic reaction to drugs of the NSAID group. Its intensity is not related to the dosage form, and appears with the same frequency when taking tablets, using ointments and injecting into the joints. Sometimes allergies can take very severe forms, for example, aspirin asthma - an asthmatic attack when using the drug. An allergic reaction to NSAIDs can be cross-reactive, so care should be taken when taking drugs.

Ointments with NSAIDs for joint diseases

Ointments are the most common dosage form that is used for joint pain. Their popularity is due to the fact that the effect of the ointment comes quickly enough, and the side effects are minimal. The ointment can be used to relieve acute pain and in the recovery period after injuries. But if a course of injections is prescribed, then the ointments are usually canceled.

The most popular drugs in the form of ointments are Diclofenac and preparations based on it (Voltaren), Dolobene, and others. Most of them can be bought at the pharmacy without a doctor's prescription. You can use such products for a long time without harm to health.

Non-steroidal anti-inflammatory drugs in tablets for diseases of the joints

NSAIDs in tablets are prescribed for joint lesions, osteochondrosis, systemic connective tissue diseases with articular syndrome. They are used in courses, several times a year, prescribed in the acute period. But the main task of NSAID tablets is to prevent the exacerbation of diseases.

This dosage form is most effective for the treatment of diseases of the joints and spine, but has the greatest number of contraindications. In addition to the conditions listed above, tablets containing NSAIDs should not be used for liver diseases - fibrosis, cirrhosis, hepatitis, liver failure. In diseases of the kidneys, accompanied by a decrease in the filtration rate, a reduction in dosage or frequency of administration is required.

A complete list of anti-inflammatory drugs can be found on Wikipedia. Among the most famous of them is Diclofenac in tablets. Of the more modern drugs of the new generation - Xefocam, Celecoxib and Movalis. New drugs are safer, but have another negative point - high cost. Tablets should be taken after meals or with meals.

NSAIDs in solutions for intra-articular injections

This dosage form is prescribed for severe disease and for the relief of severe exacerbation. It is used by courses that are held only in a medical institution. Intra-articular injections allow the most effective delivery of the active substance to the site of inflammation. But they require high qualifications from the doctor who conducts them, since they are associated with a risk of damage to the ligament of the joint.

Diclofenac, Movalis, Ksefokam and other drugs are available in injectable form. They are used to treat lesions of large joints, most often the knee, less often the elbow. Intra-articular injections are not prescribed for lesions of the joints of the hands and feet, as well as for diseases of the spine. This is due to the fact that the technical difficulties of administering the drug make this method of treatment almost impossible.

Intra-articular injections are considered a rather complex medical manipulation, and must be carried out in a treatment room, as they require sterility to avoid infection and highly qualified medical staff.

List of the best anti-inflammatory drugs

Let us consider in more detail the features of the use of the most popular drugs from the NSAID group.

Diclofenac (Voltaren, Naklofen, Olfen, Diklak, etc.)

Diclofenac and preparations based on it are produced in the form of tablets, capsules, ointments, gels, suppositories, injection solutions. These drugs exhibit a powerful anti-inflammatory effect, quickly relieve pain, lower the temperature and alleviate the patient's condition. A high concentration of the active ingredient in the blood is noted within 20 minutes after taking the drug.

Like most drugs from the NSAID group, they have a negative effect on the gastrointestinal tract, I have a fairly extensive list of contraindications and side effects, so they should be used only as directed by a doctor, in short courses. The standard daily dose of Diclofenac in tablets for adult patients is 150 mg, it is divided into 2-3 doses. Local forms (ointments, gels) are applied to the affected area with a thin layer up to 3 times a day.

Indomethacin (Metindol)

It has the same therapeutic effect as Diclofenac. Available in the form of tablets, capsules, ointment, gel, rectal suppositories. But this drug has many more pronounced side effects, so it is now rarely used, giving preference to more modern drugs.

Piroxicam

A drug from the group of oxycams, with a pronounced analgesic, anti-inflammatory and antipyretic effect. Available in the form of capsules, tablets, ointments, creams, suppositories. It is used to treat gout, arthritis, joint and muscle pain, as well as in preparation for the IVF procedure.

Like other NSAIDs, it has an extensive list of side effects associated with damage to the digestive tract, impaired hematopoiesis, and reactions from the nervous system. Therefore, the drug should be used only as directed by a doctor. The analgesic effect of taking Piroxicam tablets persists throughout the day. The standard dose of the drug for an adult is up to 40 mg per day.

Lornoxicam (Xefocam, Lorakam, Larfix)

The drug has a pronounced anti-inflammatory effect, quickly copes with excruciating pain syndrome. Does not show antipyretic action. The drug is used to treat postoperative pain, algomenorrhea, in the treatment of osteoarthritis and rheumatoid arthritis.

Available in the form of tablets and powder, intended for the preparation of a solution for injection. The recommended dose for oral administration is up to 4 tablets per day in 2 divided doses. For injection into a muscle or vein, a single dose of the drug is 8 mg, the solution is prepared immediately before administration.

When using the drug, the likelihood of complications in people with gastroenterological pathologies increases, therefore, the drug is not used for diseases of the gastrointestinal tract, as well as during pregnancy, lactation, pathologies of the heart, liver and in childhood.

Meloxicam (Movalix, Revmoxicam, Melox)

Drugs based on enolic acid belong to the class of selective COX-2 inhibitors. In this regard, they cause fewer side effects from the digestive organs and do not provoke toxic damage to the kidneys and liver. Meloxicam tablets, rectal suppositories and injections in ampoules are produced.

Indications for the use of the drug are diseases of the joints of an inflammatory and degenerative nature with a pronounced pain syndrome - spondyloarthritis, osteoarthrosis and arthritis. As a rule, in the first days of treatment, the drug is used in the form of intramuscular injections, after the acute inflammatory process subsides, they switch to taking Meloxicam in tablet form (1 tablet twice a day).

Nimesulide (Nimesil, Nimesin, Remesulide)

The drug belongs to the group of highly selective COX-2 inhibitors, has a powerful anti-inflammatory effect, which is complemented by antipyretic and analgesic properties. Nimesulide is produced in the form of tablets, granules for suspension and in the form of a gel for topical use. A single dose of the drug in tablets is 100 mg, taken twice a day.

The gel is applied to the affected area several times a day (3-4), lightly rubbing. Suspension with a pleasant orange flavor can be prescribed to children from 12 years of age. The drug is intended for the treatment of post-traumatic and postoperative pain, degenerative joint lesions (accompanied by inflammation), bursitis, tendonitis.

In addition, Nimesulide is prescribed for atralgia, myalgia, painful periods, as well as for the relief of headache and toothache. The drug can have a toxic effect on the liver and kidneys, therefore, in diseases of these organs, the dose of the drug must be reduced.

Celecoxib (Revmroxib, Celebrex)

A drug from the group of coxibs, used in the treatment of inflammatory diseases of the joints, acute pain syndrome, menstrual pain. Available in the form of capsules, which may contain 100 or 200 mg of the active substance. It shows a pronounced analgesic and anti-inflammatory effect, while, if not exceeding the therapeutic dose, it has practically no negative effect on the gastrointestinal mucosa.

The maximum allowable daily dose of the drug is 400 mg divided into 2 doses. With prolonged use of Celecoxib in high doses, side effects develop - ulceration of the mucosa, disorders of the hematopoietic system and other undesirable reactions from the nervous, cardiovascular and genitourinary systems.

Aceclofenac (Zerodol)

The action of the drug is similar to Diclofenac, it is available in the form of tablets containing 100 mg of the active substance. Adults are advised to take 1 tablet twice a day. The drug is intended for the treatment of gout, arthritis of various etiologies, osteoarthritis and spondylitis.

This medication is much less likely than other NSAIDs to provoke erosive lesions of the gastrointestinal tract, but its administration may be accompanied by a number of side effects from the digestive, nervous, hematopoietic, and respiratory systems. With extreme caution, the drug is prescribed for pathologies of the liver, kidneys, diabetes mellitus, ischemia, arterial hypertension and other conditions, a list of which is given in the instructions for the drug.

Rofecoxib

This is a modern remedy from the category of highly selective COX-2 inhibitors, which have practically no negative effect on the gastrointestinal mucosa and kidneys. It is used as a strong analgesic and anti-inflammatory agent for most inflammatory and degenerative lesions of the musculoskeletal system. In addition, the medication is prescribed for migraine, neuralgia, lumbago, osteochondrosis, pain syndrome with muscle and ligament injuries.

This universal remedy is often included in the scheme of complex treatment of thrombophlebitis, diseases of the genitourinary system, is used in ophthalmology, for diseases of the ENT organs or for dental problems (stomatitis, pulpitis). With severe pain syndrome, you can take up to 4 tablets at a time. With caution, the drug is prescribed for bronchial asthma, in early pregnancy, during lactation. This medication has much fewer contraindications and side effects than other anti-inflammatory drugs.

Combined NSAIDs

New generation anti-inflammatory drugs combine a combination of an active ingredient with vitamins or other active ingredients that enhance their therapeutic effect. We present to your attention a list of the most popular drugs of combined action:

• Flamidez (diclofenac + paracetamol);
• Neurodiclovit (diclofenac + vitamins B1, B6, B12);
• Olfen-75 (diclofenac + lidocaine);
• Diclocaine (lidocaine + diclofenac in low dosage);
• Dolaren gel (diclofenac + flax oil + menthol + methyl salicylate);
• Nimid Forte (nimesulide + tizanidine);
• Alit (soluble tablets containing nimesulide and muscle relaxant dicycloverine);

This is not a complete list of combined anti-inflammatory drugs that are used to treat joints and degenerative lesions of the musculoskeletal system. For each patient, the doctor selects a treatment regimen individually, taking into account many factors. Drugs from the NSAID group have many contraindications and can cause a number of undesirable side reactions from various organs and systems.

Therefore, you can not self-medicate! Only a specialist can recommend the optimal remedy, taking into account the clinical picture of the disease, the severity of symptoms, comorbidities, and determine the required dosage of the drug and the duration of the course of treatment. This will help to avoid unwanted complications, will alleviate the patient's condition and speed up recovery.

Who to contact?

Depending on the nature of the pathology, the following specialists can deal with the treatment of a patient with joint diseases: a neurologist, a therapist, an orthopedist or a rheumatologist. It is these doctors who have the right to prescribe drugs from the NSAID group for the treatment of specialized diseases.

If the intake of anti-inflammatory drugs has led to the occurrence of adverse reactions, such narrow specialists as a gastroenterologist, cardiologist, allergist, nephrologist can join the treatment of the patient. If the patient is forced to take NSAIDs for a long time, be sure to consult a nutritionist and choose the best diet that will protect the gastric mucosa from damage.

A variety of anti-inflammatory drugs are prescribed to relieve inflammation in the lesions. Medicines of this purpose are especially important for diseases that are characterized by a chronic progressive inflammatory process, which can lead to disability.

Types of anti-inflammatory drugs

Anti-inflammatory drugs are one of the main components of treatment:

• rheumatoid arthritis;
• osteoarthritis;
• osteochondrosis;
• gout;
• rheumatism;
• hernia of the spine;
• neuralgia;
• renal and biliary colic;
• myositis;
• injuries and sprains;
• some cardiac, gynecological diseases.

Prohibited or limited anti-inflammatory drugs for:

• peptic ulcer;
• blood clotting disorders;
• pregnancy and lactation;
• allergies to these drugs;
• some kidney diseases;
• cardiovascular diseases;
• varicose disease;
• autoimmune pathology.

Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs for treatment are used in complex therapy for inflammation in bone, muscle and joint tissue. The peculiarity of these drugs is their non-specificity - they relieve the inflammatory process of any genesis in any localization. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly used drugs in the world because they also act as pain relievers.

The first NSAID in the history of pharmaceuticals was aspirin, which was obtained from willow bark in the 18th century. Based on salicylic acid, other, more modern drugs are also produced with a similar effect and, unfortunately, with similar side effects - a negative effect on the health of the stomach and duodenum, liver and circulatory system. To reduce the likelihood of negative consequences after taking non-steroidal anti-inflammatory drugs of this type, doctors do not recommend exceeding the permitted dosage.

NSAIDs of a new type based on other components have a more pronounced anti-inflammatory effect and prolonged action, but at the same time they cause various complications much less often even with long-term use. Such drugs include Meloxicam, Piroxicam (derivatives of oxicam), Nabumeton, Diclofenac (derivatives of phenylacetic acid), Ibuprofen, Ketotifen (derivatives of propionic acid) and some others.

Steroid anti-inflammatory drugs

Medicines included in the group of hormonal anti-inflammatory drugs are more potent than non-steroidal ones. These funds are produced on the basis of the adrenal hormone - cortisol. The mechanism of action of steroid drugs is the local suppression of the immune system. There are more side effects and contraindications for this group of drugs than for NSAIDs, and they are prescribed for:

• severe allergic reaction on the skin;
• rheumatoid arthritis;
• inflammation of the vessels;
• hepatitis;
• myositis;
• shock states.

Steroidal anti-inflammatory drugs are contraindicated in:

• pregnancy and breastfeeding;
• the presence of a bacterial or viral infection;
• the likelihood of bleeding;
• immunodeficiency;
• significant erosion of the joints;
• taking blood-thinning medications;
• already made three injections of steroid drugs.

Combined anti-inflammatory drugs

Combined anti-inflammatory drugs are drugs that combine several components, thereby significantly enhancing the therapeutic effect of these drugs. The most commonly used anti-inflammatory component of combined preparations is diclofenac, and it is combined with vitamins, paracetamol, lidocaine and other active substances.

Anti-inflammatory drugs - list

Only a doctor is able to correctly select anti-inflammatory drugs in each individual case. Non-steroidal anti-inflammatory drugs block the body's enzymes responsible for the production of prostaglandins, substances that cause pain and inflammation. It is impossible to use different drugs of this group to enhance the action - this will cause an increase in side effects. The use of steroidal anti-inflammatory drugs without a doctor's prescription can provoke hypertension, blood clotting disorders, masculinization of the body in women, and osteoporosis.

Anti-inflammatory pills

Painkillers and anti-inflammatory pills are the most purchased medicines. This form is convenient for use, so the most popular drugs are almost always available in the form of tablets:

• - is prescribed for severe pain in the muscles, joints, spine;
• Celecoxib - effective for arthrosis, osteochondrosis;
• - indicated for arthritis, osteoarthritis, spondyloarthritis;
• Ibuprofen - is prescribed for an average pain syndrome with back pain, inflammation of the periosteum, fever.

Anti-inflammatory injections

Preparations in the form of injections have their analgesic and anti-inflammatory effect much faster than tablets. In addition, the injection can be made in close proximity to the focus of inflammation, which will significantly speed up the flow of the drug into the inflamed tissues. Anti-inflammatory drugs for joints, muscles, bone tissue are most in demand:

• Xefocam, Movalis - effective for arthrosis, are also available in the form of tablets;
• Diclofenac - recommended for osteochondrosis, radiculitis, lumbago, inflammation of bone tissue, are also available in the form of tablets;
• Nurofen, Ketonal - effective for various inflammations, have few contraindications and side effects;
• Hydrocortisone, Kenalog, - steroid drugs, used as an emergency aid for severe inflammation and serious pain syndrome (replace opiates), are injected directly into the inflamed focus.

Anti-inflammatory suppositories

An infection that has penetrated the female reproductive organs and caused thrush, inflammation of the cervix or fibroma requires the use of anti-inflammatory vaginal suppositories, since the health of a woman and her offspring depends on the timeliness and quality of treatment. Rectal anti-inflammatory suppositories are used if necessary to cure the focus of inflammation in the rectum and organs located nearby. In addition, treatment with suppositories reduces the risk of side effects. List of anti-inflammatory suppositories:

• , Diclofenac, Ibuprofen, Paracetamol, Movalis, Voltaren, Flamax - used to relieve inflammation in the rectum or vagina, as well as cystitis, neuralgia, neuritis and when it is impossible to use anti-inflammatory drugs in other forms;
• Longidaza - vaginal suppositories are used in the treatment of inflammation of the pelvic organs;
• Fluomizin, Terzhinan - used for the treatment of endometritis, adnexitis;
• Ultraproct, Proctosedil - a steroid drug used for hemorrhoids, fissures, paraproctitis;
• - immunomodulatory and anti-inflammatory suppositories, used for inflammation of the rectum and after surgery to accelerate healing.

Anti-inflammatory ointments

Ointment is an effective form of preparation for external use, in some cases ointments are used for insertion into the vagina or rectum. Commonly used components of non-steroidal anti-inflammatory ointments are diclofenac, ibuprofen, ketoprofen. Anti-inflammatory ointments:

• Ortofen, Nurofen, Ketonal, Meloxicam - non-steroidal drugs for the treatment of inflammation externally, bypassing the gastrointestinal tract.
• Sinalar, Momat, Akriderm - steroidal anti-inflammatory ointments, are prescribed by doctors in cases where local immunity suppression is necessary - for skin diseases, shock states, hepatitis, allergies, pathologies of muscles, joints, vascular disorders.

Anti-inflammatory cream

The list of non-steroidal anti-inflammatory drugs in the form of a cream includes the names of many drugs that are available in the form of ointments. The cream is a more convenient form for external application, and the active substances are the same for all anti-inflammatory drugs. Names of anti-inflammatory creams:

• Ketoprofen, Artrosilene, Indovazin, Diclovit - non-steroidal creams used to treat skin diseases, joints;
• Momat, Akriderm - steroid drugs used to treat allergies, arthritis.

Anti-inflammatory gels

Gel - another form of preparations for external use, it is easily absorbed and does not leave a greasy film. List of anti-inflammatory drugs in the form of a gel:

• Sinalar, Bematetasone - steroid drugs for the treatment of skin diseases, allergies, accompanied by itching;
• Diclak-gel, Voltaren, Fastum-gel, Finalgel, Indovazin - are used to treat pain and inflammation in muscles and joints.

Eye anti-inflammatory drops

Eye anti-inflammatory drops are used to treat ophthalmic diseases. These anti-inflammatory drugs are produced both with and without steroids. Many eye drops can be purchased only after obtaining a prescription from a doctor, since only a qualified specialist can take into account all individual indications and contraindications.

Non-steroidal anti-inflammatory drugs (NSAIDs) or NSAIDs)- a group of drugs with analgesic, antipyretic and anti-inflammatory effects. Their action is based on blocking the production of prostaglandins, which are released at the site of any tissue damage. Currently, non-steroidal anti-inflammatory drugs are rightfully among the most popular drugs used in clinical practice.

The best known NSAID is aspirin (acetylsalicylic acid). Non-steroidal anti-inflammatory drugs also include: diflunisal, lysine monoacetylsalicylate, phenylbutazone, indomethacin, sulindac, etodolac, diclofenac, piroxicam, tenoxicam, lornoxicam, meloxicam, ibuprofen, naproxen, flurbiprofen, ketoprofen, thiaprofenic acid, nabumetone, nimesulide, mesrofealacoxib, mesrofealacoxib, and a lot others.

The main problem with the use of non-steroidal anti-inflammatory drugs is that, being the most effective drugs in the treatment of many diseases, they also have a damaging effect on the mucous membrane of the stomach and duodenum, moreover, as a therapeutic, and the damaging effects of NSAIDs are consequences of NSAID inhibition of prostaglandin production.

The main physiological functions of prostaglandins in the digestive tract are stimulation of the secretion of protective bicarbonates and mucus, activation of cell proliferation in the processes of normal regeneration, and increased local blood flow in the mucosa. Anti-inflammatory and analgesic effects of non-steroidal anti-inflammatory drugs are due to inhibition of the enzyme cyclooxygenase (COX). There are two isoforms of COX: COX-1 and COX-2. The former is present in most tissues, including the gastrointestinal mucosa, and controls the production of prostaglandins that regulate gastrointestinal mucosal integrity, platelet function, and renal blood flow. COX-2 plays the role of a "structural" enzyme only in some organs (brain, kidneys, bones, etc.) and is not normally found in other tissues. Its expression significantly increases under the influence of "pro-inflammatory" stimuli and, on the contrary, decreases under the action of endogenous substances with anti-inflammatory activity. It is believed that the anti-inflammatory effect of NSAIDs depends on the blocking of COX-2, and their side effects are associated with the suppression of COX-1 (Vasiliev Yu.V.).

Non-steroidal anti-inflammatory drugs - the cause of gastrointestinal diseases

Despite significant progress in the study of NSAIDs and the creation of safer drugs, modern statistics show: the risk of gastrointestinal bleeding when taking NSAIDs increases by 3-5 times, perforations - by 6, the risk of death from complications associated with lesions of the gastrointestinal tract - 8 times. In 40-50% of patients hospitalized with a diagnosis of acute gastrointestinal bleeding, it is due to the intake of this class of drugs. In the UK, up to 2,000 patients die from such complications every year; in the US, NSAIDs are the cause of 100,000 hospitalizations and 16,000 deaths per year.

In Moscow, 34.6% of hospitalizations diagnosed with "acute gastrointestinal bleeding" are directly related to the use of NSAIDs. Bleeding and ulcer perforation are the cause of death in patients suffering from rheumatic diseases and taking NSAIDs, and account for 13.8% of the direct causes of death in patients with rheumatoid arthritis, ankylosing spondylitis and systemic lupus erythematosus (Burkov S.G.).

• all patients requiring continuous use of NSAIDs should be stratified according to the risk of hemorrhagic complications
• at a high risk of bleeding, switching patients to selective COX-2 inhibitors in combination with a permanent intake of proton pump inhibitors or misoprostol is recommended
• with the development of bleeding, the use of NSAIDs should be discontinued (replacement with drugs of other groups); A combination of endoscopic and medical (proton pump inhibitors) hemostasis is recommended.

Professional medical articles concerning the damaging effects of non-steroidal anti-inflammatory drugs on the gastrointestinal mucosa

• Abdulganieva D.I., Belyanskaya N.E., Nasonov E.L. Relationship of clinical manifestations of NSAID-gastropathy in patients with rheumatoid arthritis with motor disorders of the upper gastrointestinal tract // Scientific and Practical Rheumatology. 2011. No. 3. S. 25–28.


• Vasiliev Yu.V. Proton pump inhibitors in the treatment of gastric and duodenal ulcers associated with non-steroidal anti-inflammatory drugs // Farmateka. - 2005. - No. 7. - p. 1–4.


• Nasonov E.L. The use of non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors at the beginning of the XXI century // Russian Medical Journal. - 2003. - Volume 11. - No. 7. - p. 375–378.


• Agapova N.G. About drug-induced gastroduodenal ulcers // Magazine "Mistetstvo likuvannya". Ukraine. - 2007. - 2(38).


• Burkov S.G. Modern approaches to the treatment of acid-related diseases // RMJ. - 2007. - Volume 15. - No. 6.


• Guidelines for the use of non-steroidal anti-inflammatory drugs and the official instruction of the company Actavis Ellzabeth LCC "Diclofenac sodium extended-release tablets" for US healthcare professionals (English, pdf): "Diclofenac sodium extended-realeas tablets".


• The official instructions for the manufacturer of naproxen preparations Year Genentech, Inc. for US Patients (Medical Guide) “What are non-steroidal anti-inflammatory drugs? EC-Naprosyn (long-acting naproxen tablets), Naprosyn (naproxen tablets), Anaprox / Anaprox DS (naproxen sodium tablets), Naprosyn (naproxen suspension)" (in English, pdf): "Medication Guide EC-Naprosyn ® (naproxen delayed -release tablets), Naprosyn ® (naproxen tablets), Anaprox ® / Anaprox ® DS (naproxen sodium tablets), Naprosyn ® (naproxen suspension) ".

Application. Non-steroidal anti-inflammatory drug in the Anatomical Therapeutic Chemical Classification (ATC)

M01A Non-steroidal anti-inflammatory drugs:

M01AA Butylpyrazolidones

M01AA01 Phenylbutazone
M01AA02 Mofebutazone
M01AA03 Oxyphenbutazone
M01AA05 Clofezon
M01AA06 Quebuzon

For the treatment of joints, various groups of drugs are used. Some are necessary for the relief of pain, others - for the restoration of cartilage tissue, and others - for the removal of the inflammatory process. Anti-inflammatory drugs include steroid and non-steroidal drugs, their difference from each other is what you need to know for the correct prescription of a course of treatment.

Glucocorticosteroids (hormones of the adrenal cortex) began to be used for the treatment of joints more than 50 years ago, when their positive effect on the severity of the articular syndrome, the duration of morning stiffness became known.

The most popular means from the group of steroids in rheumatology are:

• Prednisolone (Medopred);
• Triamcinolone (Kenakort, Kenalog, Polcortolone, Triamsinolol);
• Dexamethasone;
• Methylprednisolone (Metipred);
• Betamethasone (Celeston, Diprospan, Flosteron).

It should be noted that nonsteroidal hormones are not used in the treatment of joint diseases.

Mechanism of action

The pronounced anti-inflammatory effect of steroid structure drugs is achieved in several ways:

• an obstacle to the movement of neutrophils (the main cells of inflammation) from the vessels into the tissues, to the affected area;
• a decrease in the permeability of biological membranes, which inhibits the release of proteolytic enzymes;
• suppression of the formation of cytokines;
• influence on epithelial cells;
• stimulation of the formation of lipocortin.

This mechanism of action, which slows down all phases of the inflammatory response, leads to a rapid relief of symptoms and an improvement in the condition of patients.

Indications

All anti-inflammatory steroid drugs have a strict list of indications for prescription. This is due to the fact that hormones have a large number of side effects. Therefore, they are a reserve group in the treatment of joint diseases.

Steroid drugs are prescribed for conditions such as:

1. high disease activity.
2. Systemic manifestations of pathology.
3. Weak effectiveness of non-steroidal anti-inflammatory drugs.
4. The presence of contraindications to the appointment of NSAIDs that prevent their use.

Side effects

Like any other drugs, steroid hormones have a number of undesirable effects. These include:

• dyspeptic symptoms (feeling of nausea, abdominal pain, urge to vomit, bloating, hiccups, loss of appetite, taste perversion);
• increase in the pH of gastric contents;
• development of myocardial insufficiency, in its presence - aggravation of the condition;
• increase in blood pressure numbers;
• liver enlargement;
• thrombus formation;
• obesity;
• increased excretion of potassium and calcium, retention of sodium ions;
• osteoporosis;
• muscle weakness;
• skin rashes;
• increased sweating;
• weakness;
• depressive states;
• allergic local and systemic reactions;
• weakened immunity, reduced body resistance to infections, exacerbation of chronic diseases;
• increased blood sugar levels;
• deterioration of wound healing;
• menstrual irregularities, etc.

Almost all steroids to a greater or lesser extent have the listed side effects. Their number and strength of action depend on the method of administration of the drug, dosage and duration of use.

Contraindications

Anti-inflammatory steroid drugs should be prescribed with caution in the following conditions:

The listed contraindications do not mean that steroid preparations cannot be used. However, comorbidities should always be taken into account when prescribing medications.

Non-steroid drugs (NSAIDs, NSAIDs)

The history of the creation of nonsteroidal drugs goes deep into antiquity. Even our ancestors knew that when the temperature rises, you need to make a decoction of willow tree twigs. Later it turned out that the composition of the willow bark contains the substance salicyl, from which sodium salicylate was later created. And only in the 19th century, salicylic acid, or aspirin, was synthesized from it. It was this medicine that became the first non-steroidal remedy for inflammation.

Pathogenetic mechanism, effects

Non-steroidal anti-inflammatory drugs can inhibit the synthesis of prostaglandins (the main inflammatory mediators) from arachidonic acid. This is possible by blocking the action of the enzyme cyclooxygenase (COX).

It was found that non-steroidal drugs act on 2 types of enzyme: COX-1 and COX-2. The first affects the activity of platelets, the integrity of the lining of the gastrointestinal tract, prostaglandins, and renal blood flow. COX-2 predominantly acts on the inflammatory process.

Non-steroidal drugs that inhibit COX-1 have a large number of undesirable properties, so the use of selective NSAIDs is more preferable.

For therapeutic purposes in traditional medicine, the following properties of non-steroidal anti-inflammatory drugs are used:

1. Analgesic: drugs well relieve pain of low and moderate intensity, which is localized in the ligaments, articular surfaces, skeletal muscle fibers.
2. Antipyretic: acute stages of inflammatory diseases of the joints are often accompanied by an increase in general body temperature. NSAIDs do a good job of reducing it, while not affecting normal temperature.
3. Anti-inflammatory: The difference between NSAIDs and steroids lies in the strength of the effect. The latter have a different mechanism of action and a more powerful effect on the pathological focus. For the purpose of treating articular manifestations, Phenylbutazone, Diclofenac, Indomethacin are most often used.
4. Antiaggregatory: more characteristic of aspirin. It is used not only for the treatment of diseases of the joints, but also for concomitant pathology in the form of coronary heart disease.
5. Immunosuppressive: Non-steroidal anti-inflammatory drugs somewhat suppress the immune system. This is due to a decrease in capillary permeability and a decrease in the possibility of interaction between antigens and antibodies of foreign proteins.

Indications

Unlike steroid drugs, NSAIDs for the treatment of joints are prescribed in the following cases:

• the need for long-term medication;
• elderly and senile age of patients (more than 65 years);
• severe somatic pathologies;
• the occurrence of side effects from taking hormonal medications;
• peptic ulcer (only for COX-2 inhibitors).

Treatment of almost all joint diseases is associated with the use of non-steroidal anti-inflammatory drugs. Therapeutic courses differ in duration, dosage, method of drug administration.

It is important to remember that NSAIDs do not affect the pathogenesis of rheumatic diseases. The drugs significantly alleviate the condition of patients, relieving pain and stiffness. But they are not able to stop the pathological process, prevent joint deformity or cause remission.

Side effects

The main negative symptoms that are noted when using non-steroidal drugs are gastrointestinal disorders. They manifest themselves in the form of dyspeptic disorders, the development of erosive and ulcerative disorders and perforation of the mucous membranes of the stomach and duodenum. Most of all, side effects are characteristic of COX-1 inhibitors (Aspirin, Ketoprofen, Indomethacin, Ibuprofen, Diclofenac).

Other adverse events include the following:

• impoverishment of renal blood flow and renal failure;
• analgesic nephropathy;
• development of anemia;
• bleeding from damaged surfaces of the skin and mucous membranes;
• hepatitis;
• allergic reactions;
• spasm of the muscles of the bronchi;
• weakening of labor activity and lengthening of pregnancy.

These side effects of nonsteroidal drugs should be taken into account when choosing a treatment regimen for patients with joint diseases.

Contraindications

NSAIDs should not be prescribed to patients with comorbidities such as:

1. Ulcers of the gastrointestinal tract, especially in the acute stage of the disease.
2. A significant decrease in the functional capacity of the kidneys and liver.
3. Pregnancy.
4. Cytopenic conditions (anemia, thrombocytopenia).
5. The presence of an allergic reaction to the components of the drugs.

Differences between steroid and non-steroid drugs, their comparative characteristics

The main differences between the drugs of the two groups in the treatment of joint diseases are as follows:

1. Pathogenetic mechanism of influence. Unlike NSAIDs, steroid drugs have not only local, but also systemic effects. Their influence is stronger, multi-component.
2. Application in the treatment of joints. The range of use of non-steroidal drugs is wider, they are used not only in the treatment of inflammatory pathologies (arthritis), but also in pain syndrome associated with osteochondrosis of any localization.
3. Side effect. The spectrum of adverse events is much wider in steroid hormonal preparations. This is due to the fact that drugs have an affinity for endogenous compounds in the body.
4. Contraindications. Steroids affect almost every system in the human body. It is impossible to achieve selectivity of action using adrenal hormones. Therefore, many conditions exclude the use of this group of medicines. Selective NSAIDs (COX-2 inhibitors), on the contrary, can affect only the inflammatory component, which significantly expands the therapeutic possibilities of this group of drugs. On the other hand, steroid drugs have a weaker negative effect on the gastric and intestinal mucosa. It is this factor that is often decisive when choosing a medicine.
5. Features of the course of treatment. As a rule, NSAIDs are the first-line drugs for the treatment of articular syndrome. If the product is chosen correctly, it can be used for a long time. Only in case of insufficient effectiveness, steroid medications are prescribed. They are not used for a long time, they always try to resume taking NSAIDs. It is important to remember that the abolition of steroids can have a detrimental effect on the state of the body, a withdrawal syndrome occurs. This quality is not possessed by nonsteroidal drugs.
6. Release forms. Steroid and non-steroid drugs are available in the form of ointments, solutions for intramuscular, intravenous, intraarticular administration, gels, suppositories, tablets for oral administration. This allows you to avoid local reactions and choose the right shape for maximum impact on the inflammatory focus.

Steroid and nonsteroidal drugs are necessary for the most effective course of treatment of rheumatic diseases. You can not use them yourself without first consulting with a specialist. Only strict adherence to the proposed treatment regimen can provide permanent relief from articular manifestations and avoid undesirable effects.

Osteoarthritis, rheumatoid arthritis and other diseases of the joints and spine, occurring with pain and inflammation.

Peculiarities: all drugs in this group act on a similar principle and cause three main effects: analgesic, anti-inflammatory and antipyretic.

In different drugs, these effects are expressed to varying degrees, so some drugs are better suited for the long-term treatment of joint diseases, others are mainly used as painkillers and antipyretics.

The most common side effects: allergic reactions, nausea, abdominal pain, erosion and ulcers of the mucous membrane of the gastrointestinal tract.

Main contraindications: individual intolerance, exacerbation of peptic ulcer of the stomach and duodenum.

Important information for the patient:

Drugs that have a pronounced analgesic effect and a significant number of side effects (diclofenac, ketorolac, nimesulide and others) can only be used as directed by a doctor.

Among non-steroidal anti-inflammatory drugs, a group of so-called "selective" drugs is distinguished, which are less likely to have side effects from the gastrointestinal tract.

Even over-the-counter pain relievers cannot be used long-term. If they are required frequently, several times a week, it is necessary to be examined by a doctor and treated according to the recommendations of a rheumatologist or neurologist.

In some cases, long-term use of this group of drugs requires additional intake of proton pump inhibitors that protect the stomach.

Remember, self-medication is life-threatening, consult a doctor for advice on the use of any medications.