Living your best life with arthritis.

AS it Goes – The Debate over NSAIDs

Pain relief (and NSAIDs)

Photo courtesy of David Castillo Dominici |

The long-term usage of non-steroidal anti-inflammatories (NSAIDs) has always concerned me. Through the years I have taken different types of NSAIDs for varying periods. These NSAIDs even included (for a short time) VIOXX, which was pulled off the shelves in 2004 after studies confirmed that it increased the risk of heart attack and stroke. For many years I have taken diclofenac, which now researchers also believe carries a high cardiovascular risk, especially for people with a history of heart disease or other risk factors such as diabetes or high cholesterol.

Diclofenac also may cause stomach issues, including internal bleeding or ulcers, so users are often prescribed a stomach-coating agent to prevent any problems with using anti-inflammatories over the long term. Nonetheless, I’ve been reading some alarming and mounting evidence about diclofenac, which is one of the most widely prescribed anti-inflammatory drugs. According to Health Canada, about 2 million prescriptions for the drug were filled in Canada between 2008 and 2012. In October, Health Canada issued an advisory about possible adverse reactions to diclofenac.

The decision to take medication to combat ankylosing spondylitis (AS) is really not a decision at all. For most, it’s an absolute necessity—a way to get relief from chronic pain and cope with the ebb and flow of the disease. If the medication works, we stick with it. We are grateful for the relief, but always aware of the possible downside risks.

Personally, it was a great day when I learned that anti-inflammatory drugs would help alleviate my crippling pain and help me get back to enjoying life instead of watching from the sidelines. Although that day was over 20 years ago, I still vividly remember the rheumy reassuring me that relief could be found in a daily pill. Every day since that time, I have dutifully and religiously taken anti-inflammatory medication to keep my AS under control.

My rheumy has talked to me several times over the past few years about ratcheting up my meds to biologic drugs, which have provided amazing results for so many AS patients. This class of drugs has been shown to arrest the progression of the disease and for many AS patients, biologics have been their medical salvation. But I have held out and I maintain that while my AS remains “manageable”, I will continue with anti-inflammatory therapy to combat any AS flare-ups. The diclofenac did a good job for me and certainly helped to control my “pain-no pain” cycles.

Fran HalterHowever, in light of the mounting evidence that diclofenac may or may not pose health risks for me, I’m switching up my meds to one with naproxen (and, of course, a stomach coating agent). It has a better safety profile compared with diclofenac, and that is enough to entice me to try it out. No doubt it will also have side effects, but hopefully, the negatives will again outweigh the benefits of taking this medication. ~Fran