Indomethacin, meloxicam, celecoxib... What should I pay attention to when choosing non-steroidal anti-inflammatory drugs for the treatment of rigidity?

The "inflammation" in ankylosing spondylitis is part of the body's innate immune system (the first line of defense against disease and injury), but if the inflammatory response persists for too long, it can lead to a condition called chronic inflammation.

Steroids generally refer to steroids (hormones as we understand them), while nonsteroidal anti-inflammatory drugs (NSAIDs) refer to non-hormonal anti-inflammatory drugs

Aspirin, indomethacin, naproxen, ibuprofen, diclofenac, loxoprofen, meloxicam, celecoxib, etoricoxib, and parecoxib are all non-steroidal body anti-inflammatory drugs

The common inflammatory mediators in patients with ankylosing spondylitis include prostaglandins, interleukins and tumor necrosis factor , etc.

It should be noted, however, that ankylosing spondylitis also has a distinctive feature - new bone formation

Due to the limited effect of non-steroidal anti-inflammatory drugs on the control of deep inflammation in the joint cavity, it is "powerless" for local soft tissue adhesion, so it is difficult to prevent the formation of osteophytes.

01 Gastrointestinal tract

Abdominal discomfort, dull pain, nausea, vomiting, fullness, belching, loss of appetite and other indigestion symptoms may occur

02 Liver

At therapeutic doses, 10% of patients developed biochemical abnormalities with mild liver damage, but significantly elevated alanine aminotransferase levels occurred in less than 2%

03 Nervous system

Headache, dizziness, tinnitus, deafness, amblyopia, drowsiness, insomnia, paresthesia, numbness, etc.

04Urinary system

It can cause proteinuria, cast urine, red and white blood cells, etc.

05Blood system

Some NSAIDs can cause neutropenia, aplastic anemia, and coagulation disorders

06 Allergies

Idiopathic people may have allergic reactions such as rash, angioedema , and asthma

07 Cardiovascular System

Studies have found that NSAIDs can significantly interfere with blood pressure and increase mean arterial pressure

08 Pregnancy

Non-steroidal anti-inflammatory drugs are considered to be a potential factor in the induction of acute fatty liver of pregnancy; aspirin in pregnant women can cause bleeding during prenatal, postpartum, and delivery; indomethacin may cause some fetal brachymorphs, penile hypoplasia

① In clinical application, the combined use of two or more NSAIDs should be avoided
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② For patients with gastrointestinal discomfort or peptic ulcer, COX-2 inhibitors are preferred instead of traditional non-steroidal anti-inflammatory drugs, and gastric drugs should be added if necessary
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③ For patients with only high cardiovascular risk and no other risk factors, consider the priority use of naproxen
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④ While using non-steroidal anti-inflammatory drugs, if the situation allows, avoid the use of diuretics, ACEI/ARB antihypertensive drugs and other drugs that may affect renal perfusion at the same time
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⑤ NSAIDs have a capping effect, and overdose should be avoided
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Overdose, the efficacy does not increase, but the side effects will increase significantly
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⑥ Necessary blood and renal function monitoring should be carried out regularly under the guidance of a doctor
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