NSAIDs vs. DMARDs

When treating rheumatoid arthritis with medications there are a number of different drugs that are used together. Each drug plays a different role and is used at different times throughout the disease course.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) are two such drugs that are prescribed to rheumatoid arthritis patients. They can be used together to treat disease symptoms but they each serve different purposes and are used for different reasons.

NSAIDs vs. DMARDs for Rheumatoid Arthritis

Though NSAIDs and DMARDs are both actively used to help treat rheumatoid arthritis, they have some very important differences.

Here is a comparison of the roles and outcomes of NSAIDs vs. DMARDs in rheumatoid arthritis medical treatments.

NSAIDs     

  • Reduce inflammation
  • Alleviate pain and stiffness
  • Taken for short-term relief
  • Taken early on while waiting for DMARDs to take effect
  • Doesn’t slow disease progression
  • Fast-acting; reduces inflammation within a few hours
  • Taken in pill format (tablets or capsules)
  • Available by prescription or over-the-counter
  • Can have a number of side effects

DMARDs

  • Suppress immune system functions in different ways
  • Slow disease’s progression
  • Prevent further bone and cartilage damage in the joints
  • Taken early and aggressively
  • Taken long-term
  • Can help patient achieve remission
  • Slow-acting, several weeks to take effect
  • Taken as pills or injections
  • Available only by prescription
  • Can have a number of side effects

The most significant differences between NSAIDs and DMARDs are the types of symptoms they are used to treat as well as their availability and dosages. NSAIDs generally have a lower cost to the patient while DMARDs can become very expensive to purchase over the course of the patient’s lifetime.

Treating Rheumatoid Arthritis with NSAIDs

NSAIDs are an important component of the overall medical treatment strategy of rheumatoid arthritis. They work effectively with other medications including DMARDs and biologics.

Rheumatoid arthritis symptoms occur due to inflammation in the joints caused by autoimmune attacks. Inflammation in joints causes pain, stiffness, and loss of range of motion. NSAIDs work to reduce the levels of inflammation in the joints, thus relieving pain and restoring mobility.

Joint inflammation also causes damage to the synovial tissue, which leads to chronic deterioration of the joint structure, bones, and cartilage. NSAIDs do not treat the ongoing damage that occurs in the joint capsule. For this reason, NSAIDs treat symptoms as opposed to altering the disease course.

Treating Rheumatoid Arthritis with DMARDs

The most important part of rheumatoid arthritis treatment is to slow or stop the progressive deterioration of bones and cartilage in the affected joints. DMARDs are the medications designed to target the autoimmune functions causing the inflammation that results in joint damage.

Because DMARDs interfere with the autoimmune attacks occurring in rheumatoid arthritis patients, DMARDs not only decrease inflammation, but these medications also aim to preserve the joint structures and functions in rheumatoid arthritis patients.

When to Take NSAIDs for Rheumatoid Arthritis

NSAIDs are recommended and prescribed to rheumatoid arthritis patients early on and throughout the disease course. Early use of NSAIDs helps alleviate symptoms of pain and stiffness by reducing inflammation in patients. Often times, DMARDs take weeks or months to begin working and so patients choose NSAIDs in the meantime to alleviate pain and continue with their daily activities.

There are many types of NSAIDs available ranging between over-the-counter to prescription types, which are stronger. Doctors may prescribe different types of NSAIDs to different types of patients. The types of NSAIDs that doctors recommend or prescribe may also depend on the state of the disease and the rate at which it has progressed.

NSAIDs are taken on an as-need basis for a short period of time. They aren’t meant to be taken daily for the long-term.

When to Take DMARDs for Rheumatoid Arthritis

DMARDs are taken for rheumatoid arthritis treatment early on in the course of the disease. Rheumatologists aim to start their patients on appropriate DMARDs as soon as possible after diagnosis.

It has been proven that DMARDs are much more effective at preventing joint destruction if they are taken early enough. For most patients DMARDs take four to six weeks to take effect. For some patients, however, it may take up to three to four months to begin working.

There are many different types of DMARDs, but they all require a prescription. The most common type of DMARD is called methotrexate but there are several others, including a newer class of immunotherapy known as biologics.

DMARDs are a long-term medication. Most rheumatoid arthritis patients will take conventional DMARDs and/or biologics for the rest of their lives.

Combining NSAIDs and DMARDs

In many situations, rheumatoid arthritis patients will combine NSAIDs and DMARDs as they have complimentary effects. By taking these two types of drugs at once, it helps in several ways. NSAIDs are effective at reducing inflammation and pain while patients wait for the DMARDs to take effect. Additionally, NSAIDs can be taken during flare-ups to support the efforts of DMARDs.

Side Effects of NSAIDs vs. DMARDs

Both NSAIDs and DMARDs have their own sets of side effects and potential risks. Side effects can also vary by the type of drug taken. For example, ibuprofen and naproxen may have different side effects though they are both NSAIDs. Here are the most common and concerning side effects of NSAIDs vs. DMARDs:

NSAIDs

  • Stomach aches and damage including ulcerations and bleeding
  • Nausea
  • Diarrhea
  • Headaches
  • Higher risk of heart disease
  • Kidney damage
  • Liver damage

DMARDs

  • Increased risk of viral or bacterial infection due to weakened immune system
  • Kidney damage
  • Liver damage
  • Lung damage
  • Stomach aches
  • Digestion problems

Patients should only take one type of NSAID at a time. DMARDs, however, can be combined with each other including combining conventional DMARDs with biologics. You should always speak with your doctor before combining medications as different types can produce adverse reactions when taken together.