Speaking of [non-steroidal anti-inflammatory drugs], many people may be confused. Have you ever heard of [fortalin] [ibuprofen] [diclofenac]?
Friends of patients with recurrent gout will not be unfamiliar with these drugs. During acute attacks, doctors will prescribe [diclofenac] [ibuprofen] and other drugs. Sometimes patients will ask for a painkiller because they think other drugs are not effective.
Gout analgesics are divided into three categories. We have already introduced colchicine in previous articles. You can click on the link below to review it again:
> > Colchicine has such a big side effect, can you still eat it?
Today, let’s talk about the role of non-steroidal anti-inflammatory drugs in gout treatment.
How do NSAIDs work?
Non-steroidal anti-inflammatory drugs (NSAIDS) mainly inhibit inflammatory reactions and achieve analgesic effects by inhibiting the activity of an enzyme in human body. The enzyme it inhibits is called cyclooxygenase (COX).
There are mainly two kinds of cyclooxygenase in human body: COX-1 and COX-2. The former exists under normal physiological conditions and has protective effect on gastric mucosa. The latter is expressed in large quantities only when there is inflammation.
For example, the former is a defense soldier, the latter is an enemy, and non-steroidal anti-inflammatory drugs (NSAIDS) are weapons.
According to different mechanisms of action, NSAIDS can be roughly divided into non-selective and selective categories.
- Non-selective NSAIDS: Inhibition of COX-1 and COX-2 at the same time may cause certain damage to gastrointestinal tract while resisting inflammation. That is to say, this kind of [weapon] will damage both one’s own people and enemies, and it is not selective. Selective NSAIDS: Side effects on gastrointestinal tract are less, because it will only attack [enemies], but it may be more harmful to cardiovascular diseases than other [weapons].
What kind of painkillers should I choose?
The 2012 US ACR Guidelines also did not specify a NSAID as a first-line treatment.
1. Patients without underlying diseases
Both drugs can relieve pain, with little difference.
2. Patients with gastrointestinal risk
Gastrointestinal risk includes not only stomach diseases such as gastric hemorrhage and gastric ulcer, but also other risk factors that need to be evaluated by doctors, such as old age, whether to use anticoagulants, hormone combination, etc.
If the above situation exists, NSAIDS should be avoided. If it is really needed, it can be considered to combine gastric mucosal protective agents or to use selective COX-2 inhibitors.
3. Patients with cardiovascular diseases
If aspirin is being used, it is best not to take it at the same time as NSAIDS. If aspirin is not used, non-selective or selective NSAIDS can be used for a short period of time.
What are the specific non-steroidal anti-inflammatory drugs?
1. Non-selective COX-1 inhibitor
Including ibuprofen, naproxen, diclofenac, indomethacin, etc.
2. Selective COX-2 inhibitor
- Celecoxib: Celecoxib (Celebrex), Relying on Celecoxib (Ankang Letter); Xicam: Meloxicam (Mobicol); Nimesulide, etc.
Other side effects also require attention
In addition, NSAIDS has some other side effects, such as liver and kidney function damage, influence on blood system, etc.
Outpatient clinics have seen some patients taking painkillers on their own for a long time, resulting in gastrointestinal hemorrhage, liver damage or kidney damage.
Therefore, the use of such painkillers still needs to be carried out under the guidance of doctors, and they should not be taken for a long time by themselves.