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.
Illness (a condition in which the body attacks itself, causing damage to organs and systems), typically with redness, swelling, heat, pain, and dysfunction
.
Non-steroidal anti-inflammatory drugs are one of the common "anti-inflammatory" drugs used in patients with ankylosing spondylitis
.

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.
, these inflammatory mediators are the main culprits of ankylosing spondylitis pain
.
When inflammatory mediators are inhibited by drugs, inflammation can be relieved, and pain can also be relieved
.
Non-steroidal anti-inflammatory drugs (NSAIDs) are such drugs, which act on cyclooxygenase and inhibit the synthesis of prostaglandins from arachidonic acid, thereby inhibiting inflammation and reducing pain
.

It should be noted, however, that ankylosing spondylitis also has a distinctive feature - new bone formation
.
Bone destruction and bony fusion of the sacroiliac joints may occur in patients with ankylosis.
Spinal involvement may be accompanied by heterotopic ossification including tendon ligaments, intervertebral discs, endplates, and bony process structures.
Ligament osteophytes grow from adjacent vertebrae and eventually connect to each other.
A new bone bridge is formed, which resembles a bamboo-like change
.
These pathological changes further affect physical function, severely reduce quality of life , and ultimately lead to disability
.
Therefore, the inhibition of new bone formation is of great significance
.

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.
Therefore, for patients with middle and advanced ankylosis, the single use of non-steroidal anti-inflammatory drugs It is difficult to control the disease with medicine
.
This has little to do with the drug itself, but the complexity of the local problem, which has gone beyond the scope of the drug's action
.

Like any other drug, non-steroidal anti-inflammatory drugs can produce some adverse reactions while using them for a long time
.
The adverse reactions of non-steroidal anti-inflammatory drugs are mainly manifested in the following aspects
.

01 Gastrointestinal tract

Abdominal discomfort, dull pain, nausea, vomiting, fullness, belching, loss of appetite and other indigestion symptoms may occur
.
In patients taking long-term oral NSAIDs, 10% to 25% may develop peptic ulcers , and less than 1% of them have serious complications such as bleeding or perforation
.

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.
may occur
.
Some symptoms are uncommon, such as hyperactivity, excitement, hallucinations, tremors, etc.
, the incidence is generally less than 5%
.

04Urinary system

It can cause proteinuria, cast urine, red and white blood cells, etc.
in the urine.
In severe cases, it can cause interstitial nephritis
.
In a multicenter clinical study, patients taking long-term oral NSAIDs had a 2.
1-fold higher risk of developing kidney disease than the general population
.

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
.
It has also been reported that after taking rofecoxib for 18 months, the relative risk of cardiovascular events (such as heart attack and stroke) increased in patients
.

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
.

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
.

③ For patients with only high cardiovascular risk and no other risk factors, consider the priority use of naproxen
.

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
.

⑤ NSAIDs have a capping effect, and overdose should be avoided
.
Overdose, the efficacy does not increase, but the side effects will increase significantly
.

⑥ Necessary blood and renal function monitoring should be carried out regularly under the guidance of a doctor
.