NSAIDS, Pain Management, & Lupus

NSAIDs such as aspirin and ibuprofen can help reduce pain and inflammation in people with lupus. In fact, about 80% of Lupus Warriors include the medication as part of their treatment plan.

Non-steroidal anti-inflammatory medications, or NSAIDs, work by blocking Cyclo-oxygenase enzymes, also known as COX enzymes. These enzymes control the production of prostaglandins, which are important lipids that regulate:

• inflammation
• blood flow
• clotting
• the female reproductive system
  • involved in control of ovulation, the menstrual cycle, and the induction of labor

NSAIDs reduce swelling and inflammation. So, they can be powerful tools for reducing pain and many symptoms of lupus. They can even reduce the risk of cardiovascular disease and stroke for some people.

Risks for Lupus Warriors

People with lupus are more vulnerable to the side effects and complications of using NSAIDs, including allergic reactions and skin symptoms. You can read more about cutaneous lupus, the skin-related lupus symptoms, here.

While the blood thinning effects of these medications can help reduce the risk of heart attacks, they can also lead to reactions that increase cardiovascular risks in other areas such as high blood pressure and rhythm abnormalities.

NSAIDS also prevent clotting by impairing thromboxane-dependent platelet aggregation. Platelets are key to hemostasis (how a body seals a ruptured blood vessel). Increased bleeding from wounds includes  internal bleeding caused by irritation, like in the gastrointestinal tract.

Gastrointestinal irritation, bleeding, and ulcers are a well-known side effect of NSAIDs. The irritation is caused by lowered levels of prostaglandins. This reduces the production of protective mucous in the stomach and intestines. Both the bleeding, and the pain from irritation, can be quite severe.

People with systemic lupus erythematosus (SLE) should always consult their medical team before using NSAIDs.

Types of NSAIDs

There are many different non-steroidal anti-inflammatory drugs, but they are mostly similar to one other; they work much the same way on the same symptoms. However, they can be placed into groups based on what COX enzymes they effect. This determines the side effects that are more likely.

If they effect the COX-1 enzyme, then gastrointestinal side effects are more likely, but the cardiovascular effects are less pronounced. The opposite happens if they effect the COX-2 enzyme. The cardiovascular risks go up while the gastrointestinal risks decrease.

That said, dose size plays a large role in determining the degree of inhibition of each enzyme, regardless of NSAID. Thus, the risks, benefits, and variability among the medications is dose dependent.

Aspirin and Ibuprofen

Aspirin and Ibuprofen are well-known, easily purchased over-the-counter NSAIDs that can help people with lupus. They can relieve pain and inflammation while being milder than many other lupus medications. Both are COX-1 and COX-2 inhibitors.

Aspirin can react with ibuprofen, increasing the risk of ulcers, and both can react with other medications including:

• Methotrexate
  • Ibuprofen prevents methotrexate from being processed by the body, leading to more of the medication in the body and more side effects.
• Anticoagulants
  • Both aspirin and ibuprofen block platelet formation and clotting, thinning the
    blood. They also have the potential to cause irritation and bleeding in the gut. In combination
    with anticoagulants, this can lead to dangerous bleeds.
• Cyclosporine
  • Because prostaglandins are involved in kidney function, inhibiting prostaglandins
    with aspirin and ibuprofen can make the kidneys more vulnerable to damage, one of
    cyclosporine (an immunosuppressant) side effects

NOTE: Always speak with your treatment team before starting new medication and review potential drug interactions

Other Types of NSAIDs

Aspirin and Ibuprofen are well-known NSAIDs that can be found in the aisles of most drug stores, but they are far from the only NSAIDs available:

Keterolac (Toradol) is an NSAID taken intravenously, intramuscularly, or intranasaly. This means that it can be taken if a person with lupus cannot take the drug by mouth, and may be useful after surgery.

Diclofenac (Cambia; Cataflam) is an NSAID in the form of a patch or solution. Taken via the skin, it decreases the risk of gastrointestinal irritation.

Naproxen (Aleve) is taken for mild to moderate pain, fever, and inflammation.

You can find a list of other USA-approved NSAIDS here.

Taking NSAIDS for lupus

NSAIDs of all sorts can lead to a range of side effects, even aside from the well-known cardiovascular risks and bleeding in the stomach and intestines. Side effects are more common in medications taken chronically to manage lupus pain and inflammation. Many organs within the body may be impacted.

Stomach side effects can include:

• bloating
• diarrhea
• constipation
• nausea or vomiting
• general irritation of the stomach lining

The kidneys can also be affected due to changes in blood flow through the organ and with how the kidneys regulate sodium and water. This can lead to swelling and high potassium levels which can damage the kidneys. This may make lupus-related damage, such as from lupus nephritis, much worse. You can read more about lupus nephritis here.

Other potential side effects include brain and neurological related symptoms like fatigue, headaches, insomnia, vertigo, and seizures. This could be linked to changes in blood flow, but it may have other causes.

Despite these risks, about 80% of people with lupus are treated with NSAIDs. Researchers concluded that the medications are safe for Lupus Warriors so long as clinicians evaluate the dose and purpose on a regular basis.

The risks and benefits can vary from person-to-person based on each person’s individual biology and medical regimens. Check with your lupus treatment team to see if NSAIDs are right for you, or if you should continue any NSAID regimens you may already be on.