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NSAIDs - Non Steroidal Anti-inflammatory Drugs

NSAIDs are drugs, sold over-the-counter or by prescription. They reduce swelling and relieve the pain of inflamed joints. Many people use them to treat headaches and menstrual pain. They also may be used to treat two complications of Crohns disease and ulcerative colitis:

  • arthritis, and
  • erythema nodosum (which causes red, tender bumps on the lower legs and, sometimes, on the thighs or arms).
NSAIDs should be used with caution.

  • Studies have shown that NSAIDs, anti inflammatory drugs, can cause stomach and duodenal (upper portion of the small intestine) ulcers.


  • These drugs also can worsen symptoms of Crohns disease and ulcerative colitis.


  • NSAIDs anti inflammatory drugs can increase bleeding and cause inflammation of the small intestine.


  • They also may trigger the recurrence of these illnesses in those who are in remission.

Acetylsalicylic acid (commonly known as aspirin) was the very first NSAID, anti inflammatory originally isolated from willow bark. That was more than 120 years ago. Since that time, dozens of other products have joined Aspirin.

Over-the-counter NSAID anti inflammatory preparations:

  • Ibuprofen (Motrin®, Advil®, others)
  • Naproxen sodium (Aleve®)
  • Ketoprofen (Orudis®)

Prescription-only NSAIDs anti inflammatory drugs:

  • Naproxen (Anaprox®, Naprosyn®, Naprelan®)
  • Ketorolac (Toradol®, Acular®)
  • Diclofenac sodium (Voltaren®)
  • Piroxicam (Feldene®)
  • Sulindac (Clinoril®)
  • Indomethacin (Indocin®)
  • Nabumetone (Relafen®)
  • Oxaprozin (Daypro®)
  • Etodolac (Lodine®)
  • Flurbiprofen (Ansaid®)
  • Diclofenac potassium (Cataflam®)
NSAIDs - COX-2 inhibitors:
  • Celecoxib (Celebrex®)
  • Rofecoxib (Vioxx®)
  • Valdecoxib (Bextra®)

HOW NSAIDs WORK

NSAIDs work by checking inflammation i.e. symptoms of swelling and pain that arises when the body experiences an injury and the immune system comes to its aid.

Unlike steroids, which quiet inflammation by suppressing the immune system, these non-steroidal drugs have a different action. They act by stopping an enzyme, a protein, that stimulates changes in the body, from performing its function.

The enzyme in question is cyclooxygenase, also known as COX. It has two forms. The first, COX-l, aids the kidneys and also guards the stomach lining against digestive chemicals and acids. The second, COX-2, is an enzyme that makes prostaglandins, hormone-like substances, that cause inflammation, pain, and fever.

NSAIDs manage to relieve inflammation and pain by blocking the activity of both COX-1 and COX-2. In doing so, they also may cause stomach upset and, occasionally, ulcers in both the stomach and duodenum (the first part of the small intestine), as well as bleeding.

To counter those effects, another category of NSAIDs was developed. These are the COX-2 inhibitors, which block the action of the COX-2 enzyme that plays a key role in pain and inflammation. Because the COX-1 enzyme isn't its target, this class of drugs does not provoke the undesirable gastrointestinal symptoms as often as traditional NSAIDs do.

In healthy people, the intestinal environment maintains a healthy balance, with anti-inflammatory proteins keeping pro-inflammatory molecules in check. In people with Inflammatory Bowel Disease - Crohns Disease and Ulcerative Colitis, however, the immune system can't calm the inflammatory response occurring in the gut. The result is damage to the intestinal lining, which also causes ulcers and increases the flow of intestinal contents, leading to diarrhea and bleeding.

In addition to causing chronic inflammation of the digestive tract, the immune response also accounts for the presence of disease beyond the intestine, as inflammatory cells are found in the joints, among other parts of the body.

In fact, arthritis is the most common "extra-intestinal" complication of Inflammatory Bowel Disease, affecting approximately 25% of people with Crohn's disease or ulcerative colitis. Although NSAIDs block prostaglandins, thereby reducing fever, pain, and swelling that prostaglandins cause, it's not necessarily a good thing for the gastrointestinal (GI) tract.

Prostaglandins play a useful role in the GI tract, where they have a protective effect on the mucosal lining of the gut. They can lessen the effects of cytokines, which are proteins released by the immune system, that produce inflammation.

Although NSAIDs can ease joint pain they can also cause damage to the mucosa in healthy people or reactivate the symptoms of disease in Inflammatory Bowel Disease - Crohns Disease and Ulcerative Colitis sufferers.