Psoriatic Arthritis Treatment: NSAIDs

Potential Risks of NSAIDs for Psoriatic Arthritis

“Many people take NSAIDs for a headache or a pulled muscle, and for most people that sort of short-term use is fine — that’s why they’re offered over the counter,” says Dr. Husni.

But when someone takes prescription NSAIDs to treat psoriatic arthritis, the dosage is usually higher and they’re taken more frequently, Husni notes. So you “need more monitoring on prescription NSAIDs and you should always take the lowest dosage for your symptoms in the shortest duration.”

Doctors should take a good medical history and use caution for patients on blood thinners, those who have hypertension or renal disease, a history of peptic ulcer disease, or are 65 and older, says Husni.

For some people, NSAIDS can cause blood pressure to rise. “If you’re already prone to high blood pressure, you might not be a good candidate for an NSAID,” says Husni.

NSAIDs can also erode the stomach lining, so they should be avoided by people who are at risk of, or have a history of, peptic ulcers.

“Both over-the-counter and prescription NSAIDs come with a warning that they may increase your risk of heart attack, stroke, and [gastrointestinal and other types of] bleeding,” adds Husni.

For people with a history of gastrointestinal bleeding or ulcers, doctors may prescribe an acid blocker along with the NSAID.

RELATED: 3 Reasons You May Need to Change Your Psoriatic Arthritis Treatment

What to Know Before Taking NSAIDs for Psoriatic Arthritis

The type of NSAID you use and the dosage involve decisions that you and your doctor make together. Here are some questions to consider asking.

1. Contraindications: Do I have health issues that make it riskier for me to take NSAIDs? Raise any concerns you may have about your kidneys, liver, stomach, colon, lungs, or heart. If you are worried about high blood pressure or blood clots, ask about these potential complications, too.
2. Allergic reactions: What are my chances of having an allergic reaction? If you’ve had problems with aspirin or have nasal polyps, your risk increases.

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3. Drug interactions: Will NSAIDs interfere with any of my other medications? Some drugs that may be affected by NSAIDs include blood pressure medications, steroids, and blood thinners.
4. Alcohol and NSAIDs: Can I drink alcohol while taking NSAIDs? More than two drinks a day may increase your risk of stomach problems.
5. The effect of age on risk: Will my age affect my risk of NSAID complications? People over age 65 are at greater risk from complications.
6. Pregnancy: Can I take NSAIDs if I am (or want to become) pregnant? Women who are still of childbearing age should ask about the risk of taking NSAIDs while pregnant or breastfeeding.
7. Generics vs. brand-name drugs: Is there a generic NSAID available? Over-the-counter NSAIDs are not expensive, but some brand-name prescription NSAIDs may require preauthorization from your doctor for insurance coverage, and you may do just as well with a generic.

“It is important that you talk to your doctor — they know your history and they can customize your treatment,” says Husni. “There are tweaks we can make in how we deliver the medicine, and so it’s not just a yes or no decision.”

There are lots of considerations that go into prescribing NSAIDs in the safest and most effective way. Plus, if these drugs are not right or are not working for you, there are other effective treatment options for psoriatic arthritis, including injectable and oral medications. Sometimes, Husni adds, you may use NSAIDs along with these other medications.

Additional reporting by Becky Upham and Deborah Shapiro.