Using COX-2 Inhibitors and Corticosteroids for Rheumatoid Arthritis

COX-2 Inhibitor NSAIDs
COX-2 inhibitors, like traditional NSAIDs, block COX-2, an enzyme in the body that stimulates an inflammatory response. Unlike traditional NSAIDs, however, they do not block the action of COX-1, an enzyme that protects the stomach lining.
Side effects of these medicines include stomach irritation, ulceration, and bleeding. Caution is advisable for patients with a history of bleeding or ulcers, decreased kidney function, liver disease, high blood pressure (hypertension), or asthma.
Use of COX-2s with low-dose aspirin is permitted but may slightly increase the risk of ulcers. Doctor monitoring is recommended before taking a COX-2 inhibitor, especially if you have had a heart attack, stroke, angina, blood clot, hypertension, or sensitivity to aspirin or other NSAIDs.
Doctor monitoring for possible allergic responses to celecoxib is important.

Corticosteroids as Medications for Rheumatoid Arthritis

These medications are given by mouth or injection. Corticosteroids are used to relieve inflammation and reduce swelling, redness, itching, and allergic reactions.
Side effects can include increased appetite, indigestion, nervousness, or restlessness.
Prior to taking any corticosteroid, let your healthcare provider know if you have one of the following: fungal infection, a history of tuberculosis, underactive thyroid, herpes simplex of the eye, high blood pressure, osteoporosis, or stomach ulcers.
Common corticosteroids used for rheumatoid arthritis may include:
  • Methylprednisolone (Depo-Medrol®, Medrol®)
  • Prednisone.
Methylprednisolone and Prednisone
These steroids are available in pill form or as an injection into a joint. Improvements in symptoms are usually seen pretty quickly, usually within several hours after administration (but it could take up to 24 hours). There is the potential for serious side effects, especially at high doses. These drugs are used for severe flares and when the disease does not respond to NSAIDs and DMARDs.
Side effects can include: osteoporosis, mood changes, fragile skin, easy bruising, fluid retention, weight gain, muscle weakness, onset or worsening of diabetes, cataracts, increased risk of infections, and hypertension (high blood pressure).
Doctor monitoring for continued effectiveness of medication and for side effects is needed.
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