The use of non-steroidal anti-inflammatory medications (NSAIDS) is also an important treatment. Aspirin is the most commonly used anti-inflammatory medication, but many people cannot take it because of either allergy or gastrointestinal difficulties. There are many aspirin substitutes that are currently on the market but are significantly more expensive than aspirin. None of them have been shown to work any better than aspirin but they do have less side effects and more convenient dosage frequencies.

There are probably 25-30 of these types of medication on the market today. Each company claims superior effectiveness of their own brand. Sometimes one brand, as opposed to another, may seem to work better for one individual. However, generally speaking, they are all equally effective. The newer brands are usually advertised more vigorously and carry a higher price tag.

The earlier brands (Ibuprofen, Naproxen) are no longer under patent and can be purchased much more inexpensively and often at lower doses as an over-the-counter formulation. Sometimes, for unclear reasons, one may work better for an individual. However, if you have tried 2-3 of these and have inadequate relief, there is no value in testing others. The most common side effects of these are gastrointestinal (GI) irritation and bleeding. Rarely kidney or liver damage can occur.

Celebrex is a unique “cox 2” inhibitor. Its efficacy in treating arthritis pain is no different than all of the other NSAIDS. However, this drug is much less likely to cause GI irritation or bleeding than the other NSAIDS. This drug also does not interfere with platelet clotting function and therefore can be safely taken by patients using anticoagulant medicines (blood thinners). It also does not interfere with the therapeutic anti-platelet action of aspirin like the other NSAIDS do. Therefore, patients who are taking aspirin to prevent heart attacks and strokes may be better off taking celebrex rather than other NSAIDS.

There were two other “cox2” inhibitors previously on the market, which were recalled by the FDA. Vioxx was found to have a higher rate of cardiac complications than other NSAIDS. Bextra rarely caused a severe skin reaction called Stevens-Johnson syndrome. Although Celebrex is also a “cox 2” inhibitor, it causes no more cardiac problems than other NSAIDS and may well be safer than other NSAIDS in patients who need to take aspirin for clot prevention.

Celebrex is still patented; therefore it costs much more (approximately $100 per month) than other NSAIDS. Despite its proven better safety, insurance companies often place pressure on patients to use a less safe option. If you can’t afford celebrex, Mobic is the closest substitute as a mixed cox1/cox2 inhibitor. It is available as a cheap generic.

Other combination medicines including an NSAID plus a stomach protector are now available. Another strategy is to use over-the-counter prilosec as a stomach protector.