There are several important points to remember about NSAIDs.
1. They are to be taken with food and NEVER ON EMPTY STOMACH.
2. They are to be taken ONLY AS NEEDED and not on a daily basis for majority of patients unless it is directed by a physician.
3. Theses drugs need to be monitored with blood tests if taken on a regular basis.
4. It can be taken along with an acid reducer such as Prilosec or Nexium to avoid gastric irritation. H2 blockers are not as effective.
5. Those who respond dramatically with much improvement on these drugs most likely have an inflammatory arthritis. Spondyloarthritis or Spondyloarthropathies do respond dramatically to NSAIDs and all the symptoms come back when NSAIDs are discontinued.
6. NSAIDs should be avoided in diabetic patients, those with cardiac disease, and those taking a diuretic.
7. It should be avoided in those with eGFR of less than 60.
8. COX-2 drugs such as Celebrex may have favorable GI profile but can cause just as much kidney damage as other NSAIDs.
9. Those who go off of NSAIDs may sometimes experience significant pain for a period of 2-3 weeks. This frequently occurs in patients with inflammatory arthritis specifically those with spondyloarthropathies. Surprisingly, after three weeks, their symptoms will go back to the same baseline they were when they were taking NSAIDs. This is especially true with Diclofenac and Celebrex.
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