NSAIDs (nonsteroidal anti-inflammatory drugs)

NSAIDs (nonsteroidal anti-inflammatory drugs) are some of the most used pain medicines in adults. They are also a common treatment for health problems, such as arthritis (rheumatoid arthritis, osteoarthritis, and others) and systemic connective tissue diseases. NSAIDs can decrease symptoms of inflammation, such as fever, swelling, and redness.

Traditional NSAIDs include aspirin, ibuprofen (Advil, Motrin, etc.), naproxen (e.g., Aleve), and many other generic and brand name drugs. Celecoxib (Celebrex) belongs to a newer class of NSAIDs, called “COX-2 inhibitor,” and is designed to avoid upset stomach.

How To Take It

Each NSAID has its own dosing. The dosage size of over-the-counter medicine is often less than prescription versions of the same medicine. NSAIDs usually start to work within a few hours. Pain control tends to occur much quicker than its effect on swelling.

Do not combine NSAIDs or take more than the recommended dose. Do not give aspirin to children under age 12. Teens with a virus should also avoid drugs containing aspirin. There is a risk of Reye’s syndrome, a rare but deadly illness that can affect the brain and liver.

Side Effects

Possible risks of all NSAIDs include stomach problems (such as bleeding, ulcer, and stomach upset), kidney problems, high blood pressure or heart problems, fluid retention, rashes, or allergic reactions and other adverse reactions.

Tell Your Rheumatology Provider

You should notify your rheumatology provider if you have symptoms of an infection, such as a fever or cough, or if you think you are having any side effects, especially diarrhea or allergic reactions, while taking this medication. If you are allergic to aspirin, other NSAIDs, sulfa drugs, or have nasal polyps (linked to a greater chance of NSAID allergy), let your doctor know.

Some patients should not take NSAIDs. You should discuss with your rheumatology provider whether it is okay to take NSAIDs if any of the following apply:

• Known problems with kidneys or liver
• History of stomach problems (such as reflux or ulcers)
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• If you take blood thinners or corticosteroids
• If you have cardiovascular problems (such as high blood pressure, heart failure, past stroke or a heart attack)

Notify your other physicians while you are taking this drug. If you are pregnant, considering pregnancy, or breastfeeding, let your doctor know before starting this medication. Some patients on NSAIDs may have difficulty conceiving. In those rare cases, it would be recommended to stop NSAIDs before conception. The use of NSAIDs in the third trimester is discouraged due to increased risk of premature closure of the ductus arteriosus (a blood vessel in the developing fetus). You should also talk with your rheumatology provider before undergoing any surgeries while taking this medication.

Updated February 2024 by Olga Petryna, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.