Nonsteroidal anti-inflammatory drugs (NSAIDs)

Our clinic specializes in rheumatology, neurology and immunology. Read more about some medications used to treat joints.

• Non-steroidal anti-inflammatory drugs (NSAIDs, NSAIDs);
• Steroid hormonal anti-inflammatory drugs / glucocorticosteroids / GCS;
• Immunoglobulins for intravenous (IVIG) and intramuscular administration in rheumatology. IVIG for systemic lupus erythematosus, ankylosing spondylitis, rheumatoid arthritis, etc.;
• Chondroprotectors and intra-articular fluid substitutes;
• Basic therapy. Delagil, Sulfasalazine, Plaquenil, Azathioprine, Methotrexate, Cyclophosphamide, Remicade, Infliximab, Humira and others;
• Immunomodulators;
• Medicines for the treatment of osteoporosis: bisphosphonates, calcium and vitamin D3;

"Magic" pills

There is a group of drugs collectively called non-steroidal anti-inflammatory drugs (NSAIDs), which we all have taken at least once in our lives, and many regularly. These are drugs that have analgesic, anti-inflammatory and/or antipyretic effects. Examples include Aspirin, Nurofen, Nice, Ketanov, Ketoprofen and others. Considering the “magical effects” of their action - relieving inflammation, pain and fever - they are prescribed by almost everyone, everyone, always. Prescribed by traumatologists, rheumatologists, therapists, ENT specialists, dentists. Plus, they can be purchased completely freely at any pharmacy. But, along with the “magical properties”, these drugs have a number of side effects that can be divided into 2 groups: cardio risks and gastro risks. Actually, gastrorisks will be discussed in this article.

Abbreviation NSAID

- does this tell you anything? If not, then we suggest expanding your horizons somewhat and finding out what these mysterious four letters mean. Read the article and everything will become absolutely clear. We hope that it will be not only informative, but also interesting!

NSAIDs stand for non-steroidal anti-inflammatory drugs - drugs are very popular and popular nowadays, because they can simultaneously eliminate pain and relieve inflammation in a variety of organs of our body.

If until now you have never had a need to take NSAIDs, this can be considered almost a miracle. You are one of the rare lucky ones, really, your health is enviable! NSAIDs are, let’s get ahead of the next question and immediately talk about the definition of the word “non-steroidal”, which means that these drugs are non-hormonal, i.e. do not contain any hormones. And this is very good, because everyone knows how unpredictable and dangerous hormonal drugs can be.

Most popular NSAIDs

If you think that NSAIDs are drugs whose names are rarely spoken in everyday life, then you are mistaken.

Many people do not even realize how often we have to use non-steroidal anti-inflammatory drugs to cure various ailments that have accompanied the human race since the expulsion of Adam and Eve from paradise.

Read the list of such products; you probably have some of them in your home medicine cabinet. So, NSAIDs include medications such as: Aspirin, Amidopyrine, Analgin, Piroxicam, Bystrumgel, Diclofenac, Ketoprofen, Indomethacin, Ketorol, Naproxen, “Ketorolac”, “Flurbiprofen”, “Voltarengel”, “Nimesil”, “Diclofenac”, “Ibuprofen”, “Indopan”, “Iprene”, “Upsarin UPSA”, “Ketanov”, “Mesulide”, “Movalis”, “ Nise", "Nurofen", "Ortofen", "Trombo ACC", "Ultrafen", "Fastum", "Finalgel".

Yes, these are all NSAID drugs. The list, although large, is, of course, far from complete. And yet, it gives a good idea of ​​the variety of modern non-steroidal anti-inflammatory drugs.

Some historical facts

The first primitive NSAID drugs were known to people in ancient times. For example, in Ancient Egypt, willow bark, a natural source of salicylates and one of the first non-steroidal anti-inflammatory drugs, was widely used to relieve fever and pain. And even in those distant times, healers treated their patients suffering from joint pain and fever with decoctions of myrtle and lemon balm - they also contain salicylic acid.

In the mid-19th century, chemistry began to develop rapidly, which gave impetus to the development of pharmacology. At the same time, the first studies of the compositions of medicinal substances obtained from plant materials began to be carried out. Pure salicin from willow bark was synthesized in 1828 - this was the first step towards the creation of the familiar Aspirin.

But it will take many years of scientific research before this medicine comes to light. A grandiose event took place in 1899. Doctors and their patients quickly appreciated the benefits of the new drug. In 1925, when a terrible influenza epidemic hit Europe, Aspirin became a savior for a huge number of people.

And in 1950, this non-steroidal anti-inflammatory drug was included in the Guinness Book of Records as the painkiller with the largest sales volume. Well, later pharmacists created other non-steroidal anti-inflammatory drugs (NSAIDs).

For what diseases are non-steroidal anti-inflammatory drugs used?

The range of uses of NSAIDs is very wide. They are very effective in treating both acute and chronic diseases accompanied by pain and inflammation.

Nowadays, research is in full swing to study the effectiveness of these drugs in the treatment of heart and vascular diseases. And today almost everyone knows that they can be used for pain in the spine (NSAIDs for osteochondrosis are a real salvation).

Here is a list of painful conditions in the event of which the use of various non-steroidal anti-inflammatory drugs is indicated: Fever. Headaches, migraines. Renal colic. Rheumatoid arthritis. Gout. Arthrosis. Osteoarthritis. Dysmenorrhea. Inflammatory arthropathy (psoriatic arthritis, ankylosing spondylitis, Reiter's syndrome). Postoperative pain syndrome. Pain syndrome from mild to moderate severity due to injuries and various inflammatory changes.

Classification of NSAIDs according to their chemical structure

By reading this article, you have already had the opportunity to see that there are a lot of non-steroidal anti-inflammatory drugs. To navigate among them at least a little better, let's start classifying these funds.

First of all, they can be divided as follows: a group - acids and a group of NSAIDs - non-acid derivatives.

The first include: - Salicylates (you can immediately remember about “Aspirin”). — Derivatives of phenylacetic acid (“Aceclofenac”, “Diclofenac”, etc.). - Pyrazolidines (metamizole sodium, known to most of us as “Analgin”, “Phenylbutazone, etc.). — Oxicams (“Tenoxicam”, “Meloxicam”, “Piroxicam”, “Tenoxicam”). — Derivatives of indoleacetic acid (“Sulindac”, “Indomethacin”, etc.). — Derivatives of propionic acid (“Ibuprofen”, etc.).

The second group is: - Sulfonamide derivatives (“Celecoxib”, “Nimesulide”, “Rofecoxib”). — Alkanons (“Nabumeton”).

Classification of non-steroidal anti-inflammatory drugs according to their effectiveness

The use of NSAIDs for osteochondrosis and in the treatment of other joint diseases can literally work wonders. But, unfortunately, not all drugs are equal in their effectiveness. The undisputed leaders among them can be considered: Diclofenac, Ketoprofen, Indomethacin, Flurbiprofen, Ibuprofen and some other drugs.

The listed medications can be called basic; that is, on their basis, new NSAIDs can be developed and supplied to the pharmacy chain, but under a different changed name and often at a higher price. To avoid wasting your money, study the next chapter thoroughly.

The information contained in it will help you make the right choice. What you need to pay attention to when choosing a medicine NSAIDs are, for the most part, excellent modern drugs, but when you come to the pharmacy, it is better to be aware of some of the nuances. Which ones? But read it! For example, you are faced with a choice of what is better to buy: Diclofenac, Ortofen or Voltaren. And you are trying to ask the pharmacist which of these drugs is better. Most likely, they will recommend you the one that is more expensive. But the fact is that the composition of the listed drugs is almost identical. And the difference in names is explained by the fact that they were produced by different companies, which is why the brands differ from each other.

The same can be said, for example, about “Methindole” and “Indomethacin” or “Ibuprofen” and “Brufen”, etc. To sort out the confusion, always look carefully at the packaging, because the main active ingredient of the drug must be indicated there facilities. Only it will most likely be written in small letters.

But that is not all. Or rather, it’s not that simple! Using an NSAID analogue of a drug that you are familiar with can unexpectedly cause an allergic reaction or side effects that you have never experienced before. What's the matter? The reason may lie in additional additives, which, of course, nothing was written about on the packaging. This means that you also need to study the instructions.

Another possible reason for the different results of analog drugs is the difference in dosage. Ignorant people often do not pay any attention to this, but in vain. After all, small tablets can contain a “horse” dose of the active substance. And, conversely, pills or capsules of huge sizes, it happens, consist of fillers by as much as 90 percent. Sometimes drugs are also produced in retardated form, i.e., as long-acting (prolonged) drugs. An important feature of such drugs is the ability to be absorbed gradually, due to which their effect can last a whole day. This drug does not need to be taken 3 or 4 times a day; a single dose will be sufficient. This feature of the medicine should be indicated on the packaging or directly in the name. For example, “Voltaren” in a prolonged form is called “Voltaren-retard”.

List of analogues of known drugs

We are publishing this little cheat sheet in the hope that it will help you better navigate the many beautiful pharmacy packaging. Let's say you immediately need effective NSAIDs for arthrosis to relieve excruciating pain. Take out your cheat sheet and read the following list:

• Analogs of “Diclofenac”, in addition to the already mentioned “Voltaren” and “Ortofen”, are also “Diclofen”, “Dicloran”, “Diclonac”, “Rapten”, “Diclobene”, “Artrosan”, “Naklofen”.
• "Indomethacin" is sold under such brands as "Indomin", "Indotard", "Metindol", "Revmatin", "Indobene", "Inteban".
• Analogues of "Piroxicam": "Erazon", "Pirox", "Roxicam", "Pirocam".
• Analogues of "Ketoprofen": "Flexen", "Profenid", "Ketonal", "Artrosilene", "Knavon".
• The popular and inexpensive Ibuprofen is included in such drugs as Nurofen, Reumafen, Brufen, Bolinet.

Rules for taking NSAIDs

Taking NSAIDs can be accompanied by a number of side effects, so it is recommended to follow these rules when taking them:

1. Reading the instructions and following the recommendations it contains are mandatory!
2. When taking a capsule or tablet, take it with a glass of water to protect your stomach. This rule must be followed even if you are taking the most modern drugs (which are considered safer), because extra precaution never hurts;
3. Do not lie down after taking the drug for about half an hour. The fact is that gravity will facilitate better passage of the capsule down the esophagus;
4. It is better to avoid alcoholic beverages, since NSAIDs and alcohol combined together are an explosive mixture that can cause various stomach diseases.
5. You should not take two different non-steroidal drugs on the same day - this will not increase the positive result, but, most likely, will add up to the side effects.
6. If the medicine does not help, consult your doctor; perhaps the dose you were prescribed was too small.

Side effects and nonsteroidal gastropathy

Now you have to find out what NSAID gastropathy is. Unfortunately, all NSAIDs have significant side effects. They have a particularly negative effect on the gastrointestinal tract. Patients may be bothered by symptoms such as nausea (sometimes very severe). Heartburn. Vomit. Dyspepsia. Gastrointestinal bleeding. Diarrhea. Ulcer of the duodenum and stomach.

All of the above troubles are NSAID gastropathy. This is why doctors so often try to prescribe their patients the lowest possible doses of classic non-steroidal anti-inflammatory drugs. To minimize harmful effects on the stomach and intestines, it is recommended that you never take such medications on an empty stomach and only do so after a large meal.

But problems with the digestive system are not all the side effects that some NSAIDs can cause. Certain drugs can have a bad effect on the heart and also on the kidneys. Sometimes taking them can be accompanied by headache and dizziness.

Another serious problem is that they have a destructive effect on intra-articular cartilage (of course, only with long-term use). Fortunately, today there are new generation NSAIDs on the market, which are largely free from these disadvantages.

New generation non-steroidal anti-inflammatory drugs

Over the past two decades, several pharmaceutical companies have been intensively developing new modern NSAIDs, which, along with the effective elimination of pain and inflammation, would have as few side effects as possible.

The efforts of pharmacists were crowned with success - a whole group of new generation drugs, called selective, was developed. Imagine - these drugs can be taken for very long courses under the supervision of a doctor. Moreover, the time frame can be measured not only in weeks and months, but even in years.

Medicines from this group do not have a destructive effect on articular cartilage, side effects are much less common and practically do not cause complications. New generation NSAIDs are medications such as: Movalis. “Nise” (aka “Nimulid”). "Arcoxia". "Celebrex."

We will talk about some of their advantages using Movalis as an example. It is available both in traditional tablets (7.5 and 15 mg), and in suppositories of 15 mg, and in glass ampoules for intramuscular administration (also 15 mg). This medicine acts very gently, but at the same time extremely effective: just one tablet is enough for the whole day. When a patient is indicated for long-term treatment for severe arthrosis of the hip or knee joints, Movalis is simply irreplaceable.

Different forms in which NSAIDs are available

Most popular non-steroidal anti-inflammatory drugs can be purchased and used not only in the form of tablets and capsules for oral administration, but also in ointments, gels, suppositories and injection solutions. And this, of course, is very good, since such diversity makes it possible in some cases to avoid harm during treatment while simultaneously obtaining a faster therapeutic effect.

Thus, new generation NSAIDs, used in the form of injections for arthrosis, have much less effect on the gastrointestinal tract. But there is also a flip side to this coin: when administered intramuscularly, almost all non-steroidal drugs can cause a complication - necrosis of muscle tissue. This is why NSAID injections are never practiced for a long time.

Basically, injections are prescribed for exacerbation of inflammatory and degenerative diseases of the joints and spine, accompanied by severe unbearable pain. After the patient’s condition improves, it becomes possible to switch to tablets and external agents in the form of ointments.

Typically, doctors combine different dosage forms, deciding what and when can bring the greatest benefit to the patient. The conclusion suggests itself: if you do not want to harm yourself by self-treating such common ailments as osteochondrosis or arthrosis, seek help from a medical institution, that is where they will be able to help you.

Can NSAIDs be used during pregnancy?

Doctors categorically do not advise pregnant women to take NSAIDs (this prohibition especially applies to the third trimester), as well as mothers who are breastfeeding. It is believed that drugs in this group can adversely affect the gestation of the fetus and cause various malformations in it.

According to some reports, such a harmless medicine, in the opinion of many, as Aspirin, can increase the risk of miscarriage in the early stages. But sometimes doctors prescribe this drug to women according to indications (in a limited course and in minimal doses). In each specific case, the decision must be made by a medical specialist.

During pregnancy, women often have back pain and there is a need to solve this problem with the help of non-steroidal anti-inflammatory drugs as the most effective and fast-acting. In this case, it is permissible to use Voltaren Gel. But - again - its independent use is possible only in the first and second trimester; in the later stages of pregnancy, the use of this strong drug is allowed only under the supervision of a doctor.

Conclusion

We told you what we ourselves knew about NSAIDs. Decoding abbreviations, classification of medications, rules for taking them, information about side effects - this can be useful in life. But we want our readers to need medications as rarely as possible. Therefore, in parting, we wish you good, heroic health!

NSAID gastropathy

In the scientific literature, this problem is called “NSAID gastropathy.” The term was first proposed in 1986 to distinguish specific damage to the gastric mucosa that occurs with long-term use of NSAIDs from classic peptic ulcer disease.

The difference between NSAID gastropathy and peptic ulcer disease can also be traced by the affected area. Most often, ulcers can be seen in the stomach, and not in the duodenum. Plus, the changes are more common in older people than in younger people.

Some numbers

Some statistics. In the UK, approximately 24 million NSAIDs are prescribed per year. 70% of people over 70 years of age take NSAIDs once a week, and 34% daily. In the United States, up to 6 billion worth of NSAIDs are sold annually. As a result, the risk of developing gastrointestinal bleeding (GIB) increases 3–5 times, perforation by 6 times, and the risk of death from complications by up to 8 times. Up to 40–50% of all cases of acute gastrointestinal tract infections are associated with NSAIDs.

This problem is also relevant in our country, for example, according to the Scientific Center for Cardiovascular Surgery named after. A.N. Bakulev, out of 240 patients taking aspirin daily, even in small doses, gastroscopy revealed lesions of the stomach and 12 p.c. in 30% (of which ulcers - in 23.6%, erosions - in 76.4%). A similar picture was observed among colleagues from the All-Russian Research Institute of Rheumatology of the Russian Academy of Medical Sciences - in 2126 patients taking NSAIDs without “covering” (protection) of the stomach, erosions and ulcers of the gastroduodenal zone were found in 33.8% of cases. These are very impressive and dramatic numbers of complications from taking NSAIDs, considering the number of people using these drugs in developed countries.

Chondroprotectors and intra-articular fluid substitutes

Artra, Dona, Structum, Teraflex, Chondroitin, Glucosamine, Adgelon, Piaskledin, Alflutop, Hyaluronic acid, Sinvisc, Ostenil, Noltrex, Sinocrom, Fermathron

Chondroprotectors are medications that heal joints. We use them if the nutrition of the joint is impaired (arthrosis, osteochondrosis, metabolic disorders), or the joint has been damaged by inflammation or injury. We begin full treatment with chondroprotectors after the inflammation has subsided.

Treatment with chondroprotectors for oral administration should be long-term : the effect usually begins after 3 months, and a stable effect - after at least 6 months. These medications are specifically designed for long-term use and are usually well tolerated.

Chondroprotectors for injection into a joint or intramuscularly have a faster effect, sometimes noticeable after 1 injection. In total, we perform from 1 to 5 intra-articular or 10-20 intramuscular injections per course, followed by a transition to taking drugs orally.

Injections create a high concentration of medication directly into the affected joint

Chondroprotectors help work and medications that improve blood circulation and metabolism .

Chondroprotectors for oral administration. Commonly used medications.

Piascledine is a herbal preparation that regulates metabolism in cartilage tissue. Contains unsaponifiable compounds from avocado and soybean oils. The drug helps slow down the development of the degenerative process in cartilage tissue, relieves pain (associated with this process) and restores the patient’s motor function. Stimulates the synthesis of proteoglycans and collagen. Promotes the restoration of cartilage tissue. Reduces collagenase production.

Chondroitin and/or Glucosamine are contained in the preparations Artra, Dona, Structum, Teraflex.

Chondroitin , a drug that affects phosphorus-calcium metabolism in cartilage tissue , is a high molecular weight mucopolysaccharide. Slows down the destruction of bone tissue and reduces calcium loss, accelerates the process of bone tissue restoration, and inhibits the process of degeneration of cartilage tissue. Prevents compression of connective tissue and plays the role of a kind of lubricant of articular surfaces. When used externally, it slows down the progression of osteoarthritis. Normalizes metabolism in hyaline tissue. Stimulates the regeneration of articular cartilage.

Glucosamine is a drug that affects metabolism in cartilage tissue. Replenishes the natural deficiency of glucosamine, stimulates the synthesis of proteoglycans and hyaluronic acid in synovial fluid; increases the permeability of the joint capsule, restores enzymatic processes in the cells of the synovial membrane and articular cartilage. Promotes fixation of sulfur during the synthesis of chondroitinsulfuric acid, facilitates normal calcium deposition in bone tissue, inhibits the development of degenerative processes in joints, restores their function and reduces pain. With a single oral administration of an average therapeutic dose, the maximum concentration in plasma is achieved after 3-4 hours, in the synovial fluid - after 4-5 hours.

Injectable drugs and intra-articular fluid substitutes. Frequently used drugs.

Adgelon is a drug that stimulates the process of regeneration of cartilage tissue. The active substance of the drug is a glycoprotein isolated from cattle blood serum. The drug promotes the rapid accumulation of mass of young cartilage cells and their differentiation, which leads to more rapid formation of replacement cartilage tissue, restoration of a smooth articular surface in the area of ​​damage and improved joint mobility. When using the drug, the damaged area is filled with young cartilage cells. With intra-articular injections , the basic substance produced by the cells of cartilage tissue has a more ordered structure: it becomes as dense as in normally functioning cartilage tissue.

Alflutop is an injection drug of natural origin. This is a bioactive concentrate from small sea fish Sprat (Sprattus sprattussprattus), Black Sea whiting (Odontogadus merlangus euxinus), Black Sea bellyfish (Alosa tanaica nordmanni), Black Sea anchovy (Engraulis encrassicholusponticus). The drug Alflutop regulates metabolism in cartilage tissue, consists of mucopolysaccharides, chondroitin sulfate, amino acids, peptides, sodium ions, potassium, calcium, magnesium, iron, copper and zinc. Alflutop prevents the destruction of macromolecular structures of normal tissues, stimulates restoration processes in interstitial tissue and articular cartilage tissue, which explains its analgesic effect. The anti-inflammatory effect of Alflutop and tissue regeneration are based on inhibition of hyaluronidase activity and normalization of hyaluronic acid biosynthesis. These effects are synergistic and cause activation of tissue restoration processes (in particular, restoration of metabolic processes in cartilage tissue).

100% synthetic polymer Noltrex does not contain substances of animal origin and is not a natural metabolite. Due to the presence of silver ions in the composition of the drug, Noltrex has antibacterial properties. When Noltrex is administered at the first stage, physical separation of the contacting and rubbing surfaces of the joint affected by osteoarthritis occurs as a result of an increase in the viscosity of the synovial fluid. Pain is reduced and joint mobility is improved. At the second stage, due to the unique properties of Noltrex, like a sponge, it absorbs joint fluid and water from the cartilage and subchondral bone, providing decompression of pain endings. At the third stage, biochemical fragments of the joint fluid - enzymes of inflammation and proteolysis - are adsorbed and inactivated on strictly oriented active centers of the polymer. At the same time, silver ions migrate to the surface of the joint, resulting in the suppression of endogenous infection. Noltrex is one of the most easily used means of combating arthrosis today. The entire process of using the drug comes down to a common and very widespread procedure - intra-articular injection, which does not require any additional skills from the doctor.

Substitutes for intra-articular fluid are hyaluronic acid preparations (Synvisc, Ostenil, Sinokrom, Fermatron). The therapeutic effect of Hyaluronic acid is associated with “replenishing the viscosity” of the intra-articular fluid of the affected joint. In addition, the action of sodium hyaluronate is based on the “trigger” effect - it directly restores the ability of the joint to produce hyaluronan and, thus, returns it to a state of biochemical equilibrium, which persists for several months. As accumulated clinical materials show, the following points occur when using sodium hyaluronate:

1. restores synovial balance: increases the viscosity of synovial fluid, restoring its lubricating, shock-absorbing and filtering properties;
2. protects articular cartilage from mechanical and chemical damage: restores the protective coating on the inner surface of the joint and increases the binding of free radicals;
3. inflammation of the synovial membrane decreases and its protective functions are restored.

Slowing down the destruction of articular cartilage in combination with the processes of restoring the biochemical balance of the synovial fluid leads to rapid relief of pain symptoms and regression of the phenomena of limited mobility in the joint.

The beneficial effect of sodium hyaluronate appears gradually during the course and lasts for several months. After completing a full course of 5 injections, symptoms are usually relieved for a period of 6 to 12 months.

How it works?

How do these drugs work in our stomachs? Everything is very simple, the negative impact is realized due to the imbalance of defensive and aggressive forces. We have a number of defense mechanisms in our stomach that allow us to withstand the onslaught of aggressors. Among the latest:

• An acid whose pH balance is close to that of battery acid
• Bile and pancreatic juice, which can be thrown into the stomach.
• A number of medications.
• Alcohol and nicotine.
• Irritating food components (spices, spicy foods, etc.)
• Helicobacter pylori infection and so on.

The stomach is protected due to a thick layer of mucus and bicarbonates that neutralize acid, adequate blood supply, and the ability to regenerate very quickly. When we use NSAID drugs, the balance of forces changes towards aggressive mechanisms and damage occurs to the mucous and submucosal layer of the stomach and duodenum.

Immunomodulators

Immunomodulators are medications to correct the functioning of the immune system. We resort to immunomodulators when it is necessary to increase, decrease or regulate the activity of a particular immune mechanism.

The immune system is our main defender. It saves us from pathogenic microbes, fungi, parasites and cancer cells. For medical purposes, it is customary to consider three parts of the immune system:

1. Cellular immunity. It is determined by the presence and activity of different types of white blood cells (leukocytes).
2. Humoral (immunoglobulin) immunity. Immunoglobulins are special proteins that can recognize harmful biological and chemical factors that have entered the body.
3. Cytokines are special protein molecules that mainly provide communication and coordination between immune cells. The blood test mainly evaluates the content of interferons (a subtype of cytokines); they are especially important for fighting viral infections. In addition, cytokines play an important role in autoimmune inflammation (tumor necrosis factor, IL-6, etc.).

All parts of the immune system work in close relationship with each other.
The selection of immunomodulators is made according to immunological blood tests . Modern immunomodulators make it possible to selectively influence one or another deviation in the functioning of the immune system.

Interferon inducers (Cycloferon, Panavir, Neovir, Kagocel, Amiksin, etc.). They increase the production of interferons. We often use them for chronic viral infections, together with antiviral drugs.

Interferon preparations (Viferon, Human Interferon, Anaferon, etc.). They replace their own interferon and thereby improve the function of the immune system. We use them in cases of significant interferon deficiency.

Regulators of cellular immunity (Galavit, Polyoxidonium, Lykopid, etc.). They stimulate (regulate) the activity and production of white blood cells. The drug Polyoxidonium is approved for use in rheumatic pathology, because does not stimulate autoimmune reactions. The drug Galavit is interesting because it blocks the production of TNF (tumor necrosis factor), which is involved in joint inflammation in autoimmune arthritis.

Thymodepressin is a new promising drug for suppressing the excessive production of aggressive immune cells. One of the safest immunosuppressants. Has proven itself in the treatment of psoriatic arthritis. Promising in the treatment of rheumatoid arthritis, ankylosing spondylitis, and vasculitis.

Diagnostics

To diagnose such changes, gastroscopy is used, which is the “gold standard”. An interesting fact is that about 40% of patients with erosive-ulcerative changes who take these drugs for a long time (more than 6 weeks) do not feel any discomfort or unpleasant, painful sensations. Stomach problems are diagnosed only when visiting other doctors, and not a gastroenterologist. And, conversely, in 40% of patients, despite the complaints they make, nothing is found.

How to take anti-inflammatory medications correctly?

First you need to carefully read the instructions. The drugs must be prescribed by the attending physician and the optimal dose and course of treatment determined. To protect the stomach, tablets should be taken with a sufficient amount of clean water.

Under no circumstances should you mix medications with alcohol. This will further affect the functioning of the stomach.

You can buy all drugs for the treatment of inflammatory processes in the network of state pharmacies “Provincial Pharmacies”. We provide medicines with a state quality guarantee. There is a pick-up system and home delivery when ordering drugs online.

What to do in this case?!

The algorithm of actions for patients who do not have stomach problems and those who have a history of peptic ulcers or erosive changes is different. For the first group, when prescribing non-steroidal anti-inflammatory drugs for more than 5 days, it is mandatory to prescribe drugs from the group of proton pump inhibitors (PPIs). Such as omeprazole, pantoprazole, rabeprazole, etc. (for the entire course of treatment). For the second group, any prescriptions from the NSAID group, regardless of the duration of use, require parallel prescription of proton pump inhibitors. It is also mandatory to take a PPI for patients taking aspirin for a long time.

Steroid hormonal anti-inflammatory drugs / glucocorticosteroids / GCS

Typical and frequently used representatives of this group of drugs: prednisolone and methylprednisolone (Solu-Medrol, Metipred, etc.), hydrocortisone, Kenalog, Diprospan, Dexamethasone. There are glucocorticosteroids for administration intravenously, intramuscularly, intraarticularly, orally, externally, in suppositories (suppositories).

The action of GCS and the principle of their operation

Steroid drugs (glucocorticosteroids, GCS) are the most powerful, hormonal, anti-inflammatory drugs. GCS have the following main effects:

1. anti-inflammatory
2. immunosuppressive (immunosuppressive)
3. antiallergic
4. anti-shock

What is inflammation? In response to the influence of any damaging factor (infection, injury, burn, introduction of a foreign protein, etc.), the body responds with a protective reaction, i.e. inflammation. In the damaged area of ​​the body, special substances are synthesized - inflammatory mediators , which create conditions to combat the damage: blood flow increases, temperature rises, the nervous system is notified of what is happening through pain receptors. The immune system is activated, immune signaling proteins (cytokines), antibodies and white blood cells at the site of inflammation become more aggressive . Hence the characteristic symptoms of inflammation: pain, swelling and swelling, increased local and general temperature, redness.

GCS suppress the body's inflammatory response, blocking the synthesis of inflammatory mediators in the body and suppressing the aggressiveness of the immune system. Symptoms of inflammation quickly decrease, but the cause of the disease remains. If the symptoms of the disease are so destructive that hormonal anti-inflammatory treatment is required, we carry out research in search of more subtle and safe ways to influence the course of the disease . Even when the disease has genetic roots, in most cases this is successful.

Possible side effects. Security measures. Diet

Most often we encounter:

1. Peptic ulcer of the duodenum or stomach
2. Exacerbation of infections due to decreased immunity
3. Increased blood pressure
4. Increased glucose (sugar) in the blood
5. Osteoporosis

Metabolic disorders with increased body weight are quite rare; In recent years, GCS preparations have become safer, and medicine has learned to use them delicately.

We will do everything possible to stop you from taking hormonal anti-inflammatory drugs. If taking GCS is a necessary measure, we will offer you a safe regimen and diet that prevents weight gain.

How to reduce the risk of side effects? First of all, this is the choice of drug . For example, methylprednisolone, which has greater therapeutic and fewer side effects compared to prednisolone, has recently become widespread. If necessary, anti-inflammatory drugs can be taken under the guise of an anti-ulcer drug . Long-term use should also include prevention of osteoporosis .

Secondly, the correct reception mode . Your doctor will tell you how to use the medicine correctly throughout the day. For long-term treatment, periodic dose changes and breaks are practiced.

Thirdly, you cannot rely only on the GCS. We must understand that this is a symptomatic treatment. We will look for and treat the causes and primary mechanisms of the disease.

Fourthly, you should remember about proper nutrition , and your weight will remain under control.

How to refuse GCS?

If you cannot refuse corticosteroids due to an increase in the symptoms of the disease, most likely, insufficient attention is paid to non-hormonal basic therapy .

Regularity of immunomodulatory treatment and infection control is also important. It is often possible to discontinue GCS after correcting the state of the immune system and treating chronic infections . Nervous stress, sleep disturbances, nervous exhaustion are also possible causes of your difficulties. To cancel long-term use of corticosteroids, a course of antidepressant treatment is sometimes sufficient.

Myths that we encounter in daily practice

Myth 1. Using NSAID drugs in the form of suppositories is less aggressive for the stomach than taking pills

This is 100% a myth. The pathogenic, destructive effect of the drug is realized through the blood, delivering it through the vessels to the stomach.

Myth 2. Medicines from the group of antacids - Rennie, Maalox, Phosphalugel and H2-blockers (Ranitidine and Famotidine) can be used as “gastroprotectors”

In this case they are not effective.

Myth 3. You can't take proton pump inhibitors regularly

The fact is that if an elderly person has been prescribed an anti-inflammatory drug for life, it is absolutely pointless to prescribe gastroprotection for a month. In such cases, medications should be taken strictly in parallel.

Myth 4. Food products (jelly, etc.) can act as “gastroprotectors”

We will leave this myth as absolutely fantastic without comment.

How to choose a medicine

In fact, the most important point is which medications we take. In the figure you can see the scale of aggressiveness of various drugs from the NSAID group in relation to the stomach.

The most aggressive drugs are Aspirin, Ketorolac, Piroxicam, Indomethacin. If possible, it is recommended to use selective drugs that have minimal gastrointestinal risks. Their use is always more desirable, these include Celecoxib and Rofecoxib. But despite their relative safety, they should be prescribed strictly according to indications by the attending doctor, do not forget about this.