NSAIDs + other arthritis meds = a few ?????

[capybara]

i hear all NSAIDs have a plateau effect = they all plateau at about the same effectiveness.
that is, aspirin, acetameniphen, and ibuprofen and all more or less equally effictive, theyt are plateau-ed.
Cortisone is more effective, but with much greater side effects which prevent its widespread or
chronic use.
1. is the effectiveness of cox2 inhibitors (such as vioxx) also plateau-ed at the same level
as aspirin and the other NSAIDs ?
2. do the nsaids do any healing (for example of my arthritic knees and elbows) or only
pain-killing?
3. do any of the over the counter meds help? for example: glucosamine, chondroitin,
MSM, garlic, catsclaw, etc?

 

[CTho9305]

for #2:
according to this page, NSAIDs appear to just treat symptoms. (at least, that is how I interpret the information on that page)

It was the first result of a google search "NSAID"

 

[Mark R]

There is relatively little to chose from between NSAIDs - apart from side effects. Ibuprofen at high dose (2.4 grams per day), is probably as effective as Diclofenac 150 mg per day, but may cause more side effects. Paracetamol (acetaminophen) is not an NSAID, and is a useful addition to an NSAID if additional pain relief is required.

Some people find that one NSAID is better than another - e.g. naproxen, better than diclofenac, or vice versa. The COX-2 selective NSAIDs are not necessarily 'better' but are better tolerated, and can therefore be given at higher doses if necessary. A new version of Vioxx has been released which is double or 4x the normal dose, and is for short term pain control - the manufacturers claim that at this dose it is more effective than conventional NSAIDs.

NSAIDs are primarily symptom relief. They ease pain, reduce swelling and therefore improve mobility.

You don't say what type of arthritis you have: if it is 'osteoarthritis' (degenerative change or wear-and-tear) then NSAIDs are the appropriate treatment. A steroid injection into the joint may help if it has swollen and become suddenly painful. The damage in OA is mechanical, and steroids won't help that. Maintaing a healthy weight and taking appropriate low-stress exercise (swimming, etc.) is the most important measure to slow progression. Once a joint is damaged, then this is generally regarded as being irreversible - the aims of treatment are to reduce symptoms, and slow down joint damage where possible. Use of steroid tablets for OA is rarely justifiable due to limited benefit and high incidence of side effects.

The role of 'complementary' therapies is slightly controversial. Glucosamine does have some evidence suggesting a benefit, but it is not clear cut. There is little evidence of significant harm from glucosamine, so some physicians do recommend it, but then some rheumatologists don't.

 

[bwanaaa]

NSAIDS interfere with the conversion of arachidonic acid into the various prostaglandins. They all work at the same level and differ only in their pharmacokinetics and therapeutic efficacy. prostaglandins are part of the inflammatory cascacade. Arthritis is inflammation of the joint space and this can arise as the result of infection, trauma, or autoimmune activation. NSAIDS and steroids work diffrently. For some kinds of arthritis, antimetabolites like methotrexate , are also useful. OTC meds cant hurt and a 30% placebo effect has been documented.

Thus, nsaids slow down the process of joint destruction but if your joint is bad, get a new one. You'll hate yourself for putting it off once you see how wonderful it is to have pain free motion. Almost like being 30 again.