Why It's Best to Avoid Taking NSAIDs

A drug commonly taken by patients to help manage the symptoms of Ankylosing Spondylitis are over-the-counter anti inflammatories, such as Advil, Ibuprofen, Aspirin, Motrin, etc. Sometimes these drugs, classified as "NSAID's" (non steroid anti inflammatory drugs) are even prescribed by Doctors, such as Celebrex among others. Using an anti inflammatory would seem to make sense because AS is a type of inflammatory arthritis and many of the symtpoms can be linked to underlying inflammation. So why not take them?


It has long been known that there was some association between AS and gut inflammation, although the exact connection has not been well defined. Studies have shown that a large percentage of AS patients have subclinical gut inflammation, if not outright Inflammatory Bowel Disease (either Crohns or Colitis). Up to 60% of AS patients who have no gastrointestinal symptoms will have microscopic (on biopsy) inflammation in the gut when colonoscopy is performed. So even if an AS patient does not experience any symptoms or exhibit any signs that there is a problem with their gut, the chances are more than likely that there IS inflammation in the intestinal tract.


Have you ever read the warnings on the labels of NSAID's? They clearly express that damage to the intestines can occur. Considering the fact that a patient who has AS is already at a higher risk of developing Inflammatory Bowel Disease, if they don’t already have it, using these drugs to treat AS is problematic because of concerns of potential activation or re-activation of disease of the bowels.


A study was led by David Y. Graham, MD, head of gastroenterology at Michael DeBakey Medical Center, and professor of medicine at Baylor College of Medicine in Houston. Doctor Graham and his fellow colleagues used a tiny "pill camera" to look inside the small intestines of twenty one men and women who used NSAIDs every day, as well as 20 people who did not use the drugs. All of the test subjects were asymptomatic.


They found that 71% of the users of NSAID drugs had some damage to their small intestines, compared with 10% of the nonusers. 5 of the NSAID users had large erosions or ulcers. This problem was not seen at all in any of the nonusers. The findings appear in the January 2005 issue of Clinical Gastroenterology and Hepatology.


The damaging effects of non steroid anti inflammatory drugs on the small and large intestine are well documented. Evidence shows that the use of NSAIDs has been associated with intestinal strictures, ulcerations, perforations, diarrhea, and villous atrophy. Considering AS shares a genetic tendency with bowel disease, anything that damages the bowels and is known in cases to trigger bowel disease, would best be avoided.


There is one exception to this rule, and that is Sulfasalazine. While it is comprised of 2 primary components (one component is antibiotic in nature, and the other is anti inflammatory in nature), the drug is not considered a NSAID. Rather, it is known as a disease modifying antirheumatic drug (DMARD). The extended release version of the drug is broken down in the colon and reduces inflammation and swelling in the gut. It also is know to reduce swelling and inflammation in joints. The mechanism of why it is effective in Ankylosing Spondylitis and other arthritic conditions, is unclear, but it is thought to be due to the antibiotic, immune-suppressive, and anti inflammatory qualities of the drug.


As with all drugs, there are potential side effects. So if one can manage without drugs at all, this is even better. Some turn to natural anti inflammatories, such as ginger root capsules, tumeric and/or fish oil.


*  Rudwaleit M, Baeten D. (June 20, 2006). "Ankylosing Spondylitis and Bowel Disease". Best Pract Res Clin Rheumatol. 2006 Jun;20(3):451-71.