Jyoti,
Not advocating letting a little old lady writhe in pain. My point is that ibuprofen or naproxen or plain aspirin, though it will work for pain, is not the best choice managing osteoarthritis for anybody. Even though the TV commercials say otherwise. Will try to explain.
Got to respect the NSAID’s. They are miracle drugs but dangerous, especially in the elderly and those of any age prone to the bad side effects. Some may have sprained a shoulder and given a treatment of say 800 mg ibuprofen three times daily, which is illegal to administer without an RX. Same with naproxen. Doc puts you on naproxen 500 mg but you can’t get 500 mg naproxen without a prescription. Silly as it sounds, you sprain a knee and your friend gives you one of his naproxen 500 mg pills. Both have committed a federal crime in the legal arena. Then you look out on the isle and the same drug is available to anyone with no regulation. Naproxen 220 mg and ibuprofen 200 mg in bulk on a discount.
Reason for this is it is hoped the consumer will limit intake to one or two pills and stay in a safer zone rather than take several 800 mg pills and bleed to death while their kidneys are failing.
Ibuprofen and naproxrn, aspirin, ketoprofen over the counter are non specific to the Cox-2 enzyme (bad inflammation). They take down COX-1 protection (good inflammation). This is especially dangerous for the elderly with long term maintenance, and makes the arthritis condition worse while assaulting the gut, circulation, kidneys and the heart.
You can think of osteoarthrisis as a condition starting in the womb. A baby moves an arm and the cartilage in the joint is damaged. The body quickly starts the repair process and everything is okay for a few decades.
Our joints are encased in a “synovial” sac filled with organic lubricants. The cartilage pads cover the bone. The bone has exquisite pain receptors on the surface that are shielded by the cartilage. It is when the cartilage is worn thru to the bone that we start to experience pain. Couple ramifications of this. First, it is not something that just happened overnight. Osteo can take many years to develop before you are aware of the condition. Second, that new painful knee is a canary in the coal mine warning. It may mean that other joints are not far behind throwing up a new flag. Simple X-Rays can assess the risk.
The damage going on with the joints requires continual supply of nutrients, oxygen carried by the blood. We just get to a point where we are falling apart faster than we can repair, but we are still fighting to repair.
Perfusion to the synovial capsule is difficult and requires as much unrestricted circulation as possible to deliver repair materials. Remember that osteoarthritis is not an inflammatory condition.
The non COX-2 specific NSAID’s, by cutting down COX-1, defeat the good inflammation that keeps micro circulation going. The result is that the repair materials are not delivered efficiently and breakdown continues at an accelerated rate. Take two identical twins with the same degree of the condition. Treat one with naproxen and give the other nothing. Come back in a year and the one treated with naproxen will have had some pain relief, but the condition is now worse than the untreated twin.
This is where things like Tylenol, meloxicam, glucosamine come in.
Historically, I remember the late 1990’s when meloxicam under the brand Mobic was still waiting for FDA approval. The fanfare was off the wall. If there could be a rockstar drug, it was meloxicam.
Meloxicam was the first drug of it’s class to have 99 percent plus affinity for COX-2. This was a godsend to people who needed an NSAID but could not tolerate the gut erosion of other available agents, side effect of unwanted COX-1 inhibition. At the time, nabumetone (Relafen) was as good as it got but not great.
Irony was around that time, we developed Vioxx and Bextra and later Celebrex, which were virtually 100 percent COX-2 specific. Vioxx and Bextra later taken off the market due to deaths from cardiac complications. Celebrex still there. Expensive but available. In the excitement about the pure COX-2 inhibitors, meloxicam was forgotten and drifted off as a cheap generic nobody used. The drug is however excellent. A bit lighter duty, but if it controls the pain, it will do so without cutting circulation off from the joints.
Meloxicam, Celebrex are safer NSAID’s for osteoarthritis. Tylenol also okay. Glucosamine compounds over the counter to start rebuilding the cartilage if there is enough left to build back up, and repairs other joints that are not yet giving signs of trouble but getting close to breakdown.
Only two other concerns about any NSAID if you are also taking daily low dose aspirin for stroke protection. Separate by at least 4 hours from the aspirin or they will get in the way and you lose the protective effect of aspirin. Concern with meloxicam is that if you have a severe sulfa allergy, meloxicam can have a nasty cross reaction. I haven’t seen this in real life, but the chemistry makes it possible.
John