Non-Steroidal Anti-Inflammatory

What is inflammation?

Inflammation is a normal reaction to protect the body from harmful pathogens or irritants, such as chemicals, and to promote healing of damaged tissues, as in arthritis. It is a complex process of cellular interactions of the immune system that is mediated by chemicals produced at the site of tissue damage, infection or trauma.

The process of inflammation includes the widening and increased permeability of small blood vessels, exudation of fluid into and migration of immune cells like macrophages and neutrophils into the tissues where damage, infection or irritation has occurred. The fluid causes swelling and the cells produce inflammatory chemicals like prostaglandins, interleukins and leukotrienes. These chemicals attract more inflammatory cells to help with wound healing and disposing of harmful pathogens but they also magnify the inflammatory response. In doing their job, some of these inflammatory mediators can also cause pain, swelling, fever and redness. If the inflammatory process continues beyond protecting and healing, it becomes chronic and can end up damaging normal tissues.

Inflammation and prostaglandins

Nonsteroidal anti-inflammatory drugs (NSAID) inhibit cyclooxygenase (COX), an enzyme involved in the synthesis of prostaglandins like PGE2, which have important functions throughout the body but are also potent inflammatory mediators and cause pain, swelling and other symptoms of inflammation. They are called nonsteroidal as corticosteroids are also used to treat inflammation but target a different enzyme in the pathway of prostaglandin synthesis.

There are two known COX enzymes, COX-1, COX-2 and there is also a variant of COX-1, known as COX-3, which is found mainly in the brain. COX-1 is present in most cells and plays an important role in many normal cell functions, including aggregation of blood platelets, which controls bleeding; protection of the stomach lining or mucosa by promoting cell growth; also in maintaining normal kidney function by regulating blood flow. COX-2 is only produced by inflammatory cells, and is induced during the inflammatory process, although it is also found in very small amounts in some tissues.

Oral anti- inflammatory drugs

Oral nonsteroidal anti-inflammatory drugs (NSAID) target inflammation systemically, wherever it occurs throughout the body and can be used for short-term or long-term treatment of inflammatory joint diseases like arthritis, to help relieve pain and improve mobility in affected joints.

Meloxicam and celecoxib are specific COX-2 inhibitors and have no inhibitory action against COX-1, which makes them more effective for pain and inflammation, without the gastrointestinal or kidney side effects associated with COX-1 inhibition.

Topical anti-inflammatory drugs

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits primarily COX-2 but also has some inhibitory effect on COX-1 and is, therefore, more specific as an anti-inflammatory than other non-specific NSAIDs like Ibuprofen. As a topical treatment for arthritis, diclofenac is absorbed through the skin and acts directly on the soft tissues surrounding joints to relieve pain and inflammation due to sprains and strains. It also acts within superficial arthritic joints, such as the hands, wrists, elbows, knees, ankles or feet, to reduce inflammation due to osteoarthritis and relieve symptoms like pain and swelling in the joints.