History of anti-inflammatory drugs creation
Though throughout ages people looked for the ways to reduce inflammation with natural products such as willow bark which is considered to be mentioned in the context by Hippocrates (460–377 BCE), first medications on the basis of the substance containing in the bark were created only in 19th century. After salicylic acid was first isolated from the bark of willow in 1829, nonsteroidal anti-inflammatory drugs had become an integral part of the treatment of different conditions accompanied by pain and inflammation. Their wide use is due to the lack of the severe side effects common for opioid painkillers such as sedation, respiratory depression, and addiction. The majority of the nonsteroidal anti-inflammatory drugs is considered quite safe and is sold without prescriptions.
The term nonsteroidal was first used in 1960. It stresses out that the medications from the group are different from steroids which have a similar effect but also cause a wide range of severe side effects that are not observed in the use of nonsteroidal medications.
The widely known medications from the group are aspirin and ibuprofen. These drugs are first-line medications in mild pain associated with traumas. They are commonly sold without prescriptions in the majority of countries of the world.
During the years, researchers also have tried to further study the mechanisms of actions of nonsteroidal anti-inflammatory drugs aiming to use them for other conditions. For example, it has been studied how NSAIDs impact the development of Alzheimer's disease in mice and human and while they have shown some positive results, there is not enough statistical data that can prove the effectiveness of this group of medications for this degenerative condition.
When anti-inflammatory drugs are currently used
Anti-inflammatory medications are used for:
- The relief of pain and inflammation in bones and joints in osteoarthritis, rheumatoid arthritis, inflammatory arthropathies such as psoriatic arthritis, reactive arthritis, and ankylosing spondylitis, in injuries, in low back pains caused by cold or mild trauma, and metastatic bone pain, in dental pain of after a dental surgery, and so on.
- The medications are also used to relief menstrual cramps, inflammation of tissues due to an injury, headache, gout, postsurgical pain, muscle aches due to Parkinson's, renal colic, and macular edema.
- Some of the medications are also used in the management of symptoms in nonspecific ulcerative colitis, ulcerative proctitis, Crohn's disease, as a preventive therapy for exacerbations of proctitis and ulcerative colitis.
- In the viral and bacterial infections of upper respiratory tract, bladder infections, and others anti-inflammatory drugs can be used along with antibiotics, anti-viral medications, or anti-bacterial drugs.
Types of anti-inflammatory medications
- Non-steroidal anti-inflammatory drugs are the most commonly medications from the group. They are used in a variety of conditions from a mild headache to treatment of chronic rheumatoid arthritis and bone metastases. The medications provide both anti-inflammatory and painkiller effect though the inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes.
- Antileukotrines are mostly used not as a pain relief but for the reduction of inflammation in the airways, in treatment lungs such as asthma and chronic obstructive pulmonary disease as well as sinus inflammation in allergic rhinitis. The effect is achieved through the inhibition of leukotriene-related enzymes. The drugs from this group also have been studied for the treatment of the diseases caused by the inflammation of the brain.
- Immune selective anti-inflammatory derivatives have a lot of properties one of which is anti-inflammatory. The medications work through the altering the activation and migration of immune cells responsible for enhancing the natural inflammatory response. The drugs are not steroidal or nonsteroidal types of medications, they form a different sub-group. The anti-inflammatory effect is achieved through the inhibition of the binding of certain antibody to human neutrophils and decrease of the intracellular oxidative activity.
Mechanism of action of anti-inflammatory drugs
The majority of nonsteroidal anti-inflammatory drugs inhibit the action of the enzymes cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). Through the inhibition of the enzymes, the anti-inflammatory and pain relief effects are achieved. The fever elimination by the drugs is achieved through the lowering of prostaglandin E2 levels by the inhibition of prostanoid biosynthesis.
The majority of the medications from the group is absorbed in the blood from stomach and intestines and is metabolized in the liver. The inactive metabolites are excreted in the urine and partially in bile. The most usually used in mild pains drugs, such as Ibuprofen, have a half-life of 2-3 hours. More potent nonsteroidal anti-inflammatory drugs can stay in the body and provide the effect for up to 60 hours.
Other medications that are used to cope with inflammation, such as Antileukotrines, do not provide pain relief though reduce the inflammation of lungs and sinuses in chronic conditions through the inhibition of leukotriene-related enzymes.
Another type of medications against inflammation, the Immune selective anti-inflammatory derivatives, provide the anti-inflammatory effect through the inhibition of the binding of certain antibody to human neutrophils and decrease of the intracellular oxidative activity.
Statistics of inflammatory diseases
The statistics for different inflammatory diseases vary. For example, inflammatory viral infections such as respiratory tract infections are much more frequent than Crohn’s disease or colitis.
- The total amount of people diagnosed with rheumatoid arthritis in the world is between 0.4 to 1.3%. In the U.S., 0.6% of population older than 18 years of age is diagnosed with the condition.
- There are not enough statistical data on the number of people in the world who have ulcerating colitis or Crohn’s disease, but the studies show that the diseases are more common in urban areas, and more frequent in northern climates. The highest Crohn’s disease spread is documented in Canada and the highest rate of ulcerative colitis is documented in Denmark, Iceland, and the United States.
Some of the conditions that are treated with the medications from the group do not and cannot have any genetic factors affecting them. For example, a trauma caused by a hit has nothing to do with genetics. Though rheumatoid arthritis, osteoarthritis, psoriatic arthritis, reactive arthritis, ankylosing spondylitis, Parkinson’s diseas, Crohn's disease, and even menstrual pains can run in a family.
Signs and symptoms
Though the diseases treated by the anti-inflammatory medications differ substantially, some common symptoms are typical for the majority of them: fatigue, tiredness, fever, pain and stiffness, anemia. Other symptoms may include weight loss, swelling of the affected area, partially immobility of the affected limb, and others.
Complications of inflammations
Pathological inflammation regardless of its localization is a dreadful condition. First of all, it is accompanied with constant ache and stiffness. Secondly, some conditions, such as arthritis, spondylitis, and Crohn's disease worsen over time if their first signs are neglected. Thirdly, the chronic inflammatory processes interfere with the normal body function and can cause the development of other diseases such as diabetes, nervous system disorders, and even cancer.
If the inflammation is caused by a trauma or a wound, it can get infected and the untreated condition can even lead to the amputation of the affected limb.
Therefore, at the first signs of an inflammatory disease or injury, you should immediately seek medical assistance and start the treatment timely.
Diagnosis of an inflammatory disease
Based on the fact that the inflammatory diseases differ drastically in nature and causes, there isn’t a single diagnosis technique. In this section, we are going to tell you how the most dangerous inflammatory disease can and should be diagnosed.
- Arthritis. First, you need to go to your physician and tell him or her about your symptoms, how intense they are, how long you have been suffering from them, and whether any of your family members suffers from a similar condition. You should also tell the doctor about other conditions that you suffer from, your lifestyle, habits, and recent travels. Next, the doctor will do a physical exam during which he or she will test your joints and ask you what positions are comfortable and uncomfortable for you. The next step is X-ray of the area that you feel pain in and blood tests for the signs of inflammation. Sometimes, fluid from the joint is also drawn for analysis.
- Colitis. The diagnosis also starts from telling your doctor about your symptoms, family history, and so on. After a physical examination, your doctor will direct you to do either blood tests, stool sample, colonoscopy, flexible sigmoidoscopy, X-ray, CT scan or a combination of two or more tests at once.
- Parkinson’s disease is difficult to diagnose at the early stages. The primary diagnosis is made based on the symptoms reported and the doctor’s observations of the visual symptoms. Next, the doctor can send you to do DaTscan for Parkinson's, i.e. an imaging technology that uses little amounts of a radioactive drug to help determine how much dopamine is available in a person's brain.
- Crohn's disease is also difficult to diagnose as its symptoms can be confused with other conditions. Therefore, in order to make a right diagnosis, your doctor will most likely appoint you several different tests to be sure that the symptoms are due namely to this condition. The tests include: blood tests, stool sample, colonoscopy, flexible sigmoidoscopy, X-ray, CT scan.
Side effects of anti-inflammatory medications
Nonsteroidal anti-inflammatory medications are believed to have a negative impact on the digestive tract. In some cases, they can even cause stomach or bowel ulcer bleeding and worsening of digestive tract inflammatory processes. Therefore, if you need to take anti-inflammatories for your bowel, you should consider other medications such as Sulfasalazine, etc.
Some medications from the group can cause side effects affecting the cardiovascular system and even trigger an infraction if used improperly or combined with other anti-inflammatory drugs.
The side effects associated with kidney function include salt and fluid retention, hypertension (high blood pressure).
Other side effects can manifest in a headache, increased liver enzymes, dizziness, confusion, and other symptoms.
Contraindications for anti-inflammatory medications use
Though the medications act differently, there are certain common contraindications for their use: in peptic ulcer or stomach bleeding, uncontrolled hypertension, severe liver or kidney impairment, after a stroke and myocardial infarction, in coronary artery disease, third trimester of pregnancy, and others.
Nonsteroidal anti-inflammatory medications are also not recommended for people with inflammatory bowel disease (Crohn's disease or ulcerative colitis) though other anti-inflammatory medications can be and are used, for example, Sulfasalazine.
If you have a history of allergy to some of the painkillers or anti-inflammatory drugs, you should consult your doctor first before buying any medication from this class.