How to reduce inflammation?

From the Guidelines

To lower inflammation, start with non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 inhibitors (COXIBs) in maximum tolerated and approved dosage, as recommended by the expert consensus guidelines for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults 1.

Key Considerations

• The treatment goals for CNO include relieving symptoms, maintaining or regaining functional capacity, reducing inflammation, and preventing structural musculoskeletal damage 1.
• Disease activity assessment is crucial, and treatment response should be evaluated at 2-4 weeks for NSAIDs/COXIBs and at 3-6 months for second-line treatments like intravenous bisphosphonates (IVBP) or tumor necrosis factor-α inhibitors (TNFi) 1.
• Lifestyle recommendations, including patient education, physiotherapy, and dental examination, should be considered alongside pharmacological treatments 1.

Treatment Options

• First-line treatment: NSAIDs/COXIBs in maximum tolerated and approved dosage, with consideration for directly adding or advancing to second-line treatment in patients with spinal bone lesions or significant accumulated skeletal damage 1.
• Second-line treatment: IVBP or TNFi, depending on patient characteristics, with the option to consider conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) especially in patients with inflammatory polyarthritis 1.
• Third-line treatment: Referral to an expert center for consideration of other treatment options for patients with insufficient response to IVBP and TNFi (or combined) 1.

Additional Recommendations

• Be aware of potential complications and adverse effects of treatment, including neurovascular complications in patients with anterior chest wall involvement and the risk of vertebral fractures in patients with spinal involvement 1.
• Monitor adverse treatment effects according to established guidelines and consider tapering or adjusting treatment as necessary based on patient response and tolerance 1.

From the FDA Drug Label

The pharmacological activity of naproxen in reducing fever and inflammation may diminish the utility of these diagnostic signs in detecting complications of presumed noninfectious, noninflammatory painful conditions The pharmacological activity of ibuprofen tablets in reducing fever and inflammation may diminish the utility of these diagnostic signs in detecting complications of presumed noninfectious, painful conditions

Naproxen and Ibuprofen can be used to lower inflammation.

• Key points:
  • Naproxen and ibuprofen have pharmacological activity in reducing inflammation.
  • They can be used to treat inflammatory conditions, but the decision to use them should be made with caution and under medical supervision.
  • Patients with certain medical conditions, such as asthma or liver disease, should be carefully monitored while taking these medications 2, 3.

From the Research

Reducing Inflammation with NSAIDs

To reduce inflammation, Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used due to their therapeutic analgesic efficacy and relative tolerability 4, 5.

• NSAIDs have been shown to be effective in reducing pain and inflammation, but they can also have adverse effects on various organs, including the gastrointestinal, cardiovascular, hepatic, renal, cerebral, and pulmonary systems 5.
• The use of NSAIDs, both traditional NSAIDs (tNSAIDs) and cyclo-oxygenase 2 (COX-2) selective (coxibs), is associated with an increased risk of adverse cardiovascular events, myocardial infarction, heart failure, and cerebrovascular events 4.
• However, some NSAIDs, such as naproxen and low-dose ibuprofen, may have a lower increased cardiovascular risk profile compared to others 4, 6.
• A meta-analysis of randomized controlled trials found that naproxen was associated with a significant decrease in C-reactive protein (CRP) levels, a marker of inflammation, whereas lumiracoxib was associated with a significant increase in CRP levels 6.

Considerations for NSAID Use

When using NSAIDs to reduce inflammation, it is essential to consider the following:

• The risk of adverse cardiovascular events is heterogenous across NSAIDs, and the risk is associated with multiple factors, including NSAID class, COX-2 selectivity, treatment dose and duration, and baseline patient risk 4.
• NSAIDs should be used at the lowest effective dose for the shortest amount of time, especially among individuals with increased cardiovascular risk 4.
• The benefits and risks of NSAID use should be carefully evaluated, and alternative treatments should be considered when possible 5.