Non-Steroidal Anti-Inflammatory Drugs for the Control of Autoimmune Diseases: A Short Review of Mechanisms, Clinical Applications, and Emerging Perspectives
DOI:
https://doi.org/10.33687/ricosbiol.04.04.117Keywords:
non-steroidal anti-inflammatory drugs, autoimmune diseases, rheumatoid arthritis, spondyloarthritis, cyclooxygenase inhibitors, drug safety, cardiovascular risk, gastrointestinal toxicity, disease-modifying antirheumatic drugs, topical NSAIDs, nitric oxide-donating NSAIDsAbstract
Non-steroidal anti-inflammatory drugs (NSAIDs) remain among the most widely prescribed medications worldwide for the management of pain and inflammation in autoimmune rheumatic diseases. This comprehensive review examines the pharmacological mechanisms, clinical applications, safety profiles, and evolving role of NSAIDs in the treatment of autoimmune diseases, with particular focus on rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), and juvenile idiopathic arthritis (JIA). NSAIDs exert their primary therapeutic effects through inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. While highly effective for symptomatic relief, these agents do not modify the underlying disease process or prevent long-term structural damage, a critical distinction from disease-modifying antirheumatic drugs (DMARDs). The review synthesizes evidence from recent clinical trials, meta-analyses, and clinical practice guidelines, demonstrating that NSAIDs serve as first-line therapy for rapid symptom control, particularly as bridging therapy while DMARDs take effect. However, their use is constrained by significant safety concerns, including gastrointestinal toxicity, cardiovascular risks, and renal impairment. Selective COX-2 inhibitors offer improved gastrointestinal safety but are associated with increased cardiovascular events, with naproxen appearing least harmful among traditional NSAIDs. Emerging trends include the development of novel formulations such as topical NSAIDs, nitric oxide-donating hybrids, dual-acting anti-inflammatory agents, and targeted drug delivery systems. Despite the advent of biologic and targeted synthetic DMARDs, NSAIDs continue to occupy an important adjunctive role in autoimmune disease management when used judiciously with appropriate risk stratification. This review provides clinicians with evidence-based guidance for optimizing NSAID therapy while minimizing adverse effects, and highlights future directions for safer, more effective anti-inflammatory agents.
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The data supporting the conclusions of this review are derived from previously published studies, which are cited throughout the manuscript. Any aggregated datasets used for comparative analysis, if applicable, are available from the corresponding author upon reasonable request.
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