Acute inflammation serves important roles in body defense and healing. Inflammatory cells are among the first responders when an injury or infection occurs, sounding the alarm for the immune system. They also serve as the cleanup and restoration crew after the local immune system battle ends. While acute inflammation is beneficial and restorative, chronic inflammation often proves destructive. Many disease processes are fueled by chronic inflammation. Anti-inflammatory medications interrupt a destructive inflammatory response.
Aspirin
Available commercially for more than 100 years, aspirin remains one of the most frequently used anti-inflammatory medications. In a 2009 review article published in "Molecular Interventions," Drs. Carlo Patrono and Colin Baigent note that aspirin is the prototype on which the nonsteroidal anti-inflammatory drugs, or NSAIDs, have been modeled. The anti-inflammatory activity of aspirin relates to its inhibition of the cyclooxygenase, or COX, enzyme system, which produces prostaglandins. Prostaglandins promote inflammatory activity through a cascade of chemical signals.
Ibuprofen
Ibuprofen is one of the oldest of the NSAIDs, first receiving approval from the U.S. Food and Drug Administration in 1974. The drug remains one of the most commonly used over-the-counter and prescription medications in the United States. "Drug Topics," an electronic newsmagazine for pharmacists, reports that more than 25.7 million prescriptions for generic ibuprofen were filled in 2009. Ibuprofen and other NSAIDs, with the exception of celecoxib, are nonspecific inhibitors of the COX enzyme system.
Indomethacin
First introduced in 1963, indomethacin was one of the first pharmaceutical compounds produced in the search for new aspirin-like anti-inflammatories, as noted in the medical reference text "Goodman and Gilman's The Pharmacological Basis of Therapeutics." Indomethacin is a potent inhibitor of the COX enzyme system and exhibits pain-relieving effects separate from its anti-inflammatory activity. Indomethacin remains in use for moderate to severe arthritic conditions, including rheumatoid arthritis, gouty arthritis, osteoarthritis, ankylosing spondylitis and shoulder tendinitis and bursitis. A high rate of gastrointestinal side effects, including bleeding, limits the use of indomethacin.
Prednisone
Prednisone is a man-made corticosteroid medication that mimics the actions of the natural steroid cortisol, which is produced by the adrenal glands. Corticosteroids are potent anti-inflammatories that suppress all stages of inflammation, as noted in "Goodman and Gilman's The Pharmacological Basis of Therapeutics." Prednisone may be used in a variety of inflammatory conditions, including gouty, psoriatic and rheumatoid arthritis; systemic lupus erythematosus; severe seborrheic dermatitis and psoriasis; drug hypersensitivity reactions; optic neuritis; sarcoidosis; autoimmune hemolytic anemia; and ulcerative colitis. Side effects associated with prolonged use of prednisone warrant caution, as noted in the prescribing information for the medication.
