Anti-inflammatory drugs, anti-inflammatory drugsAntiphlogistics are different drugs, whose common feature is their effect against inflammation. Since an inflammation is a very complex process for the human body, which has been well studied, there are various approaches among the drugs, which all suppress or reduce the inflammation. Due to the different points of attack there are big differences when which anti-inflammatory drug is the right one.

Inflammation is the uniform reaction of the body to various triggers such as pathogens, toxins or foreign bodies. Inflammation is caused on the one hand by the tissue itself, by releasing so-called tissue hormones as an alarm signal and thus alerting the immune system, and on the other hand by activating the immune system with the help of various immune cells distributed throughout the body, the scavenger cells (= macrophages), the dendritic cells in the skin or lymphocytes (to the white blood cells), which lurk for foreign substances and are activated by them and then fully develop their function. The emission of messenger substances to alert the body’s own defence system leads to the accumulation of many other immune cells in the bloodstream, which then accumulate at the site of action and cause visible inflammation to dissolve and remove the foreign body and kill the bacteria that have entered with the foreign body.

When these defence cells die, the mixture of living and dead cells and the remaining foreign body components of the pus and the inflammation around the foreign body is formed. Through this defence mechanism the body wants to work the foreign body out of the body again. The classic signs of inflammation are: If the inflammation is severe, the localized expansion described here can also spread via the bloodstream into the entire body and cause life-threatening sepsis.

  • Redness (=lat: rubor)
  • Swelling (=lat: tumor)
  • Overheating (=lat: calor)
  • Restriction of the functionality (= functio laesa). A distinction is made between so-called steroidal and non-steroidal anti-inflammatory drugs (=antiphlogistics) and these in turn are distinguished from herbal agents. Steroids play an outstanding role in our body.

Our body can form a variety of steroids, which can ultimately be assigned to the sex hormones (e.g. testosterone), the glucocorticoids (e.g. cortisol) or the mineralocorticoids (e.g. aldosterone).

Cortisol has an anti-inflammatory effect. Common to all of them is their basic chemical structure, which is called steroidal due to the arrangement of the molecules. The best known steroidal molecule in the body is cholesterol, from which all these steroids are formed in the adrenal gland of our body, among other places.

The problem here is the excessive width of the steroidal action in the body. Glucocorticoids such as cortisol are generally referred to as the stress hormone of our body. In addition to inhibiting inflammation, mobilizing energy reserves and providing the body with energy, it also suppresses the immune system and improves mood.

Each steroid can be chemically imitated and administered to the body as a tablet, but the chosen drug will always produce the effect on the entire system rather than the desired effect on a single one of these systems. Due to the wide range of effects, it can be used for allergies, asthma, bronchitis, multiple sclerosis, rheumatism, hepatitis, skin rashes, after transplants, kidney disease or autoimmune diseases. If cortisol is used as an anti-inflammatory, the effect on all other systems must always be taken into account.

The undesirable effects range from fatty deposits on the trunk of the body due to energy redistribution, osteoporosis, muscle wasting, skin changes, stomach and intestinal ulcers to high blood pressure. Non-steroidal anti-inflammatory drugs are also called anti-rheumatic drugs. They include the very well-known active ingredients acetylsalicylic acid (e.g.

Aspirin®, ASS®), ibuprofen (e.g. Nurofen®, Neuralgin®) naproxen (e.g. Dolormin®) and diclofenac (e.g. Voltaren®).

Non-steroidal because they do not have the chemical structure of steroids, i.e. they do not have the typical appearance of steroids. As the name antirheumatic drugs suggests, they are used to treat rheumatism and other inflammatory joint diseases such as rheumatoid arthritis, ankylosing spondylitis or gout. Diclofenac is the most commonly used drug in these cases.

The non-steroidal anti-inflammatory drugs act on the formation of the hormones that are released when an injury occurs to alert the immune system, the prostaglandins. The enzyme that plays a role in the formation is called cyclooxygenase. Since prostaglandins also play a role in fever and pain, these drugs also have an excellent effect on fever and pain.

The side effects arise from the role of cyclooxygenases in other processes in the body, especially the formation of gastric mucus. Normally there is a balance of different fluids on the inside of the stomach lining. On the one hand there is the aggressive stomach acid, which consists of hydrochloric acid and which the body needs to digest food so that it can then be digested by the body in the intestine.

Since the stomach acid would also digest its own stomach wall, the acid is opposed on the other hand by the protective stomach fluids, which are supposed to prevent this self-digestion. Since acids are best neutralized with alkaline liquids, this consists of a lot of bicarbonate-containing liquid, a lye. This balance enables a proper digestion of the food components while at the same time protecting the gastric mucosa on the inside of the stomach.

And it is precisely here that cyclooxygenase and prostaglandins play a decisive role in the production of the protective bicarbonate film of the gastric mucosa. If this formation is now inhibited by the non-steroidal anti-inflammatory drugs, this balance is upset and proportionally much more stomach acid is formed than bicarbonate and the stomach acid can attack the stomach wall. Patients then often complain of indigestion, nausea or stomach pain.

If the process progresses, a gastric or duodenal ulcer develops, which in extreme cases can lead to life-threatening gastric perforation. This major side effect of non-steroidal anti-inflammatory drugs can occur after only a few doses. For this reason, patients at risk should always additionally take a so-called stomach protector, e.g. a proton pump inhibitor.

Patients who take acetylsalicylic acid are particularly at risk because it also changes the properties of our blood platelets so that they can no longer clump together. Acetylsalicylic acid therefore increases the risk of bleeding enormously. A further side effect that should not be neglected when taking it over a long period of time is its damaging effect on the heart and kidneys.

Patients with problems and diseases of one of these organs should only take non-steroidal anti-inflammatory drugs after consulting a doctor or on the doctor’s instructions. This also applies to patients with lung disease, since inhibition of cyclooxygenase also leads to the overweight of other substances that alter the pulmonary alveoli and thus make breathing more difficult and in extreme cases can trigger an asthma attack in asthmatics. Herbal anti-inflammatory drugs are often a very good alternative to chemically produced tablets, not least when the inflammation is only very mild.

Their effectiveness is based on mechanisms similar to those of chemical preparations. Not infrequently the chemical preparations even have their origin in the plant world, e.g. the acetylsalicylic acid in willow bark extract. From the plant world, the devil’s cricket, ash, rose hip, aspen and stinging nettle have proved their worth.

Turmeric, oregano, rosemary, ginger and green tea also have anti-inflammatory effects and can be incorporated into the diet to improve inflammation. Anti-inflammatory agents can be obtained in many different forms due to their versatile use. Above all, the classic tablet or capsule form.

This is ideal for most patients. The exception here are patients with gastrointestinal diseases, as absorption from the intestine can be disturbed. An alternative to tablets is effervescent tablets for dissolving or dropping.

Suppositories have also proved to be effective for children. For skin diseases there is another optimal form: creams, gels or ointments. This avoids all the side effects that any medication inevitably brings with it and the anti-inflammatory drugs are applied directly to the site of action, the skin.

Known applications are the gels, e.g. with diclofenac (Voltaren®), which are regularly used for sports injuries. Also, normal skin diseases such as acne, eczema or sunburn, all of which are accompanied by inflammation, are easy to treat without side effects in the body. For severe inflammation such as the extremely painful rheumatic attack, most preparations are also available as an injection solution for direct injection into the muscle or a vein. This form of administration allows larger quantities to be injected into the body and the effect is much faster.