Medications such as ibuprofen and naprosyn, also known as NSAIDs, have known possible toxic effects involving the small and large intestine. These range from intestinal inflammation or stricturing, iron-deficiency anemia, and even bleeding or perforation. As you can see, this is quite similar to what is seen with active IBD. NSAIDs can injure the intestinal mucosa, and their absorption into the blood stream can worsen inflammation.

For example, NSAIDs are commonly used by IBD patients for the treatment of joint pain. More than one out of four people with IBD have joint pain as a result of the condition. This joint pain might be a sign of active intestinal inflammation. Careful evaluation is important in this case, because if active IBD is discovered, appropriate treatment may improve symptoms. NSAID use would not help that situation and could actually make it worse.

Some studies have suggested that even up to one-third of patients in remission can experience a clinical relapse of their IBD with a short course of NSAIDs. The newer NSAIDs (selective COX-2 inhibitors) might be safer to use for a short course, but this has only been evaluated in patients whose IBD was in clinical remission. Using NSAIDs to treat minor discomfort without trying other medications or local measures is not ideal. When considering these medications, setting up a personalized approach with your physician is best.

IBD is a chronic inflammatory disorder of the intestines with known extraintestinal manifestations presumed to be a consequence of acute and chronic inflammation. Peripheral and axial arthralgias and arthritis occur in up to 35 % of IBD patients. In this situation, NSAIDs are commonly used for local anti-inflammatory and analgesic effects. There is an association of these medications’ use and disease flares of Crohn’s disease and ulcerative colitis [1–3].