Salicylates As a Treatment Option for Arthritis

Senior woman taking salicylates.
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Decades ago, aspirin was the primary drug used to manage arthritis pain. It belongs to a category of pain relievers called non-steroidal anti-inflammatory drugs (NSAIDs). These work by stopping the production of prostaglandin—substances in the body that cause inflammation and pain.

There are three categories of NSAIDs, including salicylates, traditional NSAIDs, and COX-2 inhibitors. Salicylates are further divided into two groups—acetylated and nonacetylated. Aspirin is an acetylated salicylate. It is chemically known as acetylsalicylic acid.

Examples of nonacetylated salicylates include:

  • Disalcid (salsalate)
  • Dolobid (sodium salicylate)
  • Trilisate (choline magnesium trisalicylate)

Pepto-Bismol, or bismuth subsalicylate, also in this group, is an over-the-counter medication used for stomach upset.

The traditional NSAIDs include:

  • Ibuprofen
  • Naproxen

The COX-2 inhibitors include:

  • Bextra (valdecoxib)
  • Celebrex (celecoxib)

Risks and Benefits of Salicylates

Both the acetylated and nonacetylated salicylates are used to treat arthritis pain. They differ, however, in how they can affect the cardiovascular and gastrointestinal systems. Aspirin temporarily relieves arthritis pain, for example, but it's also known to have cardioprotective effects, making it unique among the salicylates, and a good option for patients at risk for heart disease. Aspirin prevents blood from clotting in the vessels leading to the heart and brain, reducing the risk of heart attack and stroke. Nonacetylated salicylates, along with the other NSAIDs and the COX-2 inhibitors, can potentially increase your risk of heart disease.

On the flip side, aspirin's anti-clotting effects can make you more prone to ulcers and gastrointestinal bleeding; they must also be stopped if you have surgery, to limit excessive bleeding.

Unlike aspirin, which inhibits platelet aggregation (clotting) and consequently increases the risk of bleeding, nonacetylated compounds have much less of an effect on platelets. As a result, they are less likely to cause bleeding or bleeding ulcers at doses necessary to decrease the inflammation and pain of arthritis.

Salicylate Sensitivity

If consumed in large doses—greater than what is prescribed for a therapeutic effect—both forms of salicylic acid can be toxic. However, the dose required to produce a toxic reaction varies from person to person, as some people have a decreased ability to properly metabolize and excrete the drug (known as salicylate sensitivity).

Symptoms include:

  • Agitation, fever, convulsions, confusion, coma
  • Low blood pressure
  • Rapid heart rate
  • Rapid breathing
  • Wheezing
  • Nausea and vomiting
  • Bleeding
  • Hallucinations
  • Drowsiness

Research has indicated that salicylate toxicity is more likely to affect older people. One study assessed the effect of age on salicylate toxicity in elderly people with rheumatoid arthritis. Despite taking a lower dose of salicylates than the younger group of people in the study, the elderly group was more likely to experience a toxic reaction.

Additionally, some people may be allergic to salicylic acid. Aside from its use in medicine, salicylates are used in food preservatives and antiseptics, to which you may already have a known allergy. They also have other properties that help to prevent bacterial growth, kill fungus, and peel away dead skin.

Symptoms of salicylate allergy include:

  • Asthma-like symptoms, such as trouble breathing and wheezing
  • Headaches
  • Nasal congestion
  • Changes in skin color
  • Itching, skin rash, or hives
  • Swelling of the hands, feet, and face
  • Stomach pain

A Word From Verywell

While traditional NSAIDs and the COX-2 inhibitors are considered by some doctors to be more effective than salicylates at treating the pain and inflammation of arthritis, acetylated salicylates remain a good option. They are inexpensive in comparison to other drugs, and their cardioprotective effects may make them the preferred choice for patients at risk of heart attack and stroke. Talk to your doctor about which medication is best for you, based on your medical history and risk factors.