Salicylates - A Treatment Option for Arthritis

Salicylates Are Classified as NSAIDs

Senior woman taking salicylates.
iloveimages/Juice Images/Getty Images

Chemically-speaking, salicylates are the salt or ester of salicylic acid. Most of us know that aspirin is derived from salicylic acid. Aspirin is chemically known as acetylsalicylic acid. Salicylates are divided into two groups, acetylated and nonacetylated. While aspirin is acetylated, examples of nonacetylated salicylates include Disalcid (salsalate), Trilisate (choline magnesium trisalicylate), and Pepto-Bismol (bismuth subsalicylate).

Another, called Dolobid (diflunisal), is no longer available in the US.

How Salicyates Are Used

Found naturally in certain plants, such as white willow bark and the leaves of wintergreen, salicylates were believed to have a protective effect against insects and plant diseases. In 1860, salicylic acid was chemically synthesized leading to more widespread use. Medicinally, salicylic acid has analgesic (pain-relieving), anti-inflammatory, and anti-pyretic properties. And, because it can relieve pain as well as reduce inflammation and fever, salicylic acid seemed like the Trifecta of medicine. However, at dosages needed to effect that response, salicylic acid can cause gastrointestinal issues. If consumed in large doses, greater than what is prescribed for a therapeutic effect, salicylic acid can be toxic. Additionally, some people may be allergic to salicylic acid. Aside from its use in medicine, salicylates are used in food preservatives, in antiseptics, and have other properties that help to prevent bacterial growth, kill fungus, and peel away dead skin (keratolytic, as in Kerasol).

Gastrointestinal and Cardiovascular Risk Associated With Salicylates

Unlike aspirin, which inhibits platelet aggregation 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.

On the other hand, at least compared to low-dose aspirin, there are no studies to support that nonacetylated salicylates are cardioprotective. In fact, like all other NSAIDs (nonsteroidal anti-inflammatory drugs), their use may cause an increased risk of serious cardiovascular thrombotic events, such as a heart attack.

According to rheumatologist, Scott J. Zashin, MD, "Whether or not high-dose aspirin is as cardioprotective as low-dose aspirin has not been studied. In addition, to my knowledge, there are no published studies comparing the efficacy or gastrointestinal safety of the nonacetylated salicylates and the COX-2 inhibitors."

Studies that can be found pertaining to salicylates tend to be older. A study published in the Journal of Rheumatology compared the effectiveness of salsalate (a nonacetylated salicylate) to Voltaren (diclofenac). It was concluded that salsalate and diclofenac were equally effective and that salsalate could be considered an alternative to other NSAIDs.

Another study, which also was published in the Journal of Rheumatology, 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 linked to increased toxicity.

Dr. Zashin continued, "Based on my experience, the traditional NSAIDs and the COX-2 inhibitors are, in general, more effective agents to treat the pain and inflammation of arthritis. That being said, a trial of a nonacetylated salicylate is not unreasonable in selected patients with an increased risk of bleeding or ulcers."

A Word From Verywell

Decades ago, salicylic acid or aspirin was the primary drug used to manage arthritis pain. That it seemed to reduce inflammation was a bonus at the time. Now, there are myriad drugs from which to choose. Generally thought to be safe, as well as inexpensive by comparison to other drugs, salicylates are an option which should be considered by doctors and patients.

It makes sense for you and your doctor to consider your medical history (e.g., ulcers, heart disease) when choosing between the drug options.

Sources:

Bombardier C. et al. Salsalate, a nonacetylated salicylate, is as efficacious as diclofenac in patients with rheumatoid arthritis. Salsalate-Diclofenac Study Group. Journal of Rheumatology. 1995.  April;22(4):617-24.

Grigor RR et al. Salicylate toxicity in elderly patients with rheumatoid arthritis. Journal of Rheumatology 1987. Feb;14(1):60-66.

Salicylates. Drugs.com.

Continue Reading