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NSAIDS have antipyretic activity and can be used to treat fever. [75] [76] Fever is caused by elevated levels of prostaglandin E2 , which alters the firing rate of neurons within the hypothalamus that control thermoregulation. [75] [77] Antipyretics work by inhibiting the enzyme COX, which causes the general inhibition of prostanoid biosynthesis ( PGE2 ) within the hypothalamus . [75] [76] PGE2 signals to the hypothalamus to increase the body's thermal set point. [76] [78] Ibuprofen has been shown more effective as an antipyretic than paracetamol (acetaminophen). [77] [79] Arachidonic acid is the precursor substrate for cyclooxygenase leading to the production of prostaglandins F, D & E.

Studies have shown that people who take anti-inflammatory painkillers have a small but significant increase in the risk of developing a heart attack  or stroke . Although it can occur in anybody, the risk is mainly in people already known to have cardiovascular problems such as angina or peripheral arterial disease , and in the elderly. Perhaps the highest risk is in people who have previously had a heart attack. For example, one research study looked at people who had previously had a heart attack. The results showed a marked increase in the rate of a second heart attack in people who were taking an anti-inflammatory compared to those who were not.

With the notable exception of acetaminophen, all the medications listed in the introduction are nonsteroidal anti-inflammatory drugs, commonly called NSAIDs. These drugs are widely used in both people and animals for their pain relieving, anti-inflammatory, and anti-fever properties. Veterinarians often prescribe NSAIDS for dogs with osteoarthritis, a condition where cartilage - the protective material that cushions a joint - breaks down over time, causing the bones to rub against each other. This rubbing can permanently damage the joint and cause pain, inflammation, and lameness. Veterinarians also often use NSAIDs to manage pain after surgery in both dogs and cats.

These changes alter the intrinsic mechanical properties of articular cartilage and produce swelling. 25 The articular cartilage, having lost some of its compressive ability under load, further degenerates. As the surface fibrillation progresses, the articular defects penetrate deeper into the cartilage until the cartilage is lost. The increased pressure on the subchondral bone causes it to thicken. Often bone cysts form deep to the eburnated areas. Eventually, bony nodules or osteophytes form at the periphery of the cartilage surface. All of these changes account not only for the pathology found on radiographs or histologically (findings under the microscope), but also for the joint pain, tenderness, loss of motion and stiffness of OA. 26 It is the relief of some of these clinical manifestations that accounts for the widespread use of NSAIDs not only in the United States, but around the world.

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These changes alter the intrinsic mechanical properties of articular cartilage and produce swelling. 25 The articular cartilage, having lost some of its compressive ability under load, further degenerates. As the surface fibrillation progresses, the articular defects penetrate deeper into the cartilage until the cartilage is lost. The increased pressure on the subchondral bone causes it to thicken. Often bone cysts form deep to the eburnated areas. Eventually, bony nodules or osteophytes form at the periphery of the cartilage surface. All of these changes account not only for the pathology found on radiographs or histologically (findings under the microscope), but also for the joint pain, tenderness, loss of motion and stiffness of OA. 26 It is the relief of some of these clinical manifestations that accounts for the widespread use of NSAIDs not only in the United States, but around the world.

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