I would not say that the long half life NSAID's are necessarily contraindicated during breastfeeding. They all tend to be quite highly protein bound, and their oral bioavailability tends to be low. Thus, diclofenac, or ibuprofen are better for nursing mothers because of their short half lives, but the others have been used without problems as well. The thing is that there is not much to choose from between NSAID's. They all tend to be, more or less, the same, and if someone does not respond to one they are unlikely to respond to another (no matter what the drug companies say). I think a review of the diagnosis might be worthwhile. Joint infections? Are you sure? Other medications which can be used or added are chloroquine, or low doses of prednisone. ASA could also be used. I do not understand, to tell you the truth, the approach of changing medications all the time, rather than using one to its maximum and then adding something else, if the first has little effect, because often medications which have no effect alone, can work very well, say, with 5 or 10 mg of prednisone daily in addition, with the possibility of weaning from the prednisone after control is achieved. This information is from my old days, before I became a pediatrician, and perhaps the approach has changed. Jack Newman, MD, FRCPC