A new study prepared for the annual meeting of the Radiological Society of North America (RSNA) suggested that taking popular anti-inflammatory pain relievers like ibuprofen and naproxen for arthritis can worsen inflammation over time.
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat osteoarthritis pain, a form of arthritis afflicting over 32 million American adults and over half a billion people globally.
Typically, osteoarthritis presents in the hands, knees, and hips, with the cushioning cartilage slowly degrading. Painful swelling and inflammation are also typical symptoms sufferers experience.
Despite NSAIDs being commonly prescribed to treat osteoarthritis pain and inflammation, little is known about their long-term impact on the condition.
The study’s lead author, Johanna Luitjens, a postdoctoral scholar in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco, said, “To date, no curative therapy has been approved to cure or reduce the progression of knee osteoarthritis … NSAIDs are frequently used to treat pain, but it is still an open discussion of how NSAID use influences outcomes for osteoarthritis patients.”
Luitjens was particularly interested in uncovering the impact the drugs have on synovitis. Synovitis is the swelling of the synovium membrane, the layer of connective tissue that lines a joint like the knee.
The team analyzed the correlation between taking NSAIDs and the prevalence of synovitis in people with osteoarthritis of the knee.
According to Dr. Luitjens, the study aimed to “analyze whether NSAID treatment influences the development or progression of synovitis and to investigate whether cartilage imaging biomarkers, which reflect changes in osteoarthritis, are impacted by NSAID treatment.”
To this end, 277 subjects with osteoarthritis and long-term NSAID treatment were compared to 793 participants who did not use the drugs to treat their arthritis. MRIs were used to identify thickened cartilage and other biomarkers in inflamed joints.
The authors claimed to identify that NSAIDs provided no benefits over the long term. In fact, after four years, joint health was worse in the group that used the drugs versus those that did not.
“In this large group of participants, we were able to show that there were no protective mechanisms from NSAIDs in reducing inflammation or slowing down progression of osteoarthritis of the knee joint,” said Dr. Luitjens.
She suggested that “the use of NSAIDs for their anti-inflammatory function … should be revisited, since a positive impact on joint inflammation could not be demonstrated.”
Although they accounted for exercise, Dr. Luitjens still suspects that the painkillers’ numbing action may permit individuals to be more active, possibly aggravating problematic joints further.
Those “taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to worsening of synovitis, although we adjusted for physical activity in our model.”
According to Dr. Luitjens, randomized testing will need to be done in the future to more conclusively determine the impact of NSAIDs on inflammation.
