Overview: Taking NSAIDs like ibuprofen or naproxen for arthritis may worsen inflammation over time, a new study reports.
Taking anti-inflammatory pain relievers like ibuprofen and naproxen for osteoarthritis may worsen inflammation in the knee joint over time, according to a new study to be presented next week at the annual meeting of the Radiological Society of North America (RSNA).
Osteoarthritis is the most common form of arthritis, affecting more than 32 million adults in the US and more than 500 million people worldwide. It is most common in the hands, hips, and knees. In people with osteoarthritis, the cartilage that protects the joint gradually wears away. Arthritis is often accompanied by inflammation or swelling of the joint, which can be painful.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for osteoarthritis pain and inflammation. But little is known about the long-term effects of these drugs on disease progression.
“To date, no curative therapy has been approved to cure or reduce the progression of osteoarthritis of the knee,” said the study’s lead author, Johanna Luitjens, a postdoctoral researcher in the Department of Radiology and Biomedical Imaging at the University of California, California. San Francisco.
“NSAIDs are commonly used to treat pain, but it’s still an open debate about how NSAID use affects outcomes for osteoarthritis patients. Specifically, the impact of NSAIDs on synovitis, or the inflammation of the membrane that lines the joint, has never been analyzed using MRI-based structural biomarkers.”
Dr. Luitjens and colleagues wanted to analyze the association between NSAID use and synovitis in patients with osteoarthritis of the knee and assess how treatment with NSAIDs affects joint structure over time.
“Synovitis mediates the development and progression of osteoarthritis and may be a therapeutic target,” said Dr. Luitjens. “Therefore, the aim of our study was to analyze whether treatment with NSAIDs affects the development or progression of synovitis and to investigate whether cartilage imaging biomarkers, which reflect changes in osteoarthritis, are affected by treatment with NSAIDs.”
For the study, 277 participants from the Osteoarthritis Initiative cohort with moderate to severe osteoarthritis and ongoing NSAID treatment for at least one year between baseline and four years of follow-up were enrolled in the study and compared to a group of 793 control participants who were not treated. with NSAIDs. All participants underwent a 3T MRI of the knee initially and after four years. Images were scored for biomarkers of inflammation.
Cartilage thickness, composition and other MRI measurements served as non-invasive biomarkers for evaluating arthritis progression.
The results showed no long-term benefit from using NSAIDs. Joint inflammation and cartilage quality were worse at baseline in the participants taking NSAIDs, compared to the control group, and worsened after four years of follow-up.
“In this large group of participants, we were able to show that there were no protective mechanisms of NSAIDs in reducing inflammation or slowing the progression of osteoarthritis of the knee joint,” said Dr. Luitjens.
“The use of NSAIDs for their anti-inflammatory function has often been propagated in patients with osteoarthritis in recent years and should be reviewed as a positive effect on joint inflammation could not be demonstrated.”
According to dr. Luitjens there are several possible reasons why the use of NSAIDs increases synovitis.
“On the one hand, the anti-inflammatory effect normally derived from NSAIDs may not effectively prevent synovitis, with progressive degenerative changes resulting in synovitis worsening over time,” she said.
“On the other hand, patients who have synovitis and are on analgesic medications may be more physically active as a result of pain relief, potentially leading to worsening of synovitis, even though we adjusted for physical activity in our model.”
Dr. Luitjens noted that prospective, randomized studies should be conducted in the future to provide conclusive evidence for the anti-inflammatory activity of NSAIDs.
Co-authors are Charles McCulloch, Ph.D., Thomas Link, MD, Ph.D., Felix Gassert, MD, Gabby Joseph, Ph.D., and John Lynch, Ph.D.
About this neuropharmacology and arthritis research news
Author: Linda Brooks
Contact: Linda Brooks—RSNA
Image: The image is in the public domain
Original research: The findings will be presented at the 108th Scientific Meeting and Annual Meeting of the Radiological Society of North America