Popular anti-inflammatory drugs associated with worse progression of osteoarthritis
New data presented at the annual meeting of the Radiological Society of North America suggest that long-term use of nonsteroidal anti-inflammatory drugs (NSAIDS), such as naproxen or ibuprofen, may be associated with accelerated progression of osteoarthritis symptoms. The researchers are cautious, stressing that the link is still observational and that more work is needed to understand how these drugs might be linked to worsening arthritis inflammation.
The new study, led by Johanna Luitjens of the University of California, San Francisco, focused on the link between long-term use of NSAIDs and symptoms of arthritis called synovitis. The synovial membrane is the connective tissue that lines joints like our knees or wrists, and synovitis is when that membrane becomes irritated and inflamed.
“Synovitis mediates the development and progression of osteoarthritis and may be a therapeutic target,” explained Luitjens. “Therefore, the aim of our study was to analyze whether NSAID treatment affects the development or progression of synovitis and to investigate whether cartilage biomarkers, which reflect changes in osteoarthritis, are affected by NSAID treatment.”
Researchers recruited over 1,000 subjects with moderate to severe osteoarthritis of the knee. About one-quarter of the group received continuous NSAID therapy for more than a year, while the remaining participants were not treated with conventional pain relievers. Each participant had an MRI of the knee at the start of the study and then four years later.
Assessing various MRI biomarkers of synovitis, the researchers saw no long-term benefit from NSAID use over the four-year study period. In fact, markers of joint inflammation were unexpectedly worse in the NSAID group at the end of the study, compared to those not taking anti-inflammatory drugs.
“In this large group of participants, we were able to show that there are no protective mechanisms from NSAIDs to reduce inflammation or slow the progression of knee osteoarthritis,” said Luitjens. “The use of NSAIDs due to their anti-inflammatory function has been often promoted in patients with osteoarthritis in recent years and should be reconsidered, as no positive effect on joint inflammation can be proven.”
Luitjens is careful to avoid suggesting that NSAIDs directly contribute to the worsening of synovitis over time. She says it’s possible that the anti-inflammatory effects of these drugs aren’t directly making the condition worse, but instead, those taking these painkillers may simply be moving more and speeding up the progression of their condition.
“… patients who have synovitis and take pain medication may be more physically active because of the pain relief, which could potentially lead to worsening synovitis, even though we adjusted for physical activity in our model,” added Luitjens.
Ultimately, the results of this preliminary study (which have yet to be peer-reviewed and published in a journal) leave clinicians and arthritis patients in a quandary. NSAIDs are common pain relievers in patients with osteoarthritis, so there is no indication that patients should stop taking these medications for acute pain relief. However, according to Luitjens, the long-term use of NSAIDs as a way to reduce synovitis and slow the progression of osteoarthritis is questionable after these findings.
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