Summary: A new study reports that taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for arthritis may worsen inflammation over time.
A new study presented next week at the annual meeting of the Radiological Society of North America (RSNA) shows that taking anti-inflammatory painkillers such as ibuprofen and naproxen for osteoarthritis may worsen inflammation in the knee joint over time.
Osteoarthritis is the most common form of arthritis, affecting more than 32 million adults in the United States and more than 500 million people worldwide. They occur most often in the hands, hips, and knees. In people with osteoarthritis, the cartilage that cushions the joint gradually wears away. Arthritis is often accompanied by inflammation or swelling of the joint, which can be painful.
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for the pain and inflammation of osteoarthritis. But little is known about the long-term effects of these drugs on disease progression.
“To date, no therapeutic therapy has been approved to treat or reduce the progression of knee osteoarthritis,” said the study’s lead author, Joanna Luytens, a postdoctoral researcher in the department of radiology and biomedical imaging at the University of California, San Francisco.
NSAIDs are frequently used to treat pain, but it is still an open discussion how the use of NSAIDs may affect the outcome of patients with osteoarthritis. In particular, the effect of NSAIDs on synovitis, or inflammation of the membrane lining the joint, has not been analyzed using MRI-based skeletal biomarkers.”
Luitjens and colleagues set out to analyze the relationship between NSAID use and synovitis in patients with knee osteoarthritis and to assess how NSAID treatment 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 NSAID treatment affects the development or progression of synovitis and to investigate whether chondrogenic biomarkers, which reflect changes in arthritis, are affected by NSAID treatment.”
For the study, 277 participants from the Osteoporosis Initiative cohort with moderate to severe osteoporosis and continued treatment with NSAIDs for at least one year between baseline and four-year follow-up were included in the study and compared to a group of 793 control participants who were not treated. with non-steroidal anti-inflammatory drugs. All participants underwent 3T MRI of the knee initially and four years later. Images were recorded for vital signs of inflammation.
Cartilage thickness, composition, and other MRI measurements served as noninvasive biomarkers for evaluating osteoarthritis progression.
The results showed no long-term benefit from the use of NSAIDs. Arthritis and cartilage quality were worse at baseline in the NSAID participants, compared to the control group, and worsened at the four-year follow-up.
“In this large group of participants, we were able to show that there are no protective mechanisms from 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 been published frequently in patients with osteoarthritis in recent years and should be reconsidered, as a positive effect on osteoarthritis cannot be demonstrated.”
According to Dr. Luitjens, there are several possible reasons why NSAID use can increase synovitis.
“On the other hand, the anti-inflammatory effect that would normally come from NSAIDs may not effectively prevent synovitis, with the progressive degenerative change leading to exacerbation of synovitis over time,” she said.
“On the other hand, patients with synovitis who are taking pain medication may be more physically active because of the pain relief, which may exacerbate the synovitis, even though we adjusted for physical activity in our model.”
Dr. Luitjens noted that future randomized studies should be conducted to provide definitive evidence of the anti-inflammatory effect of NSAIDs.
Co-authors are Charles McCulloch, PhD, Thomas Link, MD, PhD, Felix Jasert, MD, Gabe Joseph, PhD, and John Lynch, PhD.
About this research in Neuropharmacology and Arthritis
author: Linda Brooks
Contact: Linda Brooks – RSNA
picture: The image is in the public domain
Original search: The results will be presented at the 108th Scientific Society and Annual Meeting of the Radiological Society of North America