Common anti-inflammatories are associated with the development of osteoarthritis

New data presented at the annual meeting of the Radiological Society of North America suggests that long-term use of non-steroidal anti-inflammatory drugs (NSAIDS), such as naproxen or ibuprofen, could be associated with rapid progression of osteoarthritis symptoms. The researchers caution to stress that the association is still observational and more work needs to be done to understand how these medications may be linked to worsening of arthritis.

The new research, led by Joanna Luijens of the University of California, San Francisco, focused on the relationship between long-term NSAID use and symptoms of an arthritis called synovitis. The synovial membrane is the connective tissue that lines joints such as the knees or wrists, and synovitis occurs when this membrane becomes irritated and inflamed.

“Synovitis mediates the development and progression of arthritis 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 chondrogenic biomarkers, which reflect changes in arthritis, are affected by NSAID treatment.”

The researchers recruited more than 1,000 people with moderate to severe knee osteoarthritis. About a quarter of the group received sustained NSAID treatment for more than a year, while the remaining participants were not treated with common pain relievers. Each participant completed an MRI of the knee at the start of the study, and again four years later.

In evaluating a variety of biomarkers on MRI of synovitis, researchers saw no long-term benefits from using NSAIDs over the four-year study period. In fact, markers of arthritis were unexpectedly worse in the NSAID group at the end of the study, compared to those not taking the NSAID.

“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 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.”

Luitjens is careful to avoid suggesting that NSAIDs directly contribute to worsening of synovitis over time. It’s possible, she says, that the anti-inflammatory effects of these drugs aren’t directly aggravating the condition, but instead that those taking these painkillers could simply move more and speed up the progression of their condition.

Luitjens added, “…patients with synovitis who are taking pain medication may be more physically active because of the pain relief, which may exacerbate synovitis, even though we adjusted for physical activity in our model.”

Ultimately, the results of this preliminary study (which has not yet been peer-reviewed and published in a journal) leave doctors and arthritis patients in a difficult position. NSAIDs are common agents for pain relief for 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 arthritis is questionable following these findings.

Source: Radiological Society of North America

Leave a Reply

%d bloggers like this: