Pain relievers such as ibuprofen and naproxen can make arthritis inflammation worse
Taking anti-inflammatory pain relievers such as ibuprofen and naproxen for osteoarthritis may worsen inflammation in the knee joint over time, according to a new study.
Taking anti-inflammatory pain relievers such as ibuprofen and naproxen for osteoarthritis can make inflammation in the knee joint worse over time. That’s according to new research to be presented at the annual meeting of the Radiological Society of North America (RSNA) next week.
As the most common form of arthritis, osteoarthritis (OA) affects more than 32 million adults in the United States and more than 500 million people worldwide. It occurs most often in the hands, hips, and knees. In people with arthrosis, the cartilage that cushions the joint gradually wears out. This is why it is sometimes called degenerative joint disease or “wear and tear” arthritis. Arthritis is often accompanied by inflammation or swelling of the joint, which can be painful.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually prescribed for pain and inflammation in osteoarthritis. Common NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). However, little is known about the long-term effects of these drugs on disease progression.
“To date, no medical therapy has been approved to treat or reduce the progression of osteoarthritis of the knee,” said study lead author Johanna Luytens, a postdoctoral fellow in the Department of Radiology and Biomedical Imaging at UC San Francisco. “NSAIDs are often used to treat pain, but there is still an open debate about how the use of NSAIDs affects outcomes for patients with osteoarthritis. In particular, the effect of NSAIDs on synovitis, or inflammation of the membrane lining the joint, has never been analyzed using MRI-based structural biomarkers.’
Fat adjacent to the patella (Hoff’s fat, infrapatellar fat) can alter the MRI signal in knee inflammation. (A) Normal knee without signs of inflammation. (B) Arrow pointing to a delineated area of higher signal (bright lines) in the adipose region (usually dark), indicating the onset of an inflammatory response. (C) All fat has a higher signal (light gray with white lines), which is a sign of progressive inflammation of the knee joint. By RSNA and Johanna Luytens
Dr. Luytjens and colleagues decided to analyze the relationship between NSAID use and synovitis in patients with knee osteoarthritis and to evaluate how NSAID treatment affects joint structure over time.
“Synovitis mediates the development and progression of osteoarthritis and may be a therapeutic target,” said Dr. Luytjens. “Therefore, the aim of our study was to analyze whether NSAID treatment affects the development or progression of synovitis, and to examine whether NSAID treatment affects cartilage imaging biomarkers that reflect changes in osteoarthritis.”
For the study, 277 participants from the Osteoarthritis Initiative cohort with moderate to severe osteoarthritis and long-term NSAID treatment for at least one year between baseline and four-year follow-up were included in the study and compared with a group of 793 control participants who were not treated with NSAIDs. All participants underwent 3T MRI of the knee at baseline and four years later. Images were evaluated for biomarkers of inflammation.
Cartilage thickness, composition, and other MRI measurements served as noninvasive biomarkers to assess arthritis progression.
The results showed no long-term benefit from the use of NSAIDs. Joint inflammation and cartilage quality were worse at the start of the study in participants taking NSAIDs compared to the control group and worsened at four-year follow-up.
“In this large group of participants, we were able to show that there were no protective mechanisms for NSAIDs to reduce inflammation or slow the progression of knee osteoarthritis,” Dr. Luytjens said. “The use of NSAIDs due to their anti-inflammatory function has been widely used in patients with osteoarthritis in recent years and should be reconsidered as a positive effect on joint inflammation cannot be demonstrated.”
According to Dr. Luytjens, there are several possible reasons why NSAID use increases synovitis.
“On the one hand, the anti-inflammatory effect that normally comes from NSAIDs may not effectively prevent synovitis, with progressive degenerative changes leading to worsening synovitis over time,” she said. “On the other hand, patients with synovitis who are taking pain medication may be more physically active due to pain relief, potentially making the synovitis worse, although we adjusted for physical activity in our model.”
Dr. Luytjens noted that future prospective randomized trials are needed to provide conclusive evidence of the anti-inflammatory effects of NSAIDs.
Co-authors include Charles McCulloch, PhD, Thomas Link, PhD, Felix Gassert, MD, Gabby Joseph, PhD, and John Lynch, PhD.
Meeting: 108th Scientific Assembly and Annual Meeting of the Radiological Society of North America
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