Anti-inflammatory painkillers can worsen the inflammation in osteoarthritis

Anti-inflammatory painkillers can worsen the inflammation in osteoarthritis

Taking anti-inflammatory painkillers such as 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 Radiological Society of North America (RSNA) annual meeting.

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. It most commonly occurs 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.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed for osteoarthritis pain and inflammation. However, little is known about the long-term effects of these medications on disease progression.

To date, no curative therapy has been approved to cure or reduce the progression of knee osteoarthritis. NSAIDs are commonly used to treat pain, but there is still an open debate about how NSAID use affects outcomes for osteoarthritis patients. In particular, the impact of NSAIDs on synovitis, or the inflammation of the membrane lining the joint, has never been analyzed using MRI-based structural biomarkers.

Johanna Luitjens, lead author of the study, postdoctoral researcher, Department of Radiology and Biomedical Imaging, University of California, San Francisco

Dr. Luitjens and colleagues set out to analyze the association between NSAID use and synovitis in patients with osteoarthritis of the knee and to 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 NSAID treatment affects the development or progression of synovitis and to investigate whether cartilage imaging biomarkers reflecting changes in osteoarthritis are affected by NSAID treatment.”

The study enrolled 277 participants from the Osteoarthritis Initiative Cohort with moderate to severe osteoarthritis and sustained NSAID treatment for at least one year between baseline and four years of follow-up and compared them to a group of 793 control participants who were not treated with NSAIDs. All participants underwent 3T MRI of the knee initially and after four years. Images were assessed for biomarkers of inflammation.

Cartilage thickness, composition and other MRI measurements served as non-invasive biomarkers to assess arthritis progression.

The results showed no long-term benefit from NSAID use. Joint inflammation and cartilage quality were worse at baseline in participants taking NSAIDs compared to the control group and worsened at four-year follow-up.

“In this large group of participants, we showed that there are no protective mechanisms of NSAIDs to reduce inflammation or slow the progression of knee osteoarthritis,” said Dr. Luitjens. “The use of NSAIDs because of their anti-inflammatory function has been widely promoted in patients with osteoarthritis in recent years and should be reconsidered since a positive influence on joint inflammation has not been proven.”

According to Dr. According to Luitjens, there are several possible reasons why NSAID use increases synovitis.

“On the one hand, the anti-inflammatory effect normally provided by NSAIDs may not effectively prevent synovitis, as progressive degenerative changes lead to worsening of synovitis over time,” she said. “On the other hand, patients with synovitis who take pain-relieving medications may be more physically active due to pain relief, which could potentially lead 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 of the anti-inflammatory effects 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.

Source:

Radiological Society of North America

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