Do NSAIDs Help in the Treatment of Arthritis

Taking anti-inflammatory painkillers like ibuprofen and naproxen for osteoarthritis may cause knee inflammation to worsen over time. Osteoarthritis affects more than 500 million individuals globally including more than 32 million adults in the United States. It is the most prevalent type of arthritis. It mostly affects the hands, hips, and knees. The cartilage that cushions the joint gradually deteriorates in persons with osteoarthritis. Inflammation, or swelling, of the joint, which can be painful, is frequently a complication of arthritis.

For the pain and inflammation associated with osteoarthritis, non-steroidal anti-inflammatory medications (NSAIDs) are frequently recommended. However, little is known about how these medications affect disease development over the long term.

“To date, no curative therapy has been approved to cure or reduce the progression of knee osteoarthritis,” said the study’s lead author, Johanna Luitjens, a postdoctoral scholar 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 of how NSAID use influences 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.”

Dr. Luitjens and colleagues investigated the relationship between NSAID use and synovitis in patients with knee osteoarthritis, as well as the long-term effects of NSAID therapy on the joint structure.

“Synovitis mediates the development and progression of osteoarthritis and may be a therapeutic target,” Dr. Luitjens said. “Therefore, the goal of our study was to analyze whether NSAID treatment influences the development or progression of synovitis and to investigate whether cartilage imaging biomarkers, which reflect changes in osteoarthritis, are impacted by NSAID treatment.”

The study compared a group of 277 participants from the Osteoarthritis Initiative cohort who had moderate to severe osteoarthritis and had been taking NSAIDs for at least a year between the study's baseline and four-year follow-up with a control group of 793 participants who had not received NSAID treatment. An initial and four-year 3T MRI of the knee was performed on each subject. Biomarkers of inflammation were measured in the images.

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The course of arthritis was tracked using noninvasive biomarkers such as cartilage thickness, composition, and other MRI data.

The findings revealed no long-term advantages of NSAID use. Participants taking NSAIDs had worse baseline joint inflammation and cartilage quality than the control group, and these problems persisted during the four-year follow-up.

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“In this large group of participants, we were able to show that there were no protective mechanisms from NSAIDs in reducing inflammation or slowing down the progression of osteoarthritis of the knee joint,” Dr. Luitjens said. “The use of NSAIDs for their anti-inflammatory function has been frequently propagated in patients with osteoarthritis in recent years and should be revisited since a positive impact on joint inflammation could not be demonstrated.”

Dr. Luitjens suggests several potential explanations for the apparent rise in synovitis caused by NSAID use. “On the one hand, the anti-inflammatory effect that normally comes from NSAIDs may not effectively prevent synovitis, with progressive degenerative change resulting in worsening of synovitis over time,” she said. “On the other hand, patients who have synovitis and are taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to worsening of synovitis, although we adjusted for physical activity in our model.”

Source-Medindia