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November 23, 2022
Often prescribed to calm the pain of osteoarthritis, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, would in fact have no benefit according to a new study. Worse, they could even make the inflammation worse.
Do you regularly take ibuprofen or naproxen to relieve your osteoarthritis? You may need to revise your habits. According to a study by the Department of Radiology and Biomedical Imaging at the University of California, San Francisco, nonsteroidal anti-inflammatory NSAIDs could, in the long term, aggravate joint inflammation, especially the knee joint.
Greater inflammation after 4 years of use
In this study, first author Dr. Luitjens and colleagues set out to analyze the association between NSAID use and synovitis, the inflammation of the membrane that lines the joint, in patients with osteoarthritis of the knee and to assess how NSAID treatment affects joint structure over time.
277 patients suffering from moderate to severe knee osteoarthritis and following sustained treatment with NSAIDs for at least one year were therefore included and compared to a group of 793 control participants, who were not taking any non-steroidal anti-inflammatory drug. To check for biomarkers of inflammation (such as cartilage thickness, composition), all participants underwent knee MRIs at the start of the study and after four years.
The results are, to say the least, disappointing from a therapeutic point of view. Not only did the measurements show no long-term benefit from NSAID use. But joint inflammation and cartilage quality were worse initially in participants taking NSAIDs, compared to the control group, and worsened after a four-year follow-up.
NSAIDs: beneficial effects that have not been demonstrated
“In this large group of participants, we were able to show that NSAIDs offer no protective mechanism to reduce inflammation or slow the progression of osteoarthritis of the knee joint”said Dr. Johanna Luitjens.
A conclusion that only confirms what scientists have been considering for a long time “The use of NSAIDs for their anti-inflammatory function has frequently spread among patients with osteoarthritis in recent years and should be revisited, as a positive impact on joint inflammation could not be demonstrated.”
“During painful flare-ups, paracetamol remains the first-line drug according to the recommendations of the Haute Autorité de Santé” recalls Doctor Gérald Kierzek, emergency doctor and medical director of Doctissimo, “without forgetting the hygieno-dietetic, orthopedic and physiotherapy measures“.
A possible bias in this study?
According to Dr. Luitjens, there are several possible reasons why the use of NSAIDs increases synovitis. She thus admits a possible bias of the study. “Either the anti-inflammatory effect that normally comes from NSAIDs may not effectively prevent synovitis, with progressive degenerative change leading to worsening synovitis over time. Either patients who have synovitis and who take analgesics may be more physically active due to pain relief, which could potentially lead to worsening of synovitis, although we adjusted for physical activity in our model.” she specifies. In short, did the relief induced by NSAIDs not allow patients to move more and indirectly worsen the inflammation?
The full study will be presented next week at the annual meeting of the Radiological Society of North America (RSNA).