‘Provocative’ new study calls into question best drug for knee pain

A new study suggests that people with arthritis who take anti-inflammatory drugs such as ibuprofen and naproxen to relieve knee pain may be hurting their joints.

MRI scans of more than 1,000 patients with knee osteoarthritis reveal long-term use of NSAIDs (nonsteroidal anti-inflammatory drugs) can lead to increased joint inflammation and cartilage damage . researchers reported Monday, at the annual meeting of the Radiological Society of North America.

Osteoarthritis is the most common type of arthritis and usually affects the hands, hips, or knees. It occurs when the cartilage in a joint erodes and bone changes, causing pain, stiffness, and swelling. According to the Centers for Disease Control and PreventionApproximately 32.5 million American adults live with this condition.

“We were blown away by the findings,” lead study author Johanna Luitjens, Ph.D., a postdoctoral researcher in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco, told TODAY.com. “In fact, we thought that less inflammation in people taking NSAIDs would be the opposite of these results.”

It’s not clear why NSAIDs lead to more joint damage, Luitjens says. And previous research has been mixed on the topic of whether NSAIDs reduce or increase inflammation, she added.

To explore the effects of NSAIDs on joint health in people with osteoarthritis, Luitjens and her colleagues turned to the Osteoarthritis Initiative, a 10-year observational study sponsored by the National Institutes of Health. rice field. About 277 of the participants had moderate to severe osteoarthritis and had been on her NSAIDs for at least one year. Their scans were compared to those of her 793 participants who were not taking NSAIDs.

There were initially some differences between the groups, including worsening of inflammation and cartilage damage in those taking NSAIDs. When compared to the scans taken, researchers found significantly more inflammation in participants taking NSAIDs. This was surprising because NSAIDs are anti-inflammatory drugs.

The researchers also observed degenerative changes and decreased cartilage thickness in participants who used NSAIDs regularly, but noted that these findings were not statistically significant and may have been due to chance. means.

“I think we need to discuss the long-term effects of NSAIDs,” says Luitjens. “They are very commonly used, and I think prospective randomized studies are needed to ultimately provide definitive evidence of the anti-inflammatory effects of NSAIDs.”

The new research is “very provocative,” Dr. Anka Askanas, associate director of the Rheumatology Division at Columbia University Irving Medical Center, tells TODAY.com.

Askanase believes NSAIDs should be taken with caution due to the potential side effects, but the new study makes her patients less concerned about taking NSAIDs.

“The American College of Rheumatology guidelines, based on what works for knee, hip, and hand osteoarthritis, give NSAIDs the highest recommendation as a pharmacologic measure,” says Askanase. ‘s data gives me pause, and I don’t think it’s just me, but I don’t think there’s enough evidence that it can actually hasten the progression of osteoarthritis.”

Currently, there are no drugs that actually treat the underlying disease, says Askanase. “In terms of symptom relief, NSAIDs are considered the first go-to and safest option,” she adds. “I’m not ready to throw them away because I don’t have much else to offer my patients.”

There has been a lot of controversy surrounding NSAIDs, said Dr. Mariam Zakhary, assistant professor of sports medicine at the Icahn School of Medicine.

For example, the researchers admitted that the NSAID group started out worse than the comparison group, so “these patients were already prone to worse outcomes,” she says.

But the effects of NSAIDs on joint health aren’t the only problem with the drug, Zakhary said, and it can have many adverse effects on the whole body, including an increased risk of heart disease and damage to the stomach and kidneys. added.

This is because the drug blocks the enzyme COX-1, which protects the stomach lining and kidneys, and COX-2, which is involved in inflammation. Another option is a COX-2 inhibitor. COX-2 inhibitors selectively target inflammation, sparing the stomach and kidneys, but are still associated with hypertension and heart problems.

Zakhary hopes patients will not take NSAIDs long-term, but rather take NSAIDs to relieve pain while participating in a rehabilitation program to strengthen the muscles around the knee. .

She also feels that current research is not strong enough to change recommendations about NSAIDs.

“This is a good start and shows that we need to continue investigating,” said Zakhary. “For now, the patient should just talk to her doctor about her NSAIDs of various types, just to worry about systemic effects.”