New 'provocative' study calls into question the best knee pain medications

New ‘provocative’ study calls into question the best knee pain medications

According to a new study, people with arthritis who take anti-inflammatory drugs, such as ibuprofen and naproxen, to relieve their painful knees can damage their joints.

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

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

“We were surprised by the results,” lead study author Dr. Johanna Luitjens, a postdoctoral researcher in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco, told . “We actually thought we would see the opposite of these results with people taking NSAIDs having less inflammation.”

It’s unclear why NSAIDs might lead to more joint damage, Luitjens says. And previous studies have been mixed on whether NSAIDs reduce or increase inflammation, she adds.

To take a closer look at the impact of NSAIDs on joint health in people with osteoarthritis, Luitjens and his colleagues turned to the Osteoarthritis Initiative, a 10-year observational study sponsored by the National Institutes of Health. Some 277 of the participants had moderate to severe osteoarthritis and had taken NSAIDs for at least a year. Their analyzes were compared with those of the 793 participants who did not take NSAIDs.

There were some differences between the groups at baseline, such as worsening inflammation and cartilage damage in those taking NSAIDs. When Luitjens and his colleagues compared the initial scans of the two groups of arthritis patients to those taken four years later, the researchers found that there was significantly more inflammation in the participants taking NSAIDs, which was surprising because NSAIDs are anti-inflammatory drugs.

The researchers also found more degenerative changes and reduced cartilage thickness in participants who regularly used NSAIDs, but these results were not statistically significant, meaning they could be due to chance.

“I think we really need a discussion about the long-term effects of NSAIDs,” says Luitjens. “They are so commonly used. And finally, I think we need a prospective randomized study to provide conclusive evidence for the anti-inflammatory impact of NSAIDs.

The new study is “very provocative,” Dr. Anca Askanase, associate director of the division of rheumatology at Columbia University Irving Medical Center, told

While Askanase thinks people should be careful when taking NSAIDs because of potential side effects, the new study doesn’t make it any more worried about its patients taking them.

“The American College of Rheumatology guidelines are based on what works for osteoarthritis of the knees, hips, and hand, and they still give NSAIDs their highest recommendation for pharmacological measures,” Askanase says. “Although this data makes me think – and I think it would be more than me – I don’t think we have enough evidence that it could actually accelerate the progression of osteoarthritis.”

Currently, there is no medication that actually treats the underlying disease, Askanase says. “In terms of symptom relief, NSAIDs are considered the first, safest alternative,” she adds. “I’m not ready to throw them away because there’s not much else to offer patients.”

There’s been a lot of debate surrounding NSAIDs, Dr. Mariam Zakhary, assistant professor of sports medicine at the Icahn School of Medicine, told “There are so many things to consider.”

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

But the impact of NSAIDs on joint health isn’t the only problem with the drugs, Zakhary says, adding that they can have many systemic adverse effects, such as an increased risk of heart disease and damage to stomach and kidneys.

This is because the drugs block the enzymes COX-1, which protects the stomach lining and kidneys, and COX-2, which is involved in inflammation. There is another choice, COX-2 inhibitors, which selectively target inflammation and spare the stomach and kidneys, but are still linked to high blood pressure and heart problems.

Zakhary would prefer that patients not take long-term NSAIDs, but instead take them for pain relief while patients participate in a rehabilitation program to strengthen the muscles around the knee.

She also feels that the current study is not strong enough to change the NSAID recommendations.

“It’s a good start, and it tells us that we have to keep thinking about it,” says Zakhary. “For now, patients just need to worry about systemic effects, and they should talk to their doctor about the different types of NSAIDs.”

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