NSAIDs are prescribed in BIG amounts!
Doctors prescribe NSAIDs for osteoarthritis in large amounts. At the last count, nearly 30 million people take prescription drugs such as celecoxib, diclofenac, ibuprofen, meloxicam, and naproxen each year. That doesn’t include OTC ibuprofen (advil, Motrin IBetc) or naproxen (aleve).
We don’t worry much about short-term use of such medications for a headache or sprained ankle. It is regular daily use for osteoarthritis that we are concerned about. It is estimated that 1 in 4 adults have arthritis. That equates to tens of millions of people. Most healthcare professionals choose nonsteroidal anti-inflammatory drugs to relieve pain.
What is the problem with NSAIDs for osteoarthritis?
NSAIDs work… to relieve pain. That’s the good news. The bad news, according to a new study presented at the annual meeting of the Radiological Society of North America (RSNA), is that NSAIDs can worsen inflammation in the knee joints.
There has been a surprising lack of long-term research to determine the effect of NSAIDs for osteoarthritis on joint health. The new study presented at this year’s RSNA meeting provides some concerning data. Researchers at the Department of Radiology and Biomedical Imaging at the University of California San Francisco (UCSF) examined the effect of NSAIDs on synovitis of the knee.
The synovial membrane is critical for healthy joint function. This soft connective tissue lines the joints and produces synovial fluid. That is the lubricant that allows the bones to move comfortably without friction. It is also essential for healthy cartilage. Knee synovitis occurs when the synovium becomes inflamed or swollen. As you can imagine, that’s No a good thing!
NSAIDs and synovitis:
According to the lead author of the new study:
“Synovitis mediates the development and progression of osteoarthritis and may be a therapeutic target. Therefore, the aim 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 affected by NSAID treatment. NSAIDS”.
The UCSF researchers recruited 277 volunteers with knee osteoarthritis who had been taking NSAIDs for at least one year. The control group of 793 individuals were No taking these anti-inflammatory drugs. Both groups underwent MRIs of their knees at the start of the study. Four years later they had another set of MRIs.
After four years, those who had been taking NSAIDs were in worse shape than the control group. They had less cartilage and more inflammation according to the MRI images. Patients taking NSAIDs for osteoarthritis in the knees had more signs of synovitis than people not taking NSAIDs.
Lead author Dr. Johanna Luitjens was surprised by the result. She and her team thought that NSAIDs would reduce inflammation and synovitis. Instead, they saw more joint degeneration and thinner cartilage among users of NSAIDs for osteoarthritis.
She offers these two possibilities:
“For one thing, the anti-inflammatory effect that normally comes from NSAIDs may not effectively prevent synovitis, with progressive degenerative change resulting in worsening synovitis over time. On the other hand, patients who have synovitis and take pain-relieving medications may be more physically active due to pain relief, which could lead to worsening of synovitis, although we adjusted for physical activity in our model.”
What does this research mean?
It is surprising that we are only now learning about this potentially negative impact of prolonged NSAID use on joint tissue. It is somewhat reminiscent of cortisone-type drugs.
In the 1950s, drugs like cortisone, dexamethasone, prednisolone, and prednisone were considered wonder drugs for people with rheumatoid arthritis. It took many years before doctors realized that these corticosteroids could cause high blood pressure, ulcers, arrhythmias, osteoporosis, glaucoma, cataracts, and diabetes.
When non-steroidal anti-inflammatory drugs came on the scene, doctors thought they were a substantially safer option than cortisone-like steroid drugs. The FDA deemed ibuprofen and naproxen so safe, in fact, that it gave pharmaceutical companies the green light to sell them without a prescription.
It has taken decades to appreciate the potential complications of NSAIDs. You can read about the history of corticosteroids and NSAIDs at this link.
Side effects of NSAIDs:
- Digestive tract discomfort, stomach pain, nausea, bleeding ulcers, perforated ulcers
- Heart attack, stroke, cardiac arrest
- Irregular heart rhythms (A-fib)
- fluid retention, heart failure
- high blood pressure
- Dizziness, unsteadiness, space
- Kidney damage, liver damage,
- Skin rash and other dermatological reactions
- Ringing in the ears
- Asthma, breathing problems, allergic reactions
- vision changes
I know your eyes cloud over as you read through a long list of side effects. However, stop for a moment and look at problems like heart attacks, strokes, high blood pressure, kidney damage, and arrhythmias. They are not trivial adverse reactions.
Discovering that a new problem associated with NSAIDs for osteoarthritis of the knees could be increasing damage to joint tissue only makes things more complicated. The bottom line seems to be that non-steroidal anti-inflammatory drugs should be used with caution by patients with osteoarthritis, especially in the long term.
If you are interested in other approaches to inflammation, you may find our eGuide to Alternatives for Arthritis of interest. It can be found under the Health eGuides tab of this website. If you’re a book person, you can find the 104-page booklet in the store at this link. It is currently discounted during our Black Friday/Cyber Monday sale.