Pain relievers such as ibuprofen and naproxen may worsen inflammation in arthritis

Taking anti-inflammatory painkillers such as ibuprofen and naproxen to treat osteoarthritis may worsen knee joint inflammation
.
That's according to a new scientific study
presented next week at the annual meeting of the Radiological Society of North America (RSNA).

As the most common form of arthritis, osteoarthritis (OA) affects more than 32 million adults in the United States and more than 500 million people
worldwide.
It occurs most often on the hands, hips, and knees
.
For people with osteoarthritis, the cartilage that cushions the joints wears out
gradually.
This is why it is sometimes referred to as degenerative joint disease or "wear" arthritis
.
Arthritis is usually accompanied by inflammation or swelling of the joints, which is quite
painful.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain and inflammation
in osteoarthritis.
Common NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve).

However, little is known about the long-term effects of these drugs on disease
progression.
Johanna Luitjens, lead author of the study and a postdoctoral fellow in UCSF's Department of Radiology and Biomedical Imaging, said: "To date, no curative therapy has been approved to cure or slow the progression of
knee osteoarthritis.
" "NSAIDs are often used to treat pain, but there is debate about how NSAIDs use affects the prognosis of people with osteoarthritis
.
In particular, the effect of NSAIDs on synovitis or inflammation of the articular lining has never been analyzed
using nuclear magnetic resonance (MRI)-based structural biomarkers.
”

When the knee is inflamed, the signal on MRI changes on the fat pad (Hoffa fat pad, subpatellar fat pad) close to the kneecap
.
Higher signals in the fat pad (usually dark) area indicate the beginning of an inflammatory response, and elevated signal throughout the fat pad (light gray with white lines) is a sign of progressive knee joint inflammation
.

Dr.
Luitjens and his colleagues analyzed the relationship between NSAIDs use and synovitis in patients with knee osteoarthritis, and evaluated how treatment with NSAIDs affected joint structure
over time.

"Synovitis mediates the development and progression of osteoarthritis and may be a therapeutic target," Dr.
Luitjens said
.
"Therefore, the goal of our study is to analyze whether NSAIDs treatment affects the development or progression of synovitis, and to investigate whether cartilage imaging biomarkers reflecting changes in osteoarthritis are affected
by NSAIDs treatment.
" In this study, 277 participants from the Osteoarthritis Program cohort with moderate to severe osteoarthritis who had been receiving NSAIDs for at least one year at baseline to four-year follow-up were included in the study and compared to
a group of 793 control participants who were not treated with NSAIDs.
All participants underwent a 3T MRI of the knee initially and four years later
.
Images are scored
on inflammatory biomarkers.

Cartilage thickness, composition, and other MRI measurements can be used as non-invasive biomarkers to assess arthritis
progression.

The results showed no benefit
from long-term use of NSAIDs.
Compared to the control group, participants taking NSAIDs had worse joint inflammation and cartilage quality at baseline and worsened
at 4-year follow-up.

"In this large group of participants, we were able to demonstrate that NSAIDs do not have any protective mechanisms in reducing inflammation or slowing the progression of knee osteoarthritis," Dr.
Luitjens said
.
"The anti-inflammatory effects of NSAIDs have spread frequently in patients with osteoarthritis in recent years and should be revisited as its positive effects on joint inflammation have not been proven
.
"

According to Dr.
Luitjens, NSAIDs can increase synovitis for several possible reasons
.
"On the one hand, the anti-inflammatory effects that usually come from NSAIDs may not be effective in preventing synovitis, and progressive degenerative changes over time cause synovitis to worsen," she said
.
"On the other hand, patients who have synovitis and are taking analgesic medications may be more active because of pain relief, which may lead to worsening of synovitis, although we adjusted for physical activity in the model
.
" Future prospective randomized studies should be conducted to provide conclusive evidence
of the anti-inflammatory effects of NSAIDs.