- Researchers say pain relievers like ibuprofen may not offer long-term benefits for arthritis inflammation.
- They say the anti-inflammatory drugs can increase internal inflammation, leading to pain and joint stiffness.
- However, other experts say these drugs are effective treatments for relieving pain and reducing inflammation.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as the ibuprofen products Advil and Motrin offer no long-term benefit when used for joint inflammation such as arthritis.
That’s according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).
In the new study, which has yet to be published in a peer-reviewed journal, the researchers evaluated 129 participants with knee arthritis
All participants had moderate to severe arthritis and had been on NSAIDs for at least one year between baseline and four years of follow-up. In addition to the participants, the study included 592 people not treated with NSAIDs as controls.
All study participants initially received an MRI of the knee with a further examination four years later.
The researchers analyzed the thickness and composition of the cartilage. Both are biomarkers to assess the progression of arthritis.
The researchers found that NSAID users showed more degenerative changes, including cartilage thickness. However, the scientists did not consider the changes to be statistically significant.
Researchers concluded that long-term NSAID use may be associated with more internal inflammation, leading to increased pain and decreased joint function.
Typically, NSAIDs are used in osteoarthritis for their ability to reduce inflammation, which reduces pain. Depending on the formulation, they can last anywhere from 4 to 24 hours.
This isn’t the first study to show the downsides of long-term use of NSAIDs.
“Numerous studies show that long-term use of NSAIDs can lead to worsening inflammation, increased pain and a faster need for joint replacement,” said Dr. Medhat Mikhael, pain management specialist and medical director of the nonsurgical program at Spine Health Center at MemorialCare Orange Coast Medical Center in California.
“The serious side effects of NSAIDs can cause inflammation in the lungs, heart, gastrointestinal tract, liver and kidneys. Chronic use of NSAIDs can lead to joint replacement surgery and prevent the body’s normal response to healing and lead to re-inflammation, including worsening osteoarthritis symptoms,” Mikhael told Healthline.
Not everyone agrees with the conclusions of the study.
“This study is very dangerous,” said Dr. Travis Scudday, an orthopedic surgeon at the Hoag Orthopedic Institute in Southern California. “This is a classic example of selection bias. This is a retrospective study examining what patients did on their own without recommended intervention.
“The researchers state that the patients taking NSAIDs had more evidence of synovitis, or inflammation, in the joint at baseline, that is, before NSAID drugs,” he told Healthline. “Most likely, the patients with more severe inflammation and pain were using NSAIDs. In contrast, patients without significant inflammation and pain did not use inflammation.”
“It’s the same as looking at two groups of people, one with pneumonia and one without.” Scudday continued. “People with pneumonia received antibiotics and those without pneumonia did not. Then it was concluded that antibiotics caused pneumonia in humans because people with pneumonia were taking antibiotics more often.”
dr Michael Alaia, an orthopedic sports surgeon and associate professor at New York University, also believed the study used selection bias to develop its conclusions.
“This was not a controlled, randomized study. Ideally, they could have included an orthopedic wing of the study,” he told Healthline.
Osteoarthritis is a degenerative joint tissue. It is the most common form of arthritis. It is more common in people over 50
Researchers aren’t sure what causes or triggers the tissue breakdown in the joint. It can cause damage to:
- The meniscus in the knee
Common symptoms of osteoarthritis are:
- Pain when using the joint
- joint stiffness
- Changes in the joint that limit movement
- Feeling that the joint is loose or unstable
It occurs most commonly in the hands, knees, hips, lower back, and neck, although it can occur in other joints as well.
NSAIDs are short-term pain relievers.
“NSAIDs are a great way to treat pain associated with osteoarthritis,” said Dr. Alexander Gaukhman, an orthopedic surgeon at Baptist Health Orthopedic Care, to Healthline.
“The clinical practice guidelines published by the American Academy of Orthopedic Surgeons (AAOS) designate NSAIDs as the first line of treatment for patients with osteoarthritis,” he added.
The drugs help relieve pain and stiffness by reducing inflammation.
“NSAIDs play no role in preventing joint or cartilage disease,” notes Dr. Ilan Danan, an exercise neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “Direct use of NSAIDs will not increase inflammation.”
“While this information is helpful, it doesn’t change my clinical approach,” Danan told Healthline. “As a degenerative disease, moderate to severe joint arthritis worsens over time, particularly over several years. Most importantly, patients understand that there are more advanced ways to better manage arthritic pain beyond long-term use of NSAIDs—both surgical and nonsurgical.”
There is no cure for osteoarthritis, but there are ways to treat and manage the condition.
According to the Arthritis Foundation, some nonsurgical treatments alongside NSAIDs include:
- Analgesics such as acetaminophen (Tylenol) and opioids
- Counter-irritants, such as topicals containing capsaicin, menthol, and lidocaine
- Corticosteroids, prescription drugs that can be taken by mouth or by injection
- Drugs like duloxetine (Cymbalta) and pregabalin (Lyrica), which treat other conditions but reduce pain and inflammation
“Weight loss and physical therapy are beneficial interventions in the early stages of mild arthritis,” said Scudday.
As a last resort, joint replacement surgery may be needed to relieve pain and maintain the person’s quality of life.