- Researchers say pain relievers such as ibuprofen may not provide long-term benefits for arthritis inflammation.
- They say the anti-inflammatory drugs may increase internal inflammation, leading to pain and joint stiffness.
- However, other experts say these medications are effective treatments for pain relief and inflammation reduction.
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen products Advil and Motrin, do not provide a long-term benefit when used for joint inflammation, such as in 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 hasn’t been published yet in a peer-reviewed journal, researchers evaluated 129 participants with knee arthritis from the
All participants had moderate to severe arthritis and were on NSAID treatment for at least a year between baseline and the four-year follow-up. In addition to the participants, the study included 592 people not treated with NSAIDs as control subjects.
All participants in the study initially underwent an MRI of the knee with another exam four years later.
The researchers analyzed cartilage thickness and composition. Both are biomarkers for evaluating arthritis progression.
The researchers found that NSAID users showed more degenerative changes, including in cartilage thickness. However, the scientists did not consider the changes statistically significant.
The researchers did conclude that longtime NSAID usage could be associated with more internal inflammation, leading to increased pain and decreased joint function.
Typically, NSAIDs are used for osteoarthritis because of 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 that has shown the downside of taking NSAIDs long-term.
“Numerous studies show that long-term use of NSAIDs can result in worsening inflammation, increasing pain, and a faster need for joint replacement,” said Dr. Medhat Mikhael, a pain management specialist and medical director of the non-operative program at the Spine Health Center at MemorialCare Orange Coast Medical Center in California.
“The serious side effects of NSAIDs can drive inflammation to the lung, heart, gastrointestinal tract, liver, and kidneys. Chronic use of NSAIDs can lead to joint replacement surgeries and prevent the body’s normal response to healing and can result in rebound 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 with Hoag Orthopedic Institute in Southern California. “It is a classic example of selection bias. It is a retrospective study examining what patients did independently, without any recommended intervention.
“The researchers state that the patients who used NSAIDs had more evidence of synovitis or inflammation in the joint at baseline, meaning before NSAID medications,” he told Healthline. “Most likely, the patients with worse inflammation and pain used NSAIDs. In contrast, patients without significant inflammation and pain did not use inflammation.”
“This is the same as looking at two groups of people, one with pneumonia and one without.” Scudday continued. “The people with pneumonia received antibiotics and those without pneumonia did not. Then, concluding that antibiotics caused people to have pneumonia since people with pneumonia used antibiotics more frequently.”
Dr. Michael Alaia, a sports health orthopedic surgeon and associate professor at New York University, also felt the study used selection bias to develop their 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 more often affects those over age 50, according to the
Researchers aren’t sure what causes or triggers the breakdown of tissues in the joint. It can cause damage to:
- Cartilage
- Tendons
- Ligaments
- Synovium
- Bone
- The meniscus in the knee
Common symptoms of osteoarthritis include:
- Pain when using the joint
- Joint stiffness
- Changes in the joint that limit movement
- Feeling like the joint is loose or unstable
It most often occurs in the hands, knees, hips, lower back, and neck, although it can also appear in other joints.
NSAIDs are short-term pain relievers.
“NSAIDs are a great way to treat pain associated with osteoarthritis,” Dr. Alexander Gaukhman, an orthopedic surgeon with Baptist Health Orthopedic Care, told Healthline.
“The clinical practice guidelines released by the AAOS (American Academy of Orthopedic Surgeons) place NSAIDs as the first line of treatment for patients with osteoarthritis,” he added.
The medications help reduce pain and stiffness by reducing inflammation.
“NSAIDs do not play a role in preventing joint or cartilage disease,” notes Dr. Ilan Danan, a sports neurologist and pain management specialist at the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles. “The direct use of NSAIDs will not increase inflammation.”
“This information, while helpful, will not change my clinical approach,” Danan told Healthline. “As a degenerative disease, moderate to severe joint arthritis will worsen over time, especially over several years. Most important is that patients understand that there are more advanced means of better addressing arthritic pain beyond the long-term use of NSAIDs — both surgical and non-surgical.”
There isn’t a cure for osteoarthritis, but there are ways to treat and manage the condition.
According to the Arthritis Foundation, some non-surgical treatments besides NSAIDs include:
- Analgesics, such as acetaminophen (Tylenol) and opioids
- Counterirritants, such as topical agents with capsaicin, menthol, and lidocaine
- Corticosteroids, prescription medications that can be taken orally or by injection
- Drugs such as duloxetine (Cymbalta) and pregabalin (Lyrica) that treat other conditions but help reduce pain and inflammation
“Weight loss and physical therapy are beneficial interventions in early stage, mild arthritis,” said Scudday.
As a last resort, joint-replacement surgery may be necessary to relieve pain and maintain the person’s quality of life.