Osteoarthritis (OA) pain and stiffness is commonly treated with non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen. Although these drugs are meant to ease OA symptoms and not stop OA from progressing, no one would expect that these medications might actually make the condition worse — until now.
In a new study, published in the journal Rheumatology, scientists analyzed data on more than 2,000 people with knee OA who are part of the Osteoarthritis Initiative (OAI) to learn whether medication use might impact the joint space width (JSW) between two bones in the knee. Measuring JSW provides an indication of how far OA has progressed, as JSW shrinks as cartilage gets worn down.
The researchers found that current users of prescription NSAIDs were more likely to lose JSW — 0.042 mm to be exact — during the eight-year period compared to those who were not regular NSAID users. This connection held true even after researchers accounted for possible confounding variables including age, sex, and body mass index. The use of such other medications as statins, blood pressure medication, antidepressants, osteoporosis medication, and diabetes medication didn’t appear to have an impact on JSW.
Could NSAIDs Somehow be Making OA Worse?
No one is suggesting that OA patients stop using NSAIDs to treat osteoarthritis pain because of this study.
Though this is not the first study to examine the association between NSAIDS and change in joint space width, the authors note that is the largest study to date and the largest conducted over an eight-year period. They also, however, acknowledge the limitations of this study.
To start, it is an observational trial, so it can highlight an association but can’t prove that taking NSAIDs directly causes cartilage loss. The authors also acknowledged that they could not isolate the effect of medication on the outcome independent of the underlying disease, nor could they determine whether participants were slow, moderate, or rapid OA progressors.
Additionally, this study only looked at prescription NSAID use, whereas many OA patients rely on lower-dose versions of the same over-the-counter (OTC) drugs. Meanwhile, it seems plausible that people who require prescription-strength medication to control their OA might have a more severe condition than those who stick with OTC remedies, though the authors did not find any significant association between JSW and current use of corticosteroid injections or prescription oral COX-2 inhibitors (like Celebrex).
For these reasons, the authors agree that “further studies are required, using clinical trial data, to confirm these findings.”
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Perry TA. Association between current medication use and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative. Rheumatology. January 27, 2021. doi: https://doi.org/10.1093/rheumatology/keab059.
