Common painkillers may worsen arthritis inflammation

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Osteoarthritis is the most common form of arthritis, affecting more than 32 million adults in the U.S. and more than 500 million people worldwide.

It occurs most frequently in the hands, hips and knees. In people with osteoarthritis, the cartilage that cushions the joint gradually wears away.

Arthritis is often accompanied by inflammation, or swelling, of the joint, which can be painful.

In a study from the University of California, San Francisco, scientists found taking anti-inflammatory pain relievers like ibuprofen and naproxen for osteoarthritis may worsen inflammation in the knee joint over time.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for osteoarthritis pain and inflammation. But little is known of the long-term effects of these drugs on disease progression.

In the study, the team set out to analyze the association between NSAID use and synovitis in patients with osteoarthritis of the knee and to assess how treatment with NSAIDs affects joint structure over time.

They tested 277 participants with moderate to severe osteoarthritis and sustained NSAID treatment for at least one year.

These people were compared with a group of 793 people who were not treated with NSAIDs. All participants underwent a 3T MRI of the knee initially and after four years. Images were scored for biomarkers of inflammation.

The team found no long-term benefit of NSAID use. Joint inflammation and cartilage quality were worse at baseline in the participants taking NSAIDs, compared to the control group, and worsened at four-year follow-up.

According to the team, there are several possible reasons why NSAID use increases synovitis.

On the one hand, the anti-inflammatory effect that normally comes from NSAIDs may not effectively prevent synovitis, with progressive degenerative change resulting in worsening of synovitis over time

On the other hand, patients who have synovitis and are taking pain-relieving medications may be physically more active due to pain relief, which could potentially lead to the worsening of synovitis.

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The study was conducted by Johanna Luitjens et al and presented at the annual meeting of the Radiological Society of North America.

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