NSAIDs Might Worsen Osteoarthritis in Humans

A research report demonstrated that there are no long-term benefits on joint inflammation from the use of NSAIDs in humans, which equine practitioners should consider when prescribing medication for equine patients with OA.

An open pill bottle with orange NSAIDs spilling out from the opening.
Signs of joint inflammation worsened in people who used NSAIDs to manage osteoarthritis compared to those who did not. iStock

A recent report presented at the 2022 annual meeting of the Radiological Society of North America (RSNA) has highlighted some new findings related to NSAID use in humans. The study included 277 participants with moderate to severe osteoarthritis who medicated with NSAIDs for at least one year between the start of the study and a four-year follow-up. [Luitjens, J.; McCulloch, C.; Link T.; et al.]. Control patients numbered 793 and did not receive any NSAIDs. All participants in the study had knees evaluated with MRI at the onset of the study and after four years. Biomarkers for inflammation and progression of OA were based on cartilage thickness and composition, and other MRI measurements.

The results demonstrated that there are no long-term benefits on joint inflammation from the use of NSAIDs. In fact, compared to control participants, joint inflammation and cartilage quality were not only worse in people taking NSAIDs at the start of the study, but these signs of inflammation worsened even more at the four-year follow-up.

Johanna Luitjens, MD, from the Department of Radiology and Biomedical Imaging at the University of California, San Francisco, led the study and summarized the possible reasons for the findings. She noted that NSAIDs might not prevent synovitis, and progressive deterioration leads to worse synovitis over time. In addition, one thought is that pain relief from NSAIDs might increase physical activity on an already-injured joint, potentially worsening synovitis.

This study did not state that there is a causal relationship of NSAIDs to worsening osteoarthritis, but rather that they do not provide a protective mechanism to reduce inflammation or to slow progression of OA. NSAIDs still have a role in providing pain relief for osteoarthritis.

While this study pertained to human patients, it might be relevant to practitioners who are considering prescribing medication to equine patients affected by OA. 

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