Thursday, September 01, 2011

NSAIDS Damage Joints

In the "What I Learned Today" category: NSAIDS (like Advil, Aleve, Indocin) can accelerate joint breakdown:
"NSAIDs may be useful in reducing pain and inflammation in osteoarthritis, [but may] enhance the process of cartilage degeneration by interfering with intrinsic repair activities."1
Looks like NSAIDS that were more selective for inhibiting COX-2 enzymes were less damaging to joints, but had a higher risk for stroke and heart attack.

Here's Wikipedia's page on COX-2 inhibitors. As I understand it, all NSAIDS inhibit both COX-1 and COX-2, but some are more selective for COX-2 than, say, ibuprofen (Advil) or naproxen (Aleve, Anaprox). It's the COX-1 inhibitors that cause more GI bleeding. Aspirin inhibits both COX-1 and COX-2.

Some NSAIDS more selective for COX-2:
  • Vioxx (off market for heart attack and stroke risk)
  • Celebrex
  • Bextra
So, all NSAIDS damage joints, some less than others.

Related: COX-2 (Which NSAIDS Inhibit) Plays An Essential Role In Bone Repair
1Differential Direct Effects Of Cyclo-Oxygenase-1/2 Inhibition On Proteoglycan Turnover Of Human Osteoarthritic Cartilage: An In Vitro Study, Arthritis Research Therapy, 2005


catmum said...

Read the article, but was unable to parse a clear conclusion about which NSAID is least damaging to take for joint pain.

Bix said...

I'll edit the post with some more info.

Anonymous said...

Hi. The last sentence of your post seems inconsistent with this from the abstract "whereas high COX-2/COX-1 selective NSAIDs did not show such effects and might even have cartilage reparative properties."

Am I missing something?


Bix said...

Yes. In the body of the study, the authors say:
"Adverse direct effects of NSAIDs on cartilage with long-term treatment may have an important impact on long-term outcome."

I had read a few studies when I posted this. There has been shown a cartilage-protective effect of prostaglandin E2 (PGE2):

"PGE2 alone can inhibit collagen degradation in [osteoarthritis] articular cartilage." and "is not destructive as commonly believed."

COX-2 causes conversion of certain fatty acids to PGE2. COX-2 can also be anti-inflammatory. The inhibition of COX-2, as provided by high COX-2/COX-1 NSAIDS, is controversial, as I'm discovering. And drug companies are defending COX-2 inhibitors.

Dr. Mel said...

I tried taking aspirin for my back, etc., when the Danish study condemning nsaids came out, but it makes me feel funny if I take it everyday. It affects certain nerve endings at the back of my head--I know, that's weird, but that's my hypothesis about the funny feeling I get at the back of my head when I take aspirin. And so I went back to ibuprofen, which (I had read several years ago) might help inhibit the production of amyloid plaques in the brain, vis-a-vis Alzheimers. And now this comes out about arthritis. So basically, there is nothing one can take for minor pains (but enough to make you wakeful at night) that isn't harmful some way or another. I guess it's just a question of naming your poison, given that we're all going to be killed by *something*.

Bix said...

I know ... I take ibuprofen when I have pain. I always have it in the house in case. I know there are problems with it, but there are times the situation calls for it. I mean, I don't even think twice then! But at least I know a little more about what it could be doing and I can try to offset it with my lifestyle. You do the best you can.