NSAID drugs, the common solution for a large number of arthritis and orthopedic injuries, have worked themselves into national guidelines and are handed out like candy at most family doctor and orthopedic offices. However, while they help inflammation, are they a good idea? A new study suggests that a commonly used NSAID, Aleve for arthritis, hurts rather than helps cartilage.
NSAID is the abbreviation for nonsteroidal anti-inflammatory drugs. NSAIDs are used to relieve pain and inflammation. Common over-the-counter NSAIDs include naproxen (e.g., Aleve and Naprosyn), ibuprofen (e.g., Advil and Mortin). Prescription NSAIDs include Celebrex (celecoxib), Mobic (meloxicam), Voltaren (diclofenac), Daypro (oxaprozin), and others. Prescription NSAIDs can also be stronger versions of the over-the-counter drugs, such as naproxen and ibuprofen.
The medical literature has shown time and time again that NSAIDs are dangerous drugs with many nasty side effects including the following:
These dangerous side effects have led the FDA to issue NSAID warnings as well as pull some prescription NSAIDs, such as Vioxx, off the market. In addition, inflammation in the body has gotten a bad rap (see our practice’s book, Orthopedics 2.0) as it’s essential for normal healing.
Cartilage is made up of chondrocyte cells. Before we get into what naproxen does to cartilage, you need to understand that as chondrocytes become old and dysfunctional, they enter a stage of dying call “hypertrophy.” Much like an older person these days, they put on weight and become physically bigger and less active. This is the beginning of arthritis, as hypertrophic chondrocytes don’t last long against normal wear and tear, so the cartilage begins to break down.
Mesenchymal stem cells (MSCs) live in your joints and are the repair cells for cartilage. Once a cartilage cell dies off, MSCs are involved in replacing it. So what happens to the MSCs in your joints determines the overall ability of your joints to repair themselves after normal wear and tear.
Naprosyn and Aleve (naproxen) used to be my favorite NSAIDs because they had the least chance of killing you via a sudden-death heart attack. That’s why finding this new research was an eye opener.
The researchers took MSCs from normal healthy patients and donors with hip arthritis. They exposed them to naproxen at the dose that would be expected to make it into the joint if they had taken the medication orally. The naproxen caused the MSCs to become hypertrophic by altering their expression of genes that make proteins (like one called collagen X which is produced by hypertrophic cartilage cells). Basically, taking (naproxen) Aleve for arthritis, hurt the repair cells of the joint, making the cells old before their time.
The upshot? Naproxen is no longer my favorite NSAID, and certainly not Aleve for arthritis. While the other NSAIDs tested didn’t do this, they all have a higher cardiac risk profile, so it seems like you can’t win with this drug class. In the meantime, if you want to get off the NSAID sauce, consider reading our tips for which natural supplements pack as big an anti-inflammatory punch as NSAIDs.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…