The American Journal of Medicine
Volume 122, Issue 9 , Pages 836-842, September 2009

Do NSAIDs Affect Longitudinal Changes in Knee Cartilage Volume and Knee Cartilage Defects in Older Adults?

  • Changhai Ding, MD

      Affiliations

    • Menzies Research Institute, University of Tasmania, Hobart, Australia
    • Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Australia
    • Corresponding Author InformationRequests for reprints should be addressed to Changhai Ding, MD, Menzies Research Institute, Private Bag 23, Hobart, Tasmania 7000, Australia
    • ,
  • Flavia Cicuttini, PhD

      Affiliations

    • Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Australia
    • ,
  • Graeme Jones, MD

      Affiliations

    • Menzies Research Institute, University of Tasmania, Hobart, Australia

Abstract 

Background

The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on knee osteoarthritis progression are unclear. The aim of this longitudinal study was to determine the associations between use of NSAIDs and changes in knee cartilage volume and knee cartilage defects over 2.9 years in older adults.

Methods

T1-weighted fat-suppressed magnetic resonance imaging on the right knee was performed in a total of 395 randomly selected subjects (mean age 62 years, range 51-80 years, and 50% female) to assess knee cartilage volume at tibial sites and knee cartilage defects (0-4 scale) at baseline and 2.9 years later. Medication use in the last month was recorded by questionnaire.

Results

Compared with nonusers of NSAIDs (n=334), users of cyclooxygenase (COX)-2 inhibitors (n=40) had decreased knee cartilage defect development in the medial tibiofemoral compartment (odds ratio [OR] 0.4, 95% confidence interval [CI], 0.2-0.99), whereas users of conventional NSAIDs (n=21) had increased knee cartilage defect development in both medial (OR 3.1, 95% CI, 1.0-9.1) and lateral (OR 2.6, 95% CI, 1.0-6.7) tibiofemoral compartments. Comparing users of COX-2 inhibitors with users of conventional NSAIDs, the latter had higher knee cartilage volume loss (−5.3% vs −3.1% at medial tibia and −3.6% vs −1.1% at lateral tibia; all P <.05). All associations were adjusted for potential confounders including knee pain and radiographic osteoarthritis.

Conclusions

This study suggests that nonselective NSAIDs may have deleterious effects, while selective COX-2 inhibitors might have beneficial effects on knee cartilage. Randomized controlled trials examining knee structure to confirm this finding are warranted.

Keywords: Cartilage loss, Knee, Magnetic resonance imaging, Nonsteroidal anti-inflammatory drugs, Osteoarthritis

 

 Funding: National Health and Medical Research Council of Australia; Arthritis Foundation of Australia; Tasmanian Community Fund; University of Tasmania Grant-Institutional Research Scheme.

 Conflict of Interest: Dr. Jones has worked as a consultant, speaker, and clinical trialist with Pfizer, MSD, Roche, and Novartis, all of which manufacture NSAIDs. However, none of these companies had any input into the writing of this article. Other authors have nothing to declare.

 Authorship: All authors had access to the data in the study. Study design: Ding, Cicuttini, Jones. Acquisition of data: Ding, Jones. Analysis and interpretation of data: Ding, Cicuttini, Jones. Manuscript preparation: Ding, Cicuttini, Jones. Statistical analysis: Ding, Jones.

PII: S0002-9343(09)00341-6

doi:10.1016/j.amjmed.2009.03.022

The American Journal of Medicine
Volume 122, Issue 9 , Pages 836-842, September 2009

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