Conquering Knee Inflammation: What Doesn't Seem to Work

If you have chronic knee pain, you have almost certainly struggled with inflammation and wondered how best to suppress it.

You may have tried two things that I’m not a big fan of: anti-inflammatory over-the-counter pain relievers and steroid injections into the joint.

Well, there’s more evidence now that they’re both probably not good ideas.

(1) Anti-inflammatory pain relievers

A writeup of a study tells us that:

Taking anti-inflammatory pain relievers like ibuprofen and naproxen for osteoarthritis may worsen inflammation in the knee joint over time.

This study included more than 1,000 people from something called the “Osteoarthritis Initiative.” 277 people had moderate to severe osteoarthritis and underwent “sustained” treatment with anti-inflammatories; 793 others made up the control group.

Everyone had an MRI initially, then later after four years.

Joint inflammation and cartilage quality were worse at baseline in the participants taking [non-steroidal anti-inflammatory drugs], compared to the control group, and worsened at four-year follow-up.

Why would this be? Now this is an interesting explanation, from the study’s lead author, though maybe not for the reasons she intended:

The anti-inflammatory effect that normally comes from [non-steroidal anti-inflammatory drugs] may not effectively prevent synovitis, with progressive degenerative change resulting in worsening of synovitis over time,” she said. “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 worsening of synovitis, although we adjusted for physical activity in our model.

This first part reads a bit strangely. It’s an explanation that parses as no explanation at all. Listen carefully to what she’s saying. I’m going to translate it to simple English (synovitis is important, by the way, as it’s expected to have an effect on the progression of knee osteoarthritis):

The anti-inflammatories don’t prevent synovitis, so the knee continues to degenerate and that results in worsening synovitis. Huh? That’s a fine explanation if anti-inflammatories are no more effective than a placebo (or not taking these drugs at all, as with the control group). But that’s a lousy “no explanation” considering these knees were worse than those in the control group.

So that means that, not only do the anti-inflammatories not prevent synovitis, but they either make it worse, or worsen the degenerative processes in the knee, than if you do nothing at all. Pretty damning stuff there, though the author makes us do too much work to get to this point.

Then look at the second part of the explanation. The author manages to kind of screw this up as well. Here’s my gentle translation:

Patients taking anti-inflammatories may engage in more physical activity because of the pain relief, and that could lead to worse synovitis, though we adjusted for physical activity in our model.

Again: huh? I fully agree with the basic point on the front end of the sentence, typified by the macho man runner with bad knees who says, “Eh, I can still run four or five miles, I just pop a couple of Advil after I’m done.” He’s probably beating back the pain with the Advil and doing more damage to his knees.

But look at the back end of that sentence: “... we adjusted for physical activity in our model.” So, in other words, that should have eliminated physical activity as a factor. That's because the researchers presumably made adjustments so they were basically comparing people from the two groups (control vs. steroids) who were doing the same amount of activity, like jogging or playing tennis.

That leaves us with a frightening implication: that had this variable not been adjusted for, the people taking anti-inflammatories might have had even worse knees. Yikes.

(2) Steroid injections

Check out the findings described in this article:  

Steroid injections, which are often used to treat pain in knee osteoarthritis, may actually make arthritis worse, according to two new studies.

Again, the researchers used some participants in this Osteoarthritis Initiative, which apparently includes almost 5,000 people.

44 were injected with steroids, 26 with hyaluronic acid (which is supposed to lubricate the joint), and the other 140 didn’t get either treatment.

Those who had a steroid injection had significantly more osteoarthritis progression, including medial joint space narrowing, a hallmark of knee osteoarthritis.

Not that hyaluronic acid is necessarily a good treatment either. An osteoarthritis researcher who was quoted in the article said that there’s conclusive evidence that injections of this substance aren’t better than a placebo, and at the same time, there’s “strong evidence” that they’re associated with “serious adverse events.”

Getting on top of chronic inflammation is important. But be careful if you’re doing it through drugs. Research what you’re popping into your mouth or getting injected into your knees.