Chronic inflammation is bad for us. Always. But does fighting inflammation prevent or treat osteoarthritis (OA)?
Anti-inflammatory medications (NSAIDs) have been around for over a century and are routinely used by more than 30 million Americans. Injections of corticosteroids (steroids that suppress inflammation) have been used to treat OA pain since the 1950s and are performed several million times each year. What is the long-term impact of these inflammation-fighters in OA?
Joints affected by OA often swell, hurt, and have higher levels of inflammatory proteins (cytokines like TNF and IL-1). NSAIDs reduce this inflammation. Corticosteroids are even more potent in shutting down inflammation when injected directly into the joint. For years, many doctors also believed that using these medications and injections might help protect joints from osteoarthritis. Patients were encouraged to seek injections when needed, up to several times a year, if it helped alleviate the pain.
This method of fighting inflammation for OA was rarely questioned until a 2017 research study on corticosteroid injections was published. The researchers enrolled 140 patients with knee osteoarthritis and then randomly assigned them to receive either corticosteroid or saline injections into their affected knees every three months. After two years, they evaluated the patients' pain levels and performed MRIs of their knees. No difference in pain was seen between the steroid and saline groups. This was not entirely surprising since pain relief from steroid injections usually wears off within a month or two.
The surprising part was that those who received steroid injections actually had worse osteoarthritis than those who received saline. Fighting inflammation with steroid injections seemed to speed up joint damage from OA. NSAIDs (ibuprofen, naproxen, etc.) have also undergone a similar recent critical review, with the possibility that their long-term use may also worsen arthritis. Although many OA patients have clear inflammation, suppressing that inflammation appears to make the disease worse. But why?
To understand why, we need to carefully examine the cause of inflammation in OA. The inflammation associated with OA is like a wound that won't heal. OA might have started with an ACL tear or other injury, or it might result from the chronic inflammation seen in metabolic syndrome. We can temporarily reduce it with NSAIDs or steroid injections, but these treatments don't address the root cause. The concept is similar to caring for a broken bone that won't heal. An orthopedic surgeon would avoid corticosteroids and other immune-suppressing treatments. These interventions might temporarily relieve pain, but they slow healing in the long run.
Much like repairing a wound, treating OA requires activating immune and blood cells, not suppressing them. Activating the immune system releases growth factors and other building blocks our bodies need to restore tissue health. To treat OA, we need to stimulate, not suppress, the immune system.
There are multiple ways to activate healing systems in the body. One of the most powerful is exercise– the topic of our next blog.