As we see more patients looking for alternatives to knee surgery and many of those people are being pain managed with anti-inflammatory medications or NSAIDs (non-steroidal anti-inflammatory medications) and painkillers, one question they all seem to have is: “What are these medications doing to my knees.”
The simple answer is, according to published research, they are destroying your knees. The research supporting this statement goes back for decades. In 1993 Dr. MJ Shield of the Department of Medical and Clinical Research, Searle, Bucks, United Kingdom, wrote in the European journal of rheumatology and inflammation (1) : “Growing evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs), while able to alleviate inflammation, may damage articular cartilage.” How? By preventing the growth of new cartilage.
Nothing has changed in 28 years. These medications are continually shown to accelerate knee damage.
But, while NSAIDS can make knees feel better in the short-term, more and higher doses are needed to in the long-term to achieve similar results. In the over 22 years that we have treated patients with knee problems, there has always been the instance when a patient will ask us if they can continue with their anti-inflammatory medications. The answer is typically no. When the patient asks why? We remind them that regenerative medicine techniques like the ones we use, count on the beneficial aspects of inflammation. Inflammation is the way Nature heals. If we stop the inflammation, we stop the healing.
This simple statement, that inflammation is Nature’s way of healing has been the subject of decades long debate in the medical community. Many doctors argue that you have to shut down inflammation to prevent more damage. For decades, cortisone became the weapon of choice. Cortisone as doctors would later find out, would destroy joints and contributed to the great surge in joint replacement surgeries.
But don’t you need to shut down inflammation to heal?
A group of medical researchers in Australia looked at inflamed knees. The researchers wanted to see what came first, knee inflammation or knee degenerative changes. In other words, did the inflammation cause the degenerative knee disease or did the degenerative knee disease cause the inflammation?
Knowing which came first would make a big difference for patients with knee pain and degenerative arthritis, and, towards helping doctors and patients understand a path of treatment. This treatment path would would move away from the use of anti-inflammatories as a primary step in “conservative care” of knee pain. The research team published their findings in The Journal of Rheumatology (2) to suggest:
“Knee cartilage and subchondral bone abnormalities predicted change in effusion-synovitis, but effusion-synovitis did not predict knee structural changes. These findings suggest that synovial inflammation is likely the result of joint structural abnormalities in established osteoarthritis.”
The knee damage that causes inflammation came first. Therefore chronic inflammation would make the knee worse and send the knee towards knee replacement. This study presents an interesting scenario that the inflammation causes knee degeneration and knee degeneration causes inflammation cycle has a starting point. Significant knee damage.
The greater knee pain could contribute to a new knee injury, which is often characterized by a destabilizing meniscal tear
Taking this idea further is this 2020 study (3) suggesting:
“Within 12 months before radiographic onset, adults with advanced knee osteoarthritis report more joint symptoms, frequent use of pain medication, frequent knee swelling, and daily knee pain compared with those who develop typical knee osteoarthritis. The greater knee pain could contribute to a new knee injury, which is often characterized by a destabilizing meniscal tear. The joint trauma may be a triggering event in a joint with an impaired ability to heal, which ultimately leads to joint failure.”
“medical management of hip and knee osteoarthritis, particularly with non-steroidal anti-inflammatory drugs, may carry higher mortality compared to surgery.” Surgery is dangerous. Anti-inflammatories are more dangerous.
This is from the Journal of orthopaedic surgery,(4) and university hospitals in the United Kingdom, The doctors in this study compared the long-term safety of taking anti-inflammatory medications with the long-term safety of knee and hip replacements. They are measuring side effects including mortality.
- Mortality was the highest for naproxen (Aleve, Moltrin) and lowest for total hip replacement.
- Highest gastrointestinal complications were reported for diclofenac (Voltaren) and lowest for total knee replacement
- Ibuprofen had the highest renal complications.
- Celecoxib (Celebrex) had the highest cardiovascular risk
The researchers said: “results of this study show that medical management of hip and knee osteoarthritis, particularly with non-steroidal anti-inflammatory drugs, may carry higher mortality compared to surgery.”
I have written an extensive article Dependency on painkillers may lead to unsuccessful knee replacement that will help shed more light on this subject.
“Use of specific medications may accelerate the progression of radiographic knee osteoarthritis.”
A January 2021 study (5) found the “Use of specific medications may accelerate the progression of radiographic knee osteoarthritis.” Of the different medications, including statins, anti-hypertensives, anti-depressant/anxiolytics/psychotropics, osteoporosis-related medication, diabetes-related medication, and NSAIDs, only the NSAIDs accelerate joint space loss and a worsening knee osteoarthritis condition.
Understanding the healing and destructive roles of knee inflammation
In the research I mentioned at the top of this article, doctors looked at the inflamed synovial membrane in the knees of 413 patients with painful osteoarthritis. The patients were almost equally divided into similar groups of women and men, and the average age was 63 years old.
The synovial membrane is a tissue that surrounds the knee and protects the joint capsule. In addition, to acting as a protective lining, the membrane secretes synovial fluid. Synovial fluid is a lubricant that helps the cartilage of the knee glide through normal range of motion.
When the synovial membrane becomes inflamed, it secrets inflamed synovial fluid.
Inflamed synovial fluid makes more inflammation.
While rheumatoid arthritis or immune disorder can cause synovitis, this study focuses on the development of synovitis as being caused by degenerative wear and tear arthritis..
Back to the the Australian research team. In the subject patients the doctors measured:
- The inflamed fluid of the knee synovitis, cartilage defects, cartilage volume, and bone marrow lesions via magnetic resonance imaging.
- Joint space narrowing and osteophytes (bone spurs) were assessed using radiograph.
- Knee symptoms were assessed by using the popular Western Ontario and McMaster University (WOMAC) osteoarthritis index scoring system.
Here is the research conclusion:
Knee cartilage and subchondral bone abnormalities predicted change in effusion-synovitis (more inflammation), but effusion-synovitis (more inflammation) did not predict knee structural changes. These findings suggest that synovial inflammation is likely the result of joint structural abnormalities in established osteoarthritis. This means that that anti-inflammatory treatments are only suppressing inflammation, the degenerative damage to the knees continues.
Moving away from anti-inflammatory treatments and moving towards pro-inflammatory treatments.
Treatments such as cortisone injections, Regenokine injections, NSAIDs (non-steroidal anti-inflammatories) may do more damage than good in some people. The inflammation is trying to heal damage, shutting off the inflammation makes MORE damage. This is why certain branches of medicine are moving away from anti-inflammatory treatments and moving towards pro-inflammatory treatments.
In our clinic not only do we use Stem Cell Therapy and Platelet Rich Plasma Therapy. We have published research on the effectiveness of the treatments
You can read our published research in this article Stem cell therapy for knee osteoarthritis. In this article I present research to support the use of stem cell treatments for knee osteoarthritis.
Do you have questions? Ask Dr. Darrow
Marc Darrow, MD., JD. is the medical director and founder of the Darrow Stem Cell Institute in Los Angeles, California. With over 23 years experience in regenerative medicine techniques and the treatment of thousands of patients, Dr. Darrow is considered a leading pioneer in the non-surgical treatment of degenerative Musculoskeletal Disorders and sports related injuries. Dr. Darrow has co-authored and continues to co-author leading edge medical research including the use of bone marrow derived stem cell therapy for shoulder, hip, knee and spinal disorders.
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Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician.
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1 Shield MJ. Anti-inflammatory drugs and their effects on cartilage synthesis and renal function. European journal of rheumatology and inflammation. 1993;13(1):7-16.
2 Wang X, Jin X, Blizzard L, Antony B, Han W, Zhu Z, Cicuttini F, Wluka AE, Winzenberg T, Jones G, Ding C. Associations Between Knee Effusion-synovitis and Joint Structural Changes in Patients with Knee Osteoarthritis. The Journal of Rheumatology. 2017 Sep 1:jrheum-161596.
3 Driban JB, Harkey MS, Barbe MF, Ward RJ, MacKay JW, Davis JE, Lu B, Price LL, Eaton CB, Lo GH, McAlindon TE. Risk factors and the natural history of accelerated knee osteoarthritis: a narrative review. BMC musculoskeletal disorders. 2020 Dec;21:1-1.
3 Aweid O, Haider Z, Saed A, Kalairajah Y. Treatment modalities for hip and knee osteoarthritis: A systematic review of safety. Journal of Orthopaedic Surgery. 2018 Nov 8;26(3):2309499018808669.
4 Perry TA, Wang X, Nevitt M, Abdelshaheed C, Arden N, Hunter DJ. Association between current medication use and progression of radiographic knee osteoarthritis: data from the Osteoarthritis Initiative. Rheumatology. 2021 Jan 27.—