Osteoarthritis is the term we use to describe degenerative joint disease. This is due to a breakdown of the tissue surrounding a joint due to increased loading. When a joint is abnormally loaded for a prolonged period of time the body responds by breaking down cartilage and the softer tissue while building up the bony tissue. The end result of this process is to fuse that joint together. Osteoarthritis (OA) is not known to correlate well to pain, meaning you can have OA in a joint but not have any pain. When we see OA in a joint we know that that joint is at an increased risk for becoming symptomatic. It is typical for the Medical community to treat patients with pain due to OA with non-steroidal anti-inflammatory drugs (NSAIDs.) A recent study found, for cases of OA, NSAIDs Increase the Risk for Cardiovascular Disease.
Osteoarthritis has already been shown to be an independent risk factor for cardiovascular disease but the authors of this study wanted to figure out what part NSAID’s played in the risk. The researchers identified 7743 people with osteoarthritis and an age- and sex-matched cohort of 23,229 people without osteoarthritis from 720,055 administrative health records in British Columbia. In other words, this is a study of a large population of people. Their results showed risk for congestive heart failure was 42% higher in people with osteoarthritis, for ischemic heart disease risk was 17% higher, and for stroke risk was 14% higher. When they examined prescription drug records for NSAID use they found that approximately 67.5% of the total effect of osteoarthritis on cardiovascular disease risk was related to NSAID use. Specifically, the risk for congestive heart failure increased by 44.8% with NSAID use, the risk for ischemic heart disease increased by 94.5%, and the risk for stroke increased by 93.3%. If you take a prescription NSAID to manage pain related to OA, based on this data, you will likely develop either ischemic heart disease and/or suffer a stroke.
What is a bit depressing is the authors of this study believe these numbers are conservative because their data only included prescription NSAID use, it did not include any OTC NSAIDs such as ibuprofen. The authors have no solutions to offer on this issue of pain. In fact the lead author was quoted in an interview regarding what to tell patients as; “Do you want to live with pain or live longer?” What an option, live in pain or live a shorter life because you die from cardiovascular disease due to taking pain medications. Maybe you could try joint replacement,the author says but “otherwise stick to the pills.” The study is concerning by itself but reading what the lead author had to say is a bit disturbing. Its like they know the drugs are not good for our long term health but take them anyway because pain sucks. I’ll agree that pain sucks but I know something that they apparently don’t know, there are effective non-drug and non-surgical options to mange pain due to OA.
I want to be clear, studies such as these look at patients who take these medications on a daily basis for years. These patients have chronic pain and they manage it by taking these drugs and typically nothing else. Taking an NSAID, prescription or OTC, for a few days to a few weeks is not the type of use that will result in an increased risk for cardiovascular disease. If you are taking an NSAID to manage chronic aches and pains, just like the commercials suggest, you are trading less pain for a shortened lifespan. Patients with chronic pain shouldn’t be forced into making a decision between live with pain or a shortened lifespan and they don’t have to. Physicians need to understand the role chiropractic care can have in helping to treat these patients when their pain comes from OA in the spine. The study we reported on several weeks ago helps to do just that. When it comes to spine pain, chiropractic care is a safe and effective treatment and all patients should be offered it as an option.