Is there an association between the use of different types of nonsteroidal antiinflammatory drugs and radiologic progression of osteoarthritis? The Rotterdam study

Objective. To investigate the influence of the use of various types of nonsteroidal antiinflammatory drugs (NSAIDs) on progression of osteoarthritis (OA) of the hip and knee. Methods. In 1,695 subjects (2,514 hips) and 635 subjects (874 knees) ages 55 years and older from the Rotterdam Study, radiographs of the hip and knee at baseline and followup (mean followup time 6.6 years) were evaluated. Radiologic OA (ROA) progression was defined as a minimum increase of I in the Kellgren/Lawrence grade or incident joint replacement at followup. The associations between the different types of NSAIDs and progression of ROA were assessed using multivariate logistic regression analysis. Results. Those subjects who were receiving diclofenac > 180 days had a 2.4-fold increased risk (95% confidence interval [95% CI] 1.0-6.2) of progression of hip ROA and a 3.2-fold increased risk (95% CI 1.0-9.9) of knee ROA, compared with those considered short-term users (diclofenac for 1-30 days). These associations were adjusted for age, sex, body mass index, baseline ROA, followup time, and defined daily dosage. Conclusion. These data suggest that diclofenac may induce accelerated progression of hip and knee ROA. Whether this occurs because of a true deleterious effect on cartilage or because of excessive mechanical loading on a hip following pain relief remains to be investigated.