Articles by Dr. Arnold

Articles by Dr. Arnold

Small RhombusHealth articles by Dr. Fred Arnold focus on prolotherapy, pain rehabilitation and natural healing.

Articles by Dr. Fred Arnold

Dr. Fred Arnold



If you have ever had a painful joint such as the hip, knee, shoulder or low back your doctor may have prescribed a Nonsteroidal anti-inflammatory drug, also known as a NSAID.  These drugs are among the most commonly used drugs in the world for the treatment of osteoarthritis (OA) symptoms.  What you may have not been told is NSAIDs have been shown to cause osteoarthritis and accelerate the breakdown of cartilage in joints such as the knee, hip and low back.

Each year over 70 million NSAID prescriptions are given to patients in the United States, 20 million in Great Britain and 10 million in Canada.  These numbers do not include the 30 billion over-the-counter tablets sold each year in the United States alone.

The worldwide pain management prescription drug market totaled approximately $24 billion in 2002 and passed $30 billion by 2006.

Of the people who are taking NSAIDS, 20-30% of these people are over the age of 64 years of age and in developed countries these numbers are expected to rise as the baby boomers age.

Some of the most common NSAIDS, both prescription and over the counter, include aspirin, celebrex, advil, motrin, celebrex, aleve, toradol, relafen, daypro and clinoril.

Numerous scientific studies have shown that patients who use NSAID to treat osteoarthritis have a faster rate of cartilage breakdown that leads to the need for joint replacements.  It is the massive use of these medications in patients with OA during the past forty years that has lead to the rapid rise in the need for hip and knee replacements.  Between 1997 and 2005 the number of knee surgeries climbed by 69% from 328,000 to 555,800 and hip replacements rose 32% from 290,000 to 383,500.  During this time period, spinal fusion surgeries  also increased by 73% from 202,100 procedures to 349,000 per year.

Organizations such as the International Cartilage Repair Society and Osteoarthritis Research Society International have made recommendations regarding the use of NSAIDS.  They recommend these drugs be used at the lowest effective dose, long-term use be avoided (if possible), and they not be used as a first-line therapy for OA.  The International League Against Rheumatism and the World Health Organization have recommended any drug used to treat OA not have a damaging effect on the joint cartilage.  If this recommendation was followed, the vast majority, if not all NSAIDS, would be immediately taken off the market and no new one would get approved.

In addition to accelerating OA, over 100,000 people are hospitalized for gastrointestinal bleeding and of those 16,500 people die from NSAID toxicity each year.  People are at higher risk if they are age 60 or older, have had stomach ulcers or bleeding problems, take a blood thinning agent or steroid drug and have three or more alcoholic drinks every day.

Because doctors are frequently taught treatment approaches supported by pharmaceutical companies, it is also the responsibility of the patient to make themselves aware of the dangers and alternatives to NSAIDS.

  1. 1. Other Pain Medications:  there are pain medications that are not anti-inflammatory and they do not cause the breakdown of articular cartilage.  Tylenol (acetametaphin) is an  example of an over-the-counter pain medication and there are other numerous prescription pain medications that are not anti-inflammatory that can be prescribed.
  3. 2. Limit the dose and time period NSAID's are taken: take the smallest dose possible for the shortest period of time.  NSAID's at higher dosages and taken for extended periods of time will cause joint damage.
  4. 3. Consider Natural Alternatives for the treatment of joint inflammation;  there are many natural alternatives that includes an anti-inflammatory diet and numerous supplements such as fish oil, Vitamin D, resvesatol, and curcumin.
  5. 4. Regenerative Medicine Injections:  there are proven regenerative medicine injections to regenerative and repair arthritic joints such as prolotherapy, prolozone, platelet rich plasma (PRP) and stem cell therapy.

Numerous scientific studies clearly show that NSAID's actually worsen osteoarthritis for which it is most commonly prescribed for and leads to the need for hip and knee joint replacement along with spinal fusion surgeries.

It should be realized that there are other proven alternatives to the use of NSAIDS as a first line therapy of osteoarthritis and joint pain without the severe side effects caused by NSAIDS.

Unless there is a restriction on the use of NSAIDs, as has been recommended by different organizations, there will continue to be an exponential rise in degenerative arthritis and subsequent musculoskeletal surgeries for decades to come.

It is the responsibility of each patient to be aware of the risks and benefits of each medication they are putting into their body and discuss any concerns with their doctor.

Hauser, Ross A., The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs, Journal of Prolotherapy, Volume 2, Issue 1, February 2010.