Does Taking NSAIDS for Back Pain Mask Inflammation in MRI Scans?

In a recent article I found on the Medical Republic website they write that taking the common drug NSAIDs for back pain may mean pain is mistakenly attributed to mechanical rather than inflammatory causes.

Almost one-quarter of patients diagnosed with axial spondyloarthritis, who had MRI evidence of active sacroiliitis when off NSAIDs for 1-2 weeks, showed no signs of inflammation on an MRI repeated while taking NSAIDs.

The study involved around 300 adults with suspected or established axSpA recruited from multiple centres in the UK.

Patients were asked to stop taking NSAIDs for one to two weeks before having a sacroiliac joint MRI scan. The patients then restarted their medication.

Those who had MRI evidence of bone marrow oedema lesions (50% of the original sample) then underwent a second scan six weeks later to determine the effect of NSAIDs on the lesions, whereupon 31 (24%) scanned negative.

Given the role of NSAIDs in treatment and the importance of MRI for to determine suitability for biologics, these findings could have significant implications for clinical practice.

Of the patients who successfully completed the NSAID washout and had the first scan, almost half reported an increase in spinal pain and more than half experienced worsening of disease activity.

What are NSAIDs?

NSAIDs are non-steroidal anti-inflammatory drugs (NSAIDs) are medicines that are widely used to relieve pain, reduce inflammation, and bring down a high temperature.

NSAIDs are available as tablets, capsules, suppositories (capsules inserted into the bottom), creams, gels and injections.

Some can be bought over the counter from pharmacies, while others need a prescription.

The main types of NSAIDs include:

• ibuprofen
• naproxen
• diclofenac
• celecoxib
• mefenamic acid
• etoricoxib
• indomethacin
• aspirin for pain relief (low-dose aspirin is not normally considered to be an NSAID)

NSAIDs may be sold or prescribed under these names or a brand name.

They're all similarly effective, although you may find a particular one works best for you.

It's a good idea to ask a pharmacist or doctor for advice before taking any NSAIDs.

Over-the-counter NSAIDs generally have fewer side effects than stronger prescription medicines.

Possible side effects of NSAIDs include:

• indigestion – including stomach aches, feeling sick and diarrhoea
• stomach ulcers – these can cause internal bleeding and anaemia; extra medicine to protect your stomach may be prescribed to help reduce this risk
• headaches
• drowsiness
• dizziness
• allergic reactions
• in rare cases, problems with your liver, kidneys or heart and circulation, such as heart failure, heart attacks and strokes

If you're bothered by side effects, stop taking your medicine and tell your doctor.

The main alternative for pain relief is paracetamol, which is available over the counter and is safe for most people to take.

For lots more information about NSAIDs head to the NHS website here.

Source: Medical Republic NHS