September 2017

Intraarticular NSAIDs and opioid meds may contribute to cartilage cell death

In the moment: Knee OA

By Jordana Bieze Foster

Treating lower extremity joint pain with intraarticular non­steroidal anti-inflammatory drugs (NSAIDs) and opioid medications may contribute to cartilage cell death, which could accelerate the progression of osteo­arthritis, according to an in-vitro study from Stanford University in California.

Investigators arthroscopically harvested human cartilage from the intercondylar notch of the femur and replicated it in vitro. Cultured chondrocytes were then exposed to four types of pain medication solutions (ketorolac tromethamine, morphine sulfate, meperidine hydrochloride, and fentanyl citrate) at various single-dose equivalent concentrations; the chondrocytes were also exposed to saline as a control.

All concentrations of the NSAID ketorolac and the opioid meperidine were associated with significantly greater chondrocyte death than the saline condition, and a dose-response relationship was also observed for those two medications. Chondrocyte mortality associated with morphine and fentanyl, however, did not differ significantly from that associated with the control condition, even after an additional two weeks of exposure.

The findings were epublished in September by the American Journal of Sports Medicine.


Abrams GD, Chang W, Dragoo JL. In vitro chondrotoxicity of nonsteroidal anti-inflammatory drugs and opioid medications. Am J Sports Med Sept 13. [Epub ahead of print]

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