Tag Archives: osteoarthritis

Ibuprofen or paracetamol?

John Dickson, a Middlesbrough GP and community rheumatologist, was once a clinical adviser for Nice guidance on osteoarthritis.

He says that concerns about the safety of paracetamol go back to the Sixties, but were largely dismissed because drugs such as aspirin and morphine were thought more dangerous.

This is thanks to aspirin’s risk of stomach bleeding and morphine’s risk of overdose and addiction.

‘This issue has taken about 45 years to come to a head,’ he says. ‘Research shows that paracetamol can act as a placebo for relieving acute and chronic pain. But it is not a safe placebo, like a dummy sugar pill.

‘Thanks to the damage it can cause to the kidneys and cardiovascular system, it is at least as dangerous as regularly taking non-steroidal anti-inflammatory drugs such as ibuprofen.’

Dr Dickson is particularly concerned by research showing that sustained paracetamol use over months or years causes gastric bleeding.

‘This is particularly dangerous for elderly people, because this causes the loss of haemoglobin – the molecule in red blood cells that carries oxygen.

‘This significantly harms their quality of life by making them feel ill and listless.’ There may be another reason to be wary.

The U.S. drug watchdog, the Food and Drug Administration (FDA), has been issuing warnings about paracetamol and its potential link with rare but serious skin reactions.

Ibuprofen

Ibuprofen

These reactions – Stevens-Johnson Syndrome, toxic epidermal necrolysis and acute generalised exanthematous pustulosis – are excruciating, with the skin separating from the body and sloughing off, with fatal consequences.


The FDA has said: ‘These reactions can occur with first-time use of paracetamol or at any time while it is being taken.

‘Any patient who develops a skin rash or reaction while using paracetamol should stop the drug and seek urgent medical attention right away.’

Other American research has linked long-term use of paracetamol with blood cancer.

In one study of nearly 65,000 people, taking paracetamol for at least four days a week for four years was linked to nearly double the risk of being diagnosed with leukaemia or lymphoma.

The possible mechanism for this risk has not yet been identified.

MRI scanning to detect arthritis

A new type of MRI scanning could help doctors detect arthritis at an earlier stage, allowing them to treat it more successfully, according to a new study.

Normal MRI imaging is usually not powerful enough to detect early damage being caused by osteoarthritis.

However, researchers at New York University have found that more advanced scanning can be used to reveal small changes in the structure of joint cartilage.

Scientists believe this type of scanning could eventually be used by specialists to spot the early signs of osteoarthritis in young patients and help provide better treatment for arthritis.

MRI scanning

MRI scanning

Osteoarthritis is the most common form of arthritis and the majority of Irish people over 55 years of age have some degree of evidence of the condition in their joints.

The researchers say new scanning techniques are now accurate enough to enable detection of subtle joint changes that can point to future osteoarthritis.


According to Arthritis Ireland, “it is unlikely that MRI or advanced MRI would be used to detect osteoarthritis in Ireland in the short-term as the cost and accessibility to these advanced scanners is prohibitive. However, this situation will hopefully change in the future.”

The research was published in the Journal of the American Academy of Orthopaedic Surgeons.