Effects of anti-inflammatory (NSAID) treatment on human tendinopathic tissue

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat tendinopathy, but evidence for this treatment is lacking, and little is known regarding effects of NSAIDs on human tendinopathic tendon. This study investigated effects of NSAID treatment (ibuprofen) on human tendinopathic tendon, with changes in gene expression as the primary outcome, and tendon pain, function and blood flow as secondary outcomes. Twenty-six adults (16 male, 10 female) diagnosed with chronic Achilles tendinopathy were randomized to one-week treatment with ibuprofen (600mgx3/day) (n=13) or placebo (n=13) (double-blinded). Ibuprofen content in blood, visual analog scale (VAS) score for tendon pain at rest and activity, Victorian Institute of Sports Assessment-Achilles (VISA-A) scores for tendon function, tendon thickness (with ultrasonography) and color Doppler were measured pre- and one hour post-treatment. After the last post-test, a full-width tendon biopsy was taken from the affected area. Real-time-RT-PCR was used to assess expression of collagen I, collagen III, transforming growth factor (TGF-ß) isoforms, cyclooxygenase-2 (COX-2), Angiopoietin-like 4 (ANGPTL4) and Cyclic AMP-dependent transcription factor (ATF3) in tendon tissue. Expression of collagens and TGF-ß isoforms showed relatively low variation and was unaffected by ibuprofen treatment. Further, no changes were seen in tendon thickness or VISA-A score. The placebo treatment reduced the color Doppler (in tendon plus surrounding tissue) compared to the ibuprofen group, and also increased the perception of pain at rest. In conclusion, there was no indication that short-term ibuprofen treatment affects gene expression in human chronic tendinopathic tendon or leads to any clear changes in tendon pain or function.

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