FRI0457 Is the inflammatory reaction an essential part of recovery after muscle injury?
Authors: M. Rother, E.J. Seidel, A. Fischer, I. Rother
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Eccentric muscle contraction causes a microtrauma induced inflammatory reaction with muscle pain peaking 24 to 48 hours after exercise (delayed onset of muscle soreness (DOMS). The use of NSAIDs seems like a reasonable therapeutic approach for treatment and is frequently used in daily practice. But evidence for treatment effects is controversial. One of the reasons why the effect of NSAID's might be limited are detrimental effects on recovery, e.g. Nieman et al [1] found elevated cytokine levels in ibuprofen users following a 160 km race. We developed a robust model of DOMS induced by walking down stairs that allows monitoring of the kinetic of treatment effects in DOMS [2] Ketoprofen and diclofenac are highly potent inhibitors of inflammatory cytokines [3], whereas celecoxib seems to be less potent [4]. <h3>Objectives</h3> To compare the effects of two products with different anti-inflammatory potency (ketoprofen and celecoxib) on the kinetic of DOMS. <h3>Methods</h3> Two randomised, placebo-controlled studies using a similar design were conducted. In both studies, DOMS was induced by walking down of stairs with an altitude depending on body weight. Study I compared the effect of 200 mg celecoxib bid (n=40) to placebo (n=40). Study II compared the effect of 100 mg ketoprofen (n=24) b.i.d. to placebo (n=48). Treatment was applied for 7 days after exercise. Pain scoring was performed using a 11 point numerical scale. Rating was performed at least daily to monitor kinetic effects. <h3>Results</h3> In Study I, maximum pain during contraction in the calf was observed at 24, 36 and 48 h after exercise (4.2±1.9, 4.8±2.2, 4.2±2.5). There was a non-significant trend of pain reduction in the celecoxib group (3.7±1.6, 4.4±2.0, 3.8±1.9). Study II showed thatketoprofen application resulted in pain reduction as compared to placebo during the first 24 h of treatment. But considering the full observation period (AUC), the ketoprofen group showed higher pain scores as compared to placebo (<i>p</i>=0.0240). Also, maximum pain and time to maximum pain were numerically higher for the ketoprofen group. Evaluation of all parameters indicated that most of the negative effect of oral ketoprofen was caused by a delay of recovery (Time to full recovery: <i>p</i>=0.0046). <h3>Conclusions</h3> Ketoprofen as a highly potent anti-inflammatory drug may, in contrast to the less potent celecoxib, causes deleterious effects on recovery from muscle soreness induced by eccentric contraction. This is in line with results from a study comparing ketoprofen to celecoxib after tonsillectomy [5] showing a more pronounced treatment effect for the ketoprofen group during the first 24 h, but slower recovery as compared to celecoxib. The results may imply that the inflammatory reaction following muscle injury (as well as surgical intervention?) is an essential part of recovery. Since the effect of celecoxib for DOMS was only modest and not significant, usage of NSAIDs for the treatment of exercise induced muscle soreness cannot be supported. <h3>References</h3> Rother et al. Drug Design, Development and Therapy, 2009, 3; 143-149 Nieman et al. Brain, Behaviour and Immunity 2005; 19; 398-403 Inoue et al. Prostaglandins Leukot Essent Fatty Acids. 1994 Dec;51(6):457-62 Schwartz et al. J Clin Pharmacol. 2008 Jun;48(6):745-54. Epub 2008 Apr 23. Nikanne et al. Otolaryngol Head Neck Surg. 2005 Feb;132(2):287-94. <h3>Disclosure of Interest</h3> None Declared