While I’m at Sloan (presenting Saturday morning), here’s a little scenario that came up after listening to Tim Ferriss’ latest podcast. I’ll be back with the injury info next week or please don’t let this be the weekend I need to do a UTK Flash!
After a grueling 162-game season, a star MLB player finds himself struggling with persistent elbow pain and inflammation. The usual regimen of ice baths, NSAIDs, and corticosteroid injections has kept him on the field, but the toll is undeniable. His athletic trainer, always on the lookout for innovative recovery methods, suggests something different — Xeljanz, a JAK inhibitor originally developed for rheumatoid arthritis. The idea is intriguing: instead of masking pain or risking long-term damage from steroids, he could take a pill that targets the inflammatory response at the cellular level. As the player weighs the risks and benefits, he wonders whether this could be the key to prolonging his career, keeping him in peak form as he heads into another post-season.
This scenario is fictional, but there’s more than a little suggestion that some players in MLB and in other sports have begun using drugs in the same class as Xeljanz. It’s that thin line between performance enhancement and medicine that creates dilemmas like this, with the rewards of millions of dollars in contracts and endorsements as incentive, beyond the simple human need of comfort. “Dear lord, please let my elbow stop hurting” is a standard prayer for pitchers at night and we’ve seen the worst of it in the Tyler Skaggs case.
The development of Janus kinase (JAK) inhibitors represents one of the most significant advancements in the treatment of inflammatory and autoimmune diseases. Originally designed to target the JAK-STAT pathway (and doesn’t JAK-STAT sound like something Baseball Prospectus created?), which is crucial for cytokine signaling and immune response regulation, these small-molecule drugs were first developed for conditions like rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, and myelofibrosis. Xeljanz, the first JAK inhibitor approved by the FDA, paved the way for additional medications such as Olumiant, Rinvoq, and Jakafi, each targeting different combinations of JAK enzymes to fine-tune immune modulation. Their rapid adoption in medicine has led to considerations beyond their intended clinical applications, particularly in sports where the management of inflammation and recovery is a central concern.
In professional baseball and other high-performance sports, the ability to manage inflammation and injury is paramount. Players endure long seasons, repetitive stress, and injuries that require recovery strategies extending beyond traditional methods. JAK inhibitors, by suppressing cytokine-mediated inflammation, theoretically offer an advantage in reducing recovery times, controlling chronic inflammatory conditions, and potentially even enhancing durability over a season. Their mechanism of action differs from non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids by directly interfering with the cellular signaling of inflammation rather than simply masking symptoms. If an athlete were dealing with persistent joint inflammation, tendon issues, or autoimmune-related musculoskeletal pain, the appeal of JAK inhibitors would be evident, particularly when compared to other treatment options that may come with more significant side effects or a higher risk of dependency.
Despite the potential benefits, there has been little widespread discussion regarding the use of JAK inhibitors in professional sports. Unlike performance-enhancing drugs such as anabolic steroids, erythropoietin (EPO), or growth hormone, JAK inhibitors do not directly contribute to muscle growth, endurance, or strength. Their effects are more subtle, focusing on reducing inflammation and possibly accelerating recovery. As of now, the World Anti-Doping Agency (WADA) does not explicitly ban JAK inhibitors, as they do not fit neatly into existing categories of prohibited substances. However, the fact that they modulate immune function and inflammation could lead to regulatory scrutiny in the future. The classification of substances under WADA’s S0 category, which covers non-approved drugs, does not apply here because JAK inhibitors have legitimate medical uses and have been approved for human use by regulatory agencies such as the FDA and EMA. Still, governing bodies could decide to monitor their use more closely if they perceive them as a competitive advantage or a potential health risk.
The detectability of JAK inhibitors in standard doping tests presents another layer of complexity. Most anti-doping tests focus on known anabolic agents, stimulants, and substances with a clear history of abuse in sports. JAK inhibitors are metabolized differently depending on the specific drug, with some primarily cleared through the liver and others excreted via the kidneys. The half-life of these drugs is relatively short, often ranging from a few hours to a day, meaning that unless a test is specifically designed to detect JAK inhibitors, they are unlikely to be identified in routine urine screens. Advanced liquid chromatography-mass spectrometry (LC-MS/MS) techniques could be employed to detect these substances if anti-doping agencies decided to include them in their testing protocols. However, given the lack of widespread discussion on JAK inhibitor use in sports, there is currently no dedicated effort to monitor their presence among athletes.
For a baseball player, the decision to consider JAK inhibitors would likely revolve around chronic inflammation that impacts performance. The grind of a 162-game season can lead to persistent joint pain, tendinitis, or other inflammatory conditions that traditional methods such as NSAIDs, corticosteroids, or biologics may not adequately address. Additionally, corticosteroids come with their own set of long-term risks, including bone density loss and metabolic issues, whereas biologic drugs used for autoimmune diseases require injections and a more complex administration process. The oral availability of JAK inhibitors, combined with their ability to modulate inflammation at a cellular level, could make them an attractive option for players seeking long-term solutions for inflammation-related performance decline. That said, the risks associated with these drugs, including potential cardiovascular issues, increased infection risk, and in some cases, malignancy concerns, would be factors that any athlete and their medical team would need to consider before pursuing this approach.
The cost and availability of JAK inhibitors present another consideration. These drugs are expensive, with many being priced at thousands of dollars per month without insurance coverage. Xeljanz, for example, can cost upwards of $4,000 per month, while other JAK inhibitors like Rinvoq and Olumiant have similar price points. For professional athletes earning millions, these costs may be negligible, but for those in minor leagues or less financially lucrative sports, the affordability factor could be a limiting consideration. Some insurance plans cover JAK inhibitors for approved conditions such as rheumatoid arthritis or ulcerative colitis, but athletes without a clear medical diagnosis might struggle to obtain them legally and affordably. Unlike anabolic steroids or other banned substances, JAK inhibitors are not widely available through black-market sources, meaning that any potential misuse would likely involve obtaining them through off-label prescriptions or questionable online pharmacies, which comes with its own set of risks.
The landscape surrounding JAK inhibitors (and potentially other drugs like GLP-1 and GIP drugs in wide use) in sports remains largely uncharted. While their primary medical use is well established, their potential role in managing inflammation and recovery in professional athletes has not been deeply explored, let alone studied for performance-related applications. Because they are not explicitly banned by anti-doping agencies, and because testing protocols do not currently prioritize their detection, it is unlikely that they have become a widespread phenomenon in baseball or other major sports. However, as medical science advances and as athletes and medical professionals seek novel ways to extend careers and optimize performance, the conversation around JAK inhibitors and their role in sports medicine may become more prominent in the coming years. Should governing bodies determine that their effects provide an unfair advantage or carry undue health risks, it would not be surprising to see them placed under increased scrutiny or even added to the list of prohibited substances in the future. Until then, their role in sports remains speculative, hovering in a gray area between legitimate medical use and potential off-label applications for athletic performance and recovery.