CINCINNATI (AP) — Two players carted off, two others suspended, many fines to follow. One of the NFL's nastiest rivalries set new lows in prime time, forcing fans to avert their eyes.
What's to be done about this long-running animosity between the Steelers (10-2) and Bengals (5-7)? Do the teams encourage the mayhem by downplaying it? Do the NFL and the networks promote it by showing it in prime time every season?
Those questions were raised in the aftermath of a game so brutal that it made viewers cringe. Pittsburgh rallied for a 23-20 victory at Paul Brown Stadium on Monday night, its sixth straight win over the Bengals.
What it'll be remembered for, though, is how it felt more like a street brawl at times. The NFL responded by suspending Steelers receiver JuJu Schuster-Smith and Bengals safety George Iloka for one game each on Tuesday, and fines for other players are expected later in the week.
"I'll acknowledge there were some unfortunate things in that game that we don't need in our game — by both sides," Steelers coach Mike Tomlin said Tuesday.
It's been going on for years, with grudges deepening.
Bengals linebacker Vontaze Burfict — a focal point for much of the animosity — left the field on a cart with a concussion after Schuster-Smith leveled him with a blindside hit. The receiver then stood over the fallen linebacker to taunt him.
As Schuster-Smith apologized for taunting after the game, receiver Antonio Brown yelled: "Karma! It's called karma!"
The NFL's letter to Schuster-Smith informing him of the suspension said the egregious hit and the taunting "fell far below the high standards of sportsmanship expected of an NFL player."
Iloka hit Brown in the head after his touchdown catch tied the game in the fourth quarter. Brown wasn't hurt, but the NFL suspended the Bengals safety for the type of flagrant hit that has "no place in our game."
Those moments have defined the rivalry since 2015, when Burfict made a twisting tackle on Le'Veon Bell that left the Steelers running back with a torn knee. Burfict celebrated — the Bengals say he was just happy to make a big play — but Bell and the Steelers took umbrage.
Players went back-and-forth on social media, and they got into a skirmish on the field during pregame warmups in the rematch in Cincinnati. They met again in the playoffs that season at Paul Brown Stadium, and Burfict's hit to Brown's head in the closing seconds moved the Steelers in range for a field goal and an 18-16 win.
In response, the NFL suspended Burfict for three games. Burfict went at it with some of the Steelers on social media. The raw feelings grew deeper.
This year's unpleasantries began with Burfict refusing to shake Steelers' hands at the coin toss on Oct. 22 at Heinz Field. During the game, Burfict kicked Steelers running back Roosevelt Nix in the chest and was fined $12,154 by the league.
After the game, Bell tweeted video of Burfict's kick and said: "man dude gotta go man ... that's not football AT ALL!!"
The teams went their ways, but didn't forget.
After Bengals receiver A.J. Green was ejected from a game at Jacksonville for wrapping his arm around Jalen Ramsey's neck, taking him down and punching him, Bell and Schuster-Smith had fun at Green's expense in the Steelers' next game at Indianapolis. They re-enacted Green's takedown of Ramsey as part of their touchdown celebration.
Back together in Cincinnati on Monday night, they wasted no time going at it again.
On the game's sixth play, Bell and Burfict went face-to-face during an interception return. Bell grabbed the linebacker's facemask and shoved him to the ground, drawing a foul for unnecessary roughness, part of a combined 20 penalties totaling 239 yards. Cincinnati was penalized 13 times for a club-record 173 yards.
Some of the Bengals' frustration comes from the Steelers' ability to keep pulling out victories. The Steelers have won six straight, nine of 10 and 14 of 17 in the series.
These two teams are through with each other for the season — on the field, anyway. What comes next?
Bengals coach Marvin Lewis — who has steadfastly defended Burfict — is finishing his contract and could be done in Cincinnati after a 15-year run. He's 0-7 in the playoffs — including two losses to Pittsburgh — and he's 8-24 against the Steelers overall.
Burfict will stay. He got a contract extension earlier this year while serving another three-game suspension for an egregious preseason hit. He also was ejected from a game in Tennessee for pushing an official's arm away.
No one is backing down - not even with Steelers linebacker Ryan Shazier in a Cincinnati hospital being treated for a spine injury following what appeared to be a clean tackle.
"The rivalry is real," Bengals linebacker Kevin Minter said after the game. "We come for them, and they come for us."