β-blocker prescription is associated with lower cumulative risk of knee osteoarthritis and knee pain consultations in primary care: A propensity score-matched cohort study

Nakafero, Georgina; Grainge, Matthew J.; Valdes, Ana M.; Townsend, Nick; D. Mallen, Christian; Zhang, Weiya; Doherty, Michael; Mamas, Mamas; Abhishek, Abhishek

Abstract

Objectives: To examine the association between β-blocker prescription and first primary-care consultation for knee OA, hip OA, knee pain and hip pain. Methods: Data source: Clinical Practice Research Datalink. Participants aged ≥40 years in receipt of new oral β-blocker prescriptions were propensity score (PS) matched to an unexposed control. Cox proportional hazard ratios (HRs) and 95% CIs were calculated, and adjusted for non-osteoporotic fractures, number of primary-care consultations for knee or hip injury, and, the number of primary-care consultations, out-patient referrals and hospitalizations in the 12 months preceding cohort entry. Analysis was stratified according to β-blocker class and for commonly prescribed drugs. P < 0.05 was considered statistically significant. Results: A total of 111 718 β-blocker-exposed participants were 1:1 PS matched to unexposed controls. β-blocker prescription was associated with reduced cumulative risk of knee OA, knee pain, and hip pain consultations [with a HR (95% CI) of 0.90 (0.83, 0.98), 0.88 (0.83, 0.92) and 0.85 (0.79, 0.90), respectively]. Propranolol and atenolol were associated with a lower incidence of knee OA and knee pain consultations with a HR of between 0.78 and 0.91. β-blockers were associated with reduced incidence of consultation for large-joint lower-limb OA/pain as a composite outcome, defined as the earliest of knee OA, knee pain, hip OA or a hip pain consultation [with a HR (95% CI) of 0.87 (0.84, 0.90)]. Conclusion: Commonly used β-blockers have analgesic properties for musculoskeletal pain. Atenolol might be a therapeutic option for OA and cardiovascular co-morbidities in which β-blockers are indicated, while propranolol may be suitable for people with co-morbid anxiety. A confirmatory randomized controlled trial is needed before clinical practice is changed.

Citation

Nakafero, G., Grainge, M. J., Valdes, A. M., Townsend, N., D. Mallen, C., Zhang, W., Doherty, M., Mamas, M., & Abhishek, A. (2021). β-blocker prescription is associated with lower cumulative risk of knee osteoarthritis and knee pain consultations in primary care: A propensity score-matched cohort study. Rheumatology, 60(12), 5686-5696. https://doi.org/10.1093/rheumatology/keab234

• Journal Article Type: Article
• Acceptance Date: Feb 23, 2021
• Online Publication Date: Mar 12, 2021
• Publication Date: Dec 1, 2021
• Deposit Date: Mar 2, 2021
• Publicly Available Date: Mar 13, 2022
• Journal: Rheumatology
• Print ISSN: 1462-0324
• Electronic ISSN: 1462-0332
• Publisher: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Issue: 12
• Pages: 5686-5696
• DOI: https://doi.org/10.1093/rheumatology/keab234
• Public URL: https://nottingham-repository.worktribe.com/output/5363045
• Publisher URL: https://academic.oup.com/rheumatology/article/60/12/5686/6169013