Use of beta-blockers associated with delayed progression of knee OA, reduced need for TKA
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Key takeaways:
- Use of beta-blockers was associated with a reduced likelihood of patients undergoing TKA for OA.
- Use of nonselective beta-blockers for more than 5 years was associated with the lowest likelihood of TKA.
Results showed use of beta-blockers was associated with a reduced chance of patients undergoing total knee arthroplasty, which could be due to a possible relationship between the autonomic nervous system and progression of osteoarthritis.
Researchers from the Hospital Regional Universitario de Málaga in Spain performed a nested case-control study of 300 patients with new-onset knee pain who underwent TKA and a matched cohort of 300 patients with new-onset knee pain who did not undergo TKA. They used binary logistic regression analysis to assess the likelihood of undergoing TKA among patients who used beta-blockers for the treatment of varying cardiovascular conditions vs. patients who did not use beta-blockers.
Overall, researchers found patients who had previously used any beta-blocker had a reduced likelihood of undergoing TKA (adjusted OR = 0.51) compared with patients who never used beta-blockers. Patients who had used selective beta 1-blockers and nonselective beta 1-blockers had adjusted ORs of undergoing TKA of 0.69 and 0.42, respectively. Adjusted ORs were 0.41 for patients who used beta-blockers for less than 1 year, 0.52 for patients who used beta-blockers for 1 to 5 years and 0.36 for patients who used beta-blockers for more than 5 years.
“This study provides insight to a possible relationship between the activity of the autonomic nervous system and the progression of OA,” the researchers wrote in the study. “In addition, it provides a hypothesis for the development of future therapeutic lines targeting the adrenergic system in the treatment of OA,” they concluded.
Perspective
Back to TopPaul F. Lachiewicz, MD, and Rahul K. Goel, MD
Beta-blockers, such as propranolol and atenolol, are frequently prescribed by medical specialists for control of heart rate, especially associated with atrial fibrillation. These medications may have a “cardio-protective” effect in patients having elective TKA. These anti-adrenergic drugs can reduce levels of inflammatory cytokines in certain conditions. Inhibition of the adrenergic autonomic system could downregulate these cytokines and matrix metalloproteinases that contribute to cartilage degradation.
The theory that beta-blockers may lead to reduced joint pain has had mixed results in prior studies. This retrospective study by Iskandar Tamimi, MD, PhD, and colleagues of one institutional database compared 300 patients who had a primary TKA with a matched control group. Any use of beta-blockers was associated with a reduction in the likelihood of having a TKA (OR 0.51). The groups were controlled for patient age and gender. However, patients with TKA had significantly more prior knee procedures, specifically medial meniscectomies, which would increase the risk for TKA. These authors suggested that modulation of the central nervous system with beta-blockers may influence the symptoms and progression of OA.
However, this paper did not evaluate the serious adverse reactions associated with chronic use of beta-blockers, especially malaise, fatigue and erectile dysfunction. Patients “feel bad” while taking these medications. This study could not address many possible confounding variables, including preoperative activity level, and the decision-making process for elective TKA. The patients taking chronic beta-blockers may also have been more sedentary (and less healthy) than the TKA group. This topic requires more study in different, larger patient populations before any such treatment should be considered.
References:
Heim KA, et al. J Surg Orthop Adv. 2010;19:162-165.
Lin TT, et al. J Am Heart Assoc. 2020;doi:10.1161/JAHA.120.016084.
Nakafero G, et al. Rheumatology (Oxford). 2021;doi:10.1093/rheumatology/keab234.
Ohtsuka T, et al. J Am Coll Cardiol. 2001;doi:10.1016/s0735-1097(00)01121-9.
Zhou L, et al. Osteoarthritis Cartilage. 2020;doi:10.1016/j.joca.2019.08.008.
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