Beta-blockers may reduce risk for knee osteoarthritis, hip/knee pain
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Common beta-blockers are associated with a reduced cumulative risk for knee osteoarthritis, knee pain and hip pain consultations, according to data published in Rheumatology.
“Osteoarthritis is the most common form of arthritis and affects 15% of the general population,” coauthors Georgina Nakafero, PhD, and Abhishek Abhishek, PhD, both of the University of Nottingham, in the United Kingdom, told Healio Rheumatology in a joint statement. “No specific therapy exists for OA and medical management focuses on analgesia.”
Data derived from Nakafero G, et al. Rheumatology. 2021;doi:10.1093/rheumatology/keab234.
“However, currently used analgesics have modest efficacy for OA pain, and drugs such as NSAIDs and opioids frequently cause side-effects,” they added. “... We hypothesized that if beta-blockers can reduce pain due to OA, they will reduce primary care consultation rates for knee or hip pain, and knee or hip OA.”
To analyze the link between beta-blocker prescription and the first consultation for knee or hip OA, or pain, in primary care, Nakafero, Abhishek and colleagues examined data from the Clinical Practice Research Datalink (CPRD). According to the researchers, the CPRD is a longitudinal, anonymized electronic database containing health records for more than 10 million people in the United Kingdom. For their study, Nakafero, Abhishek and colleagues included individuals aged 40 years and older who contributed data to the CPRD between 1990 and 2017 and received a first-ever continuous beta-blocker regimen, defined as at least two prescriptions within a 60-day period.
In all, the researchers identified and included 111,718 patients who received beta-blockers, and matched based on propensity score to an equal number of unexposed individuals from the CPRD. They then calculated Cox proportional hazard ratios and confidence intervals, adjusting for knee or hip injury, as well as the number of primary care consultations, out-patient referrals and hospitalizations in the year preceding cohort entry. In addition, the researchers stratified their analysis according to beta-blocker class, as well as for commonly prescribed drugs.
According to the researchers, a beta-blocker prescription was associated with a reduced cumulative risk for knee OA (adjusted HR = 0.9; 95% CI, 0.83-0.98), knee pain (aHR = 0.88; 95% CI, 0.83-0.92) and hip pain (aHR = 0.85; 95% CI, 0.79-0.9) consultations in primary care.
Regarding specific beta-blockers, propranolol (Hemangeol, Pierre Fabre) and atenolol were both associated with a lower incidence of knee OA and knee pain consultations. Adjusted hazard ratios for knee OA consultations were 0.78 (95% CI, 0.63-0.97) for propranolol and 0.91 (95% CI, 0.82-1) for atenolol, and for knee pain consultations were 0.78 (95% CI, 0.69-0.87) and 0.86 (95% CI, 0.81-0.91), respectively, compared with unexposed individuals.
Beta-blockers were also associated with a reduced risk for consultation regarding large-joint lower-limb OA and related pain, as a composite outcome, defined as earliest of knee OA, knee pain, hip OA or hip pain consultation (aHR = 0.87; 95% CI, 0.84-0.9).
“Our findings suggest that atenolol could be considered for people with osteoarthritis and comorbidities for which beta-blockers are indicated,” Nakafero and Abhishek said. “Similarly, propranolol may be a suitable analgesic for people with OA and comorbid anxiety.”
“Although our study raises the possibility that atenolol and propranolol might be effective in reducing OA pain, this was an observational study and the findings should be interpreted with caution,” they added. “If these findings are confirmed in independent studies, and in a confirmatory randomized controlled trial, it may change clinical practice.”
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