Osteoarthritis is the commonest form of arthritis and a leading cause of joint pain. There is no treatment for osteoarthritis and its management focuses on painkillers which can cause troublesome and serious side-effects. Our previous study found that people with osteoarthritis prescribed beta-blocker medicines for angina, hypertension, and irregular heart-beat have less-severe joint pain and were less likely to require strong painkillers. As this was a hospital-based study conducted on people with severe osteoarthritis awaiting joint-replacement surgery, we want to confirm these findings in people treated by a GP.
We will utilise data from the Clinical Practice Research Datalink for this study. We will investigate if people prescribed beta-blocker medicines for other conditions are less likely to develop knee or hip osteoarthritis, require strong painkillers and joint replacement surgery. We will ascertain people who have been prescribed beta-blocker medicines and compare their risk for developing osteoarthritis to people not prescribed these medicines, controlling for other risk-factors. Similarly, we will also ascertain people who have knee or hip osteoarthritis, and have been prescribed beta-blocker medicines. Their risk of being started on strong painkillers and requiring joint replacement surgery will be compared to people not on this medicine, and controlling for other risk-factors.
Objectives: To investigate if ?-blocker prescription associates with reduced risk of symptomatic knee or hip osteoarthritis, total joint replacement, and analgesic prescription.
Methods:
Data source: CPRD
Study design: Cohort study
Cohort1: ?-blocker and incident knee/hip osteoarthritis:
Inclusion criteria: age >/=40 years
Exposed: >/=2 continuous ?-blocker prescriptions
Index date: first date of prescription of ?-blocker
Unexposed: Upto four age, sex, GP surgery and propensity score for ?-blocker prescription matched controls
Exclusion criteria: contra-indications to ?-blockers, consultations for OA or potent analgesic prescription before index date
Outcomes: Knee osteoarthritis (primary outcome), hip osteoarthritis, knee pain, hip pain.
Cohort 2; ?-blockers and total joint replacement and new analgesic prescription
Inclusion criteria: age >/=40 years, knee or hip osteoarthritis, new analgesic prescription.
Exposure and index date: As in Cohort 1.
Unexposed: As in Cohort 1, additionally matched for consultation for knee or hip osteoarthritis or new analgesic prescription prior to index date.
Exclusion criteria: contra-indications to ?-blockers, osteoarthritis at other joints prior to index date.
Outcome: Total knee replacement, total hip replacement, new analgesic prescription.
Statistical analysis: Kaplan Meier curves will be plotted and Cox proportional hazard ratios (HRs) and 95% CIs will be calculated. Stratified analysis will be performed by class of ?-blocker, intrinsic sympathomimetic effect, and indication(s) for prescription.
Knee Osteoarthritis
- Hip Pain
- Analgesic prescription
- Hip Osteoarthritis
- Total Knee Replacement
- Knee Pain
- Total Hip Replacement
Abhishek Abhishek - Chief Investigator - University of Nottingham
Georgina Nakafero - Corresponding Applicant - University of Nottingham
Ana Valdes - Collaborator - University of Nottingham
Christian Mallen - Collaborator - Keele University
Mamas Mamas - Collaborator - Keele University
Matthew Grainge - Collaborator - University of Nottingham
Michael Doherty - Collaborator - University of Nottingham
Nick Townsend - Collaborator - University of Bath
Weiya Zhang - Collaborator - University of Nottingham
HES Admitted Patient Care;HES Outpatient;Practice Level Index of Multiple Deprivation