Nakafero, G, Grainge, MJ, Valdes, AM, Townsend, N, Mallen, C ORCID: https://orcid.org/0000-0002-2677-1028, Zhang, W, Doherty, M, Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 and 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.

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Abstract

OBJECTIVES: To examine the association between β-blocker prescription and first primary-care consultation for knee osteoarthritis (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% confidence intervals (CI) 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 statistically significant.  . RESULTS: 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 aHR(95%CI) 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 aHRs between 0.78-0.91. β-blockers were associated with reduced incidence of consultation for large-joint lower-limb OA/pain as a composite outcome, defined as earliest of knee OA, knee pain, hip OA or hip pain consultation (aHR(95%CI) 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 randomised controlled trial is needed before clinical practice is changed.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Oxford University Press at https://doi.org/10.1093/rheumatology/keab234 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Anti-nociceptive, Comorbidity, Osteoarthritis, Pain, β-blockers
Subjects: R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
R Medicine > RS Pharmacy and materia medica
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 23 Mar 2021 15:20
Last Modified: 23 Mar 2021 15:25
URI: https://eprints.keele.ac.uk/id/eprint/9278

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