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

Abstract

OBJECTIVES: To examine the association between ß-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 ß-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 ß-blocker class and for commonly prescribed drugs. p< 0.05 was statistically significant. . RESULTS: 111?718 ß-blocker exposed participants were 1:1?PS matched to unexposed controls. ß-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. ß-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 ß-blockers have analgesic properties for musculoskeletal pain. Atenolol might be a therapeutic option for OA and cardiovascular co-morbidities in which ß-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.