Long term use of analgesics and risk of osteoarthritis progressions and knee replacement: propensity score matched cohort analysis of data from the Osteoarthritis Initiative

N Hafezi-Nejad; A Guermazi; F W Roemer; J Eng; B Zikria; S Demehri

doi:10.1016/j.joca.2015.11.003

Long term use of analgesics and risk of osteoarthritis progressions and knee replacement: propensity score matched cohort analysis of data from the Osteoarthritis Initiative

Osteoarthritis Cartilage. 2016 Apr;24(4):597-604. doi: 10.1016/j.joca.2015.11.003. Epub 2015 Nov 10.

Authors

N Hafezi-Nejad¹, A Guermazi², F W Roemer³, J Eng⁴, B Zikria⁵, S Demehri⁴

Affiliations

¹ Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA. Electronic address: nhafezi1@jhmi.edu.
² Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
³ Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
⁴ Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.
⁵ Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD, USA.

PMID: 26564576
DOI: 10.1016/j.joca.2015.11.003

Abstract

Objectives: To determine the association between the long-term use of analgesics and progression of osteoarthritis (OA) as evidenced by up to 3-years follow-up worsening of radiographic Kellgren-Lawrence (KL) grade and incidence of knee replacement (KR).

Design: Using nearest neighbor matching of the propensity scores with caliper in the Osteoarthritis Initiative (OAI) cohort, 173 index (Analgesic +) and 173 referent (Analgesic -) subjects were included. Analgesic + and - subjects had analgesics in all and none of their visits, respectively. Analgesic + and - subjects were balanced in their demographics, baseline, first, second and third year body mass index (BMI), Western Ontario and McMaster (WOMAC) total score, Physical and Mental health summary scales (SF-12), Physical Activity Scale for the Elderly (PASE) and Charleston Comorbidity Scale. Analgesic + and - subjects were also matched for baseline radiographic KL grade. Interval increase in the KL grade and incidence of KR were defined as the outcome.

Results: Included subjects had average 6.5 years of follow-up. By the third year, 44 subjects had an interval increase in the KL grade; 29 in Analgesic + and 15 among Analgesic - subjects (P = 0.024). By the eighth-year, 41 subjects had their first KR; 29 in Analgesic + and 12 among Analgesic - subjects (P = 0.005). Hazard Ratio (HR) of OA progression and KR for Analgesic + subjects was 1.91 (1.02-3.57) and 2.57 (1.31-5.04), respectively.

Conclusions: Long-term use of analgesics may be associated with radiographic progression of knee OA and increased risk of future KR.

Keywords: Analgesics; Knee replacement; Osteoarthritis progression; Propensity score matching.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Analgesics / administration & dosage
Analgesics / adverse effects*
Arthroplasty, Replacement, Knee / statistics & numerical data*
Cohort Studies
Disease Progression
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Male
Middle Aged
Osteoarthritis, Knee / chemically induced*
Osteoarthritis, Knee / complications
Osteoarthritis, Knee / diagnostic imaging
Osteoarthritis, Knee / surgery
Pain Measurement / methods
Propensity Score
Radiography
Severity of Illness Index

Substances

Analgesics