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.


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


  • Analgesics