FRI0610-HPR Β-ADRENORECEPTOR BLOCKING DRUGS ASSOCIATE WITH LOWER RISK OF KNEE OSTEOARTHRITIS AND KNEE PAIN CONSULTATIONS IN PRIMARY CARE: A PROPENSITY SCORE MATCHED COHORT STUDY USING THE CLINICAL PRACTICE RESEARCH DATALINK.

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Background:The pharmacologic management of OA is centred around optimising pain control but first-line analgesics only have modest efficacy1. Findings from several studies suggest thatβ-adrenoreceptor blocking drugs (β-blockers) have anti-nociceptive effects2 3. However, evidence for the benefits of β-blockers in the context of OA pain is scarce. We recently demonstrated, for the first time, an association between beta-blockers and lower pain severity, and less opioid analgesic use in a secondary analysis of data for community dwelling adults with large-joint lower OA4. This association, however, was not confirmed in a hospital-based study5.Objectives:We examined [1] the association betweenβ-blocker prescription and first primary care consultation for knee OA, hip OA, knee pain, and hip pain and [2] the classes ofβ-blocker drugs that reduce the risk of these outcomes.Methods:This was a cohort study using data from the UK Clinical Practice Research Datalink. Participants aged ≥40 years, in receipt of ≥2 β-blocker prescriptions within 60 days were matched by age, sex, and propensity score (PS) for β-blocker prescription to one control using greedy nearest neighbour matching. Participants with chronic painful conditions, contra-indications to β-blockers, maintenance analgesic prescriptions, and with <2-years registration before index or matched follow-up start date were excluded. Cox proportional hazard ratios (aHRs) and 95% confidence intervals (CI) were calculated to examine the associations adjusted for other covariates. Analyses were stratified according to β-blocker classes.Results:Data for 223,436 PS-matched exposed and un-exposed participants were included. β-blocker prescription associated with a significantly reduced 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), 0.85(0.79–0.90) respectively. The reduction in hip OA lacked statistical significance (aHR 95%CI 0.94; 0.83-1.07) (Table 1). On stratified analysis, propranolol and atenolol had a statistically significant protective effect on knee OA and knee pain consultations with aHRs between 0.78 and 0.91 (Figure 1).Table 1.The association between β-blocker prescription and incident osteoarthritis and joint painOutcomesExposedEvents (n)Person-timeEvent rate (95% CI)*HR (95% CI)1Knee OANo986262,0033.76 (3.54 – 4.01)1.00Yes1,101307,2313.58(3.38 – 3.80)0.90(0.83 – 0.98)Hip OANo451263,7531.71(1.56– 1.87)1.00Yes530310,0451.71(1.57 – 1.86)0.94(0.83 – 1.07)Knee painNo3,074255,00312.06(11.64 – 12.49)1.00Yes3,560297,02711.99(11.60 – 12.37)0.88(0.83 – 0.92)Hip painNo1,767259,5156.81 (6.50 – 7.13)1.00Yes1,981304,4546.51 (6.23 - 6.80)0.85(0.79 – 0.90)OA; osteoarthritis, *1,000 person-years,1PS matched and, additionally adjusted for age, number of GP consultations, hospital out-patient referrals, hospital admissions in the 12 month period preceding cohort entry, total number of GP consultations for knee or hip injury prior to cohort entry and non-osteoporotic fractures.Figure 1.The association between individual β-adrenoreceptor blocking drugs and incident knee osteoarthritis and knee pain11Comparison group is unexposed to β-blockers; size of the square is proportional to number of events.Conclusion:β-blockers appear to reduce consultations for knee OA, and knee or hip pain. Our results imply that, atenolol might be used preferentially for the treatment of people with cardiovascular comorbidities, while, propranolol with its’ anti-anxiety effect may be a suitable analgesic in people with OA and comorbid anxiety.