Abstract
BackgroundKnee osteoarthritis (OA) is known to be a progressive degenerative disorder; however, recent evidence suggests that inflammatory mediators contribute to cartilage degradation. Studies have reported that N-acetylcysteine (NAC) had a promising effect on the reduction of the synthesis of proinflammatory and structural mediators by synovial cells. Given the lack of relevant clinical trials, we conducted this study to determine the relationship between NAC use and risk of knee OA.MethodsWe designed a retrospective cohort study from 2000 to 2013. Patients who received oral NAC over 28 days within 1 year after the first prescription were defined as the case group, whereas those without NAC use were considered as candidates of the control group. We adopted 1:4 propensity-score matching by age, sex, index year, and comorbidities to obtain the control group. The primary outcome was a new diagnosis of knee OA during the follow-up period.ResultsOur study sample comprised 12,928 people who used NAC and 51,715 NAC nonusers. NAC users had a significantly higher incidence of osteoarthritis (adjusted hazard ratio: 1.42, P < .001) than did NAC nonusers. Also, in analyses stratified by age group and sex, all subgroups exhibited a significantly higher incidence of knee osteoarthritis (P < .0001) among NAC users than among NAC nonusers. The use of oral NAC was associated with nearly four-fold increased the risk of knee OA in the young age group.ConclusionsLong-term use of oral NAC is associated with a higher risk of knee OA.
Highlights
Knee osteoarthritis (OA) is known to be a progressive degenerative disorder; recent evidence suggests that inflammatory mediators contribute to cartilage degradation
One recent study confirmed that NAC use in patients with knee OA yielded more effective pain relief and better functional outcomes compared with intraarticular injection of hyaluronic acid (HA) [10]
All data related to these services were collected and input into the National Health Insurance Research Database (NHIRD), which was operated by the National Health Research Institutes from 1997 to 2013
Summary
Knee osteoarthritis (OA) is known to be a progressive degenerative disorder; recent evidence suggests that inflammatory mediators contribute to cartilage degradation. Studies have reported that Nacetylcysteine (NAC) had a promising effect on the reduction of the synthesis of proinflammatory and structural mediators by synovial cells. Osteoarthritis (OA) is one of the most common degenerative diseases that affects the elderly population, leading to disability and reduced quality of life [1, 2]. According to experimental and tissue culture studies, NAC is effective in clearing free-oxygen radicals, slowing the cartilage degradation process, reducing synovial inflammation, and reducing pain. One recent study confirmed that NAC use in patients with knee OA yielded more effective pain relief and better functional outcomes compared with intraarticular injection of HA [10]. Few studies have examined the therapeutic effects of NAC on OA
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