NSAID use linked to loss of radiographic joint space width in knee OA
Among patients with radiographic knee osteoarthritis, NSAID use was associated with an increased loss of medial minimum joint space width compared with other medications, according to data published in Rheumatology.
“Management of knee osteoarthritis is multi-factorial and routinely involves the use of pharmacological interventions, with most medications aimed at alleviating painful symptoms and improving function,” Thomas A. Perry, BSc, PhD, of the University of Oxford, in the United Kingdom, and Royal North Shore Hospital, at the University of Sydney, Australia, told Healio Rheumatology.
“Little is known of the long-term effects of such medications on the structural progression of radiographic knee OA,” he added. “Through examining the relationship between pharmacological interventions and the disease pathway, this may, in turn, identify potential areas for disease-modifying treatment development.”
To analyze the impact of medication use on the progression of radiographic knee OA, Perry and colleagues examined longitudinal data from the Osteoarthritis Initiative (OAI), an observational study of knee OA risk factors. The researchers included a total of 2,003 patients with radiographic knee OA — defined as a Kellgren-Lawrence grade of 2 or higher — at baseline, excluding those with prior knee-related injuries, surgeries or other musculoskeletal disorders.
Using data from the OAI, Perry and colleagues analyzed current medication use — as far back as the previous 30 days — and radiographic medial minimum joint space width for each patient at baseline and annually through 96 months. The researchers used random-effects, panel-regression to examine the link between current medication status and change in radiographic medial minimum joint space width. In this analysis, medication nonusers were treated as the reference group.
According to the researchers, NSAIDs were the most frequently used analgesia, at 14.7%. The use of antihistamines, at 10.4%, was also frequent. The most frequently used comorbidity medications were statins, at 27.4%; anti-hypertensives, at up to 15%; anti-depressant, anxiolytics and psychotropics, at 14%; osteoporosis-related medication, at 10.9%; and diabetes-related medication, at 6.9%.
The use of NSAIDs was associated with a loss of radiographic medial minimum joint space width, compared with nonusers (b = –0.042; 95% CI, –0.08 to –0.0004). The researchers reported no other associations.
“In current users of non-steroidal anti-inflammatory drugs, radiographic medial minimum joint space width was reduced compared to current non-users,” Perry said. “Clinical trials are needed to examine the disease-modifying effects of medications, particularly NSAIDs, in radiographic knee OA.”