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Osteoarthritis (OA) is one of the critical arthritis condition associated with chronic pain and disability.
The results of the study
established that the major risk factors leading to KR are symptoms, disease
severity and higher BMI and there was no association between exposure of oral
OA therapies and the occurrence of KR.
Osteoarthritis (OA) is one of the critical
arthritis condition associated with chronic pain and disability. The treatment
modality for OA includes many different pharmacological classes of agents.
These pharmacological class of agents are oral and often prescribed for chronic
administration for an extended period. In recent years, the safety of some of
these drug treatments related to potential systemic effects such as
cardiovascular risks, for instance, with non-steroidal anti-inflammatory drugs
(NSAIDs) and coxibs has been a significant concern. The increased use of
narcotics by patients in OA also produces some detrimental effects leading to
morbidity and mortality.
Concerns about the effects of these drug
treatments on the emergence of structural changes in OA, particularly in
weight-bearing joints including the hip and knee has also been raised. The
influence of such oral treatments (especially NSAIDs) on the progression and
outcome of OA disease, either positive or negative, remains at this time an
open question that needs to be further explored.
The discovery of various studies concerning
the effects of different therapeutic classes of drugs used as a treatment of OA
and their potential impact on disease progression is a challenging task.
However, the use of observational cohorts contributes to a real-life scenario.
The Osteoarthritis Initiative (OAI) cohort presents various advantages owing to
its size, duration, and abundant amount of comprehensive clinical and
demographic information available on the study participants, including drug
treatment. Assessment of structural changes by imaging using knee x-rays and
magnetic resonance imaging (MRI) was also done. Magnetic resonance imaging
(MRI) has proven to be reliable, sensitive, and worthwhile for studying disease
outcomes. Joint replacement is considered as a clinically appropriate disease
outcome in knee OA, related to both significant and structural damage. Another
fundamental reason to choose a nested case-control design was robustness of the
approach as well as measurement of the exposure to oral OA therapies in
different time windows before the KR.
Rationale behind research
The discovery of studies related to the
effects of various treatments of OA and their impact on disease progression
remains a difficult task. The present study was conducted to scrutinise the
potential benefits of observational cohort studies in determining the potential
effect of various OA treatment on disease progression and severity with an
assessment of risk factors on the appearance of knee replacement (KR)
Objective
The present
case-control study was aimed to determine the relatedness between exposure to
commonly used oral OA therapies and relevant confounding risk factors related
to the occurrence of knee replacement (KR), using the Osteoarthritis Initiative
(OAI) database.
Study outcomes:
Time Points: 2-5 years
Outcomes
Baseline:
Study outcomes:
The present study demonstrated that exposure to
some of the commonly used oral OA therapies, i.e. NSAIDs, COX-2 inhibitors,
acetaminophen, narcotics, or glucosamine/chondroitin sulfate, in a period of 2–
5 years, was not correlated with the occurrence of KR when compared to no
exposure to such medications. Many other risk factors including race, level of
symptoms, and BMI were identified as being linked to KR. The findings also revealed the neutral effect
of oral medications on knee replacement controlling the most important
confounding factors that promote such occurrences: clinical demographics,
symptom severity, socioeconomic status, radiographic grading, and structural
changes assessed by quantitative MRI. The clinical and sociodemographic data of
our study population exhibits similarity with previous studies exploring the role
of disease treatment on KR, but it does not explain the discrepancy in the
effect of such NSAIDs. The study also established the use of KR as a sole
marker and a logical outcome of disease progression. Indeed,
MRI parameters evaluated in knee OA, such as the medial compartment cartilage
volume/thickness, can also consistently predict outcomes such as KR. The
cartilage volume at index (KR) time was also similar in both groups indicating
a balance between the factors leading to the progression of cartilage volume
loss up to KR in both the groups.
The present study exhibits several strengths such as inclusion of
the large OAI database, including assessment of KR, based on patient and
physician preferences in a context of a real-world scenario, stratification of risk of KR by degree of
exposure to oral OA medication v/s no exposure, great reliability about the knee OA diagnosis and its KR
indication dependent on detailed information on demographics, imaging,
symptoms, and drug use for both patients and their matched controls, minimizing the possibility of bias, and the
excellent matching yielded from our control selection strategy.
The results of the study are clinically
significant and encouraging since they tackle the confounding role of oral
intervention to treat pain as a "last resort" prior to inevitable
surgery and also creates a spurious association between drug usage and the risk
of KR, thereby, indicating an inimical role of the medication through a
channelling bias.
Arthritis Research & Therapy (2018) 20:172
Impact of oral osteoarthritis therapy usage among other risk factors on knee replacement: a nested case-control study using the Osteoarthritis Initiative cohort
Marc Dorais et al.
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