Nakafero Georgina, Grainge Matthew, Valdes Ana, Townsend Nick, Mallen Christian, Zhang Weiya, Doherty Michael, Mamas Mamas A, Abhishek Abhishek
Academic Rheumatology, University of Nottingham, Nottingham, UK.
Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
BMJ Open. 2019 Aug 1;9(8):e032050. doi: 10.1136/bmjopen-2019-032050.
To investigate if β-adrenoreceptor blocking drug (β-blocker) prescription reduces the risk of knee or hip osteoarthritis, total joint replacement and analgesic prescription.
Primary care.
This is a cohort study using data from the Clinical Practice Research Datalink. Two separate analyses will be performed. Study 1 will be on the association between β-blocker prescription and incident knee/hip osteoarthritis. Inclusion criteria will be age ≥40 years. Exposed participants will be those with ≥2 continuous β-blocker prescriptions, and the index date will be the date of the first prescription of β-blocker. Unexposed participants will include up to four controls matched for age, sex, general practice surgery and propensity score for β-blocker prescription. Exclusion criteria will include contraindications to β-blockers, consultations for osteoarthritis or potent analgesic prescription before the index date. Outcomes will be knee osteoarthritis (primary outcome), hip osteoarthritis, knee pain and hip pain. Study 2 will be on the association between β-blocker prescription and total joint replacement and analgesic prescription in people with osteoarthritis. Inclusion criteria will be age ≥40 years, knee or hip osteoarthritis, and index date will be as in study 1. Unexposed participants will be as in study 1, additionally matched for consultation for knee or hip osteoarthritis prior to the index date. Exclusion criteria will include contraindications to β-blockers and osteoarthritis in other joints prior to the index date. Outcomes will be total knee replacement (primary outcome), total hip replacement and new analgesic prescription.
Kaplan-Meier curves will be plotted, and Cox proportional HRs and 95% CIs will be calculated. Stratified analysis will be performed by class of β-blocker, intrinsic sympathomimetic effect and indication(s) for prescription.
This study was ethically approved by the Independent Scientific Advisory Committee of the Medicines and Healthcare Authority (Ref 18_227R). The results of this study will be published in peer-reviewed journals and presented at conferences.
This prospective cohort study will evaluate the analgesic potential of commonly used drugs for osteoarthritis pain.
调查β-肾上腺素能受体阻滞剂（β-阻滞剂）处方是否能降低膝关节或髋关节骨关节炎、全关节置换及镇痛药处方的风险。
初级医疗。
这是一项使用临床实践研究数据链数据的队列研究。将进行两项独立分析。研究1将关注β-阻滞剂处方与新发膝关节/髋关节骨关节炎之间的关联。纳入标准为年龄≥40岁。暴露组参与者为有≥2次连续β-阻滞剂处方者，索引日期为首次开具β-阻滞剂处方的日期。非暴露组参与者将包括最多4名在年龄、性别、全科医疗诊所及β-阻滞剂处方倾向评分方面匹配的对照者。排除标准将包括β-阻滞剂的禁忌证、索引日期之前因骨关节炎或强效镇痛药处方而进行的会诊。结局指标将为膝关节骨关节炎（主要结局指标）、髋关节骨关节炎、膝关节疼痛和髋关节疼痛。研究2将关注β-阻滞剂处方与骨关节炎患者的全关节置换及镇痛药处方之间的关联。纳入标准为年龄≥40岁、膝关节或髋关节骨关节炎，索引日期与研究1相同。非暴露组参与者与研究1相同，另外在索引日期之前因膝关节或髋关节骨关节炎进行的会诊方面进行匹配。排除标准将包括β-阻滞剂的禁忌证以及索引日期之前其他关节的骨关节炎。结局指标将为全膝关节置换（主要结局指标）、全髋关节置换和新的镇痛药处方。
绘制Kaplan-Meier曲线，并计算Cox比例风险比及95%置信区间。将按β-阻滞剂类别、内在拟交感神经活性及处方适应证进行分层分析。
本研究已获得药品和医疗保健管理局独立科学咨询委员会的伦理批准（参考编号18_227R）。本研究结果将发表在同行评审期刊上，并在会议上展示。
这项前瞻性队列研究将评估常用药物对骨关节炎疼痛的镇痛潜力。
