Testa Edward J, Callanan Tucker C, Albright J Alex, Quinn Matthew, O'Donnell Ryan, Daniels Alan H, Arcand Michel
Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
J Shoulder Elbow Surg. 2024 Nov;33(11):2427-2432. doi: 10.1016/j.jse.2024.02.035. Epub 2024 Apr 9.
Angiotensin receptor blockers (ARBs) are commonly prescribed antihypertensive agents that have well-known antifibrotic properties. The purpose of this study was to examine the association between ARB use and the rates of new-onset adhesive capsulitis as well as adhesive capsulitis requiring operative treatment.
Using a large national insurance database, a randomly generated cohort of patients with at least 3 continuous months of ARB use between January 2010 and December 2019 (n = 1,000,000) was compared to a separate randomly generated cohort without ARB use (n = 3,000,000). Rates of newly diagnosed adhesive capsulitis and associated manipulation under anesthesia (MUA) and/or arthroscopic capsulotomy were calculated over a 1- and 2-year period following the completion of at least 3 continuous months of ARB therapy. Rates were compared using multivariable logistic regression to control for demographics and comorbidities. Both unadjusted and adjusted odds ratios and 95% confidence intervals were calculated and reported for each comparison. Statistical significance was set at P <.05.
The mean age in the ARB cohort was 61.8 years (standard deviation [SD] = 10.0), whereas in the control cohort, it was 54.8 years (SD = 12.3) (P < .001). The ARB cohort had significantly lower rates of newly diagnosed adhesive capsulitis compared with the control cohort at both 1 year (0.15% vs. 0.55%, P < .001) and 2 years (0.3% vs. 0.78%, P < .001). Similar findings were observed for the arthroscopic capsular release/MUA cohort associated with adhesive capsulitis. After adjusting for confounding factors, the lower rates of adhesive capsulitis and arthroscopic capsular release/MUA associated with adhesive capsulitis in the ARB cohort remained statistically significant (P < .001).
Patients prescribed ARBs experienced a decreased rate of newly diagnosed adhesive capsulitis, as well as adhesive capsulitis requiring surgical intervention when compared to a control cohort. These findings suggest a potential protective effect of ARBs against the development of adhesive capsulitis. Further investigations are warranted to elucidate the underlying mechanisms and establish a causal relationship.
血管紧张素受体阻滞剂（ARBs）是常用的降压药物，具有众所周知的抗纤维化特性。本研究的目的是探讨使用ARB与新发粘连性肩周炎的发生率以及需要手术治疗的粘连性肩周炎之间的关联。
利用一个大型国家保险数据库，将2010年1月至2019年12月期间随机生成的至少连续3个月使用ARB的患者队列（n = 1,000,000）与另一个随机生成的未使用ARB的队列（n = 3,000,000）进行比较。在至少连续3个月的ARB治疗结束后的1年和2年期间，计算新诊断的粘连性肩周炎以及相关的麻醉下手法操作（MUA）和/或关节镜下关节囊切开术的发生率。使用多变量逻辑回归来控制人口统计学和合并症，比较发生率。计算并报告每次比较的未调整和调整后的优势比及95%置信区间。设定统计学显著性为P <.05。
ARB队列的平均年龄为61.8岁（标准差[SD]=10.0），而对照组的平均年龄为54.8岁（SD = 12.3）（P <.001）。在1年时（0.15%对0.55%，P <.001）和2年时（0.3%对0.78%，P <.001），ARB队列新诊断的粘连性肩周炎发生率均显著低于对照组。在与粘连性肩周炎相关的关节镜下关节囊松解/MUA队列中也观察到了类似的结果。在调整混杂因素后，ARB队列中粘连性肩周炎及与粘连性肩周炎相关的关节镜下关节囊松解/MUA的较低发生率仍具有统计学显著性（P <.001）。
与对照组相比，使用ARB的患者新诊断的粘连性肩周炎发生率以及需要手术干预的粘连性肩周炎发生率均有所降低。这些发现表明ARB对粘连性肩周炎的发生可能具有潜在的保护作用。有必要进行进一步研究以阐明潜在机制并建立因果关系。
