How do people with knee osteoarthritis use osteoarthritis pain medications and does this change over time? Data from the Osteoarthritis Initiative

Abstract

IntroductionThe aim of this analysis was to describe comprehensively the cross-sectional and longitudinal patterns of analgesic and nutraceutical medication use for knee osteoarthritis (OA) in a contemporary US cohort and to investigate associated demographic and clinical factors.MethodsBaseline, 12, 24 and 36 month data were obtained retrospectively from the National Institutes of Health Osteoarthritis Initiative. Participants had symptomatic radiographic knee OA. Multiple binary logistic regression models identified characteristics independently associated with the use of analgesics or nutraceuticals.ResultsWe included 987 subjects (55.9% female, mean age 61.5 years, 71.0% white). At baseline, 68.2% reported frequent use of a conventional analgesic or nutraceutical for joint pain (for more than half of the previous month). Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs) were the most frequently reported medications (26.8%), even in those more than 75-years old. Multiple conventional analgesics were used by 11.9%. Frequent analgesic use was more likely in women (odds ratio (OR) 1.8 (95% confidence interval (CI) 1.3 to 2.3)) and people with more pain (moderate 1.7 (1.2 to 2.4); severe 3.1 (2.1 to 4.7)); nutraceutical use was less likely in non-whites (0.4 (0.3 to 0.6)), those more than 74-years old (0.6 (0.3 to 0.9)) and those with comorbidities (0.6 (0.5 to 0.9)) and more likely in people with Kellgren-Lawrence (KL) grade 4 (2.2 (1.5 to 3.3)). Overall there was no change in the proportion of participants frequently using prescription or over the counter (OTC) analgesics at 36 months, although most people had changed medication type; of those using a traditional analgesic at baseline approximately one third were still using the same type at 36 months (ranging from 26.2% of baseline prescription NSAID users to 40.6% of baseline acetaminophen users). All participants reporting baseline analgesic use also reported 36 month analgesic use. Female participants (OR 95% CI 1.2 to 3.2, P = 0.009), those with high body mass index (1.2 to 4.8, P = 0.010) and those with moderate (1.6 to 2.6, P = 0.090) or severe (1.8 to 12.0, P = 0.002) baseline pain were more likely to use pain medication during the 36 month follow-up period; participants more than 75-years old were less likely (0.2 to 1.0, P = 0.053).ConclusionsMost people with knee OA used pharmacological therapies frequently, and use appeared to be according to American College of Rheumatology recommendations. Change in medication type used was common. Persistent non-prescription NSAID use in older people is an area of concern.

Impact and therapy of osteoarthritis: the Arthritis Care OA Nation 2012 survey

“…Recommendation of weight loss and exercise was low, suggesting a focus on pharmacotherapies [37]. These findings are generally in line with other studies suggesting that pharmacological therapies are used more frequently in this population [35,36]. Previous studies have indicated that advice on weight loss is given to less than half of obese adults with arthritis [37,38].…”

“…Notably, a similar proportion reported being in constant pain despite medication, suggesting a perception that treatment will only partially relieve symptoms [30]. Prescribed medications were used by two thirds of respondents and use of OTC medications was in line with previous studies, with GPs generally aware of this use [35,36]. Irregular use of medication was common, and in line with previous reports, highlighting the previously reported perception that individuals are concerned about developing tolerance to medications and only using medication when really needed.…”

Cardiovascular disease and osteoarthritis: common pathways and patient outcomes

“…The presence of pain and joint stiffness are important contributors to a diminished health-related quality of life, and nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs (58Á9% of all prescriptions) in the treatment of OA [43].…”

Does flare trial design affect the effect size of non-steroidal anti-inflammatory drugs in symptomatic osteoarthritis? A systematic review and meta-analysis

“…The optimal treatment for people with OA combines pharmacological and non-pharmacological treatments 4. Non-steroidal anti-inflammatory drugs (NSAIDs) and selective cyclo-oxygenase-2 inhibitors are the most commonly used painkillers for people with OA in Europe and the USA, with 20% to 35% of the OA population reporting their use 5 6…”