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Individuals experiencing knee discomfort who are prescribed the common class of blood pressure-lowering medications known as beta-blockers may have a reduced risk of undergoing total knee arthroplasty (TKA) for advanced osteoarthritis (OA), according to a recent study published in The Journal of Bone & Joint Surgery. The case-control study, led by Dr. Iskandar Tamimi and colleagues from Universitario de Malaga in Spain, found that the use of β-blockers, particularly non-selective blockers, was associated with a lower likelihood of TKA. Beta-blockers may potentially slow down the progression of OA by diminishing inflammatory agents that contribute to cartilage deterioration, offering potential insights for novel OA treatment strategies.
Utilizing a database from a Spanish hospital, the researchers identified 300 patients who sought evaluation for knee pain between 2010 and 2019 and subsequently underwent TKA between 2018 and 2019. These case patients were matched with 300 controls based on age, sex, calendar year, and arthritis grade, who also sought evaluation for knee pain but did not undergo TKA. The study evaluated the impact of beta-blocker treatment on the likelihood of undergoing TKA, considering factors such as the duration of treatment and adherence to the prescription. An AI tool was employed to mitigate biases related to other potential TKA risk factors. The adjusted analysis revealed that patients using beta-blockers were approximately half as likely to undergo TKA. Notably, this association was specific to non-selective beta-blockers, which target both beta-1 and beta-2 adrenergic receptors.
For patients with knee pain on these medications, the risk of undergoing TKA was reduced by 54 percent. Conversely, those on selective beta-blockers, which primarily target beta-1 receptors in the heart, did not experience a significant reduction in TKA risk. The protective effect was even more pronounced with extended use of beta-blockers, as patients taking them for five years or more saw a 64 percent reduction in TKA risk. This effect was further amplified in patients with higher adherence, with a filled prescription on at least 75 percent of days.
Previous studies have indicated that beta-blockers downregulate various inflammatory agents associated with OA, many of which are regulated by the adrenergic pathways responsible for the blood pressure-lowering effects of these medications. Therefore, modulating the adrenergic signal could potentially alleviate cartilage degradation and slow down the progression of OA, the researchers posit. They acknowledge, however, that their study does not establish a definitive causal link between beta-blocker treatment and the likelihood of undergoing TKA.
Dr. Tamimi and coauthors conclude that they believe β-blockers might have a role in OA management beyond simply providing pain relief, potentially intervening in the degenerative processes within the cartilage. While further research is warranted, this study offers a hypothesis for future therapeutic avenues targeting the adrenergic system in OA treatment.
