A recent study has indicated that individuals who have recently been diagnosed with osteoarthritis (OA) in the knee or hip, despite having contraindications or precautions regarding non-steroidal anti-inflammatory drugs (NSAIDs), are still being prescribed these medications. Furthermore, those individuals showed an increased use of opioids and a slightly decreased reliance on physical therapy (PT) within their first year of OA diagnosis, which contradicts established treatment guidelines for OA.
Osteoarthritis is a condition that impacts 600 million individuals around the globe, making it a primary reason for disability. Currently, there are no treatments available that modify the disease, leading to the frequent recommendation of oral NSAIDs by most clinical guidelines as a way to alleviate OA-related pain. However, NSAIDs come with risks and are responsible for more emergency hospital visits than any other pharmaceutical category, especially among older individuals and those with additional health problems.
A new investigation conducted by the Boston University Chobanian & Avedisian School of Medicine discovered that individuals newly diagnosed with OA (in the knee or hip), who had contraindications or precautions for NSAID use, were still frequently prescribed these medications. In addition, these individuals made greater use of opioids and slightly lesser use of physical therapy (PT) in the year following their OA diagnosis, which does not align with treatment recommendations for OA.
Dr. Tuhina Neogi, MD, PhD, the study’s lead author and the Alan S. Cohen Professor of Rheumatology, explained, “We found that many individuals with contraindications to NSAIDs continued to receive these prescriptions, which puts them at risk for adverse effects related to NSAIDs. They also did not receive safer treatment alternatives, such as physical therapy, even though it is widely recommended as a primary treatment.”
The research team analyzed population-based register data from adults living in Sweden between 2004 and 2013 who had not previously been diagnosed with knee or hip OA. They identified individuals diagnosed with OA between 2014 and 2018 while also considering their contraindications or precautions related to oral NSAID use at the time of their OA diagnosis. They then evaluated the likelihood of: 1) regular oral NSAID use; 2) regular opioid use; and 3) engagement in PT during the first year following diagnosis, comparing those with contraindications or precautions to those without.
Notably, despite their contraindications, 21% of participants still used NSAIDs regularly within the first year after being diagnosed with OA. Similarly, 21% of those with precautions regarding NSAID use also turned out to be regular users. The study also revealed that individuals with contraindications were more likely to regularly use opioids compared to those without any such contraindications or precautions, while a marginally lower number engaged in PT.
The researchers highlighted that the reduced utilization of PT is particularly alarming since PT and exercise are commonly recognized as the first-line treatment for knee and hip OA by numerous professional organizations. “While PT uptake in this group was relatively good, likely due to the Swedish healthcare system which provides covered PT services with minimal out-of-pocket costs for patients, it is troubling that individuals with NSAID contraindications are less likely to access PT services in a system that offers and finances them,” stated Neogi, who also serves as chief of rheumatology at Boston Medical Center.
Neogi emphasized the urgent need for more effective and safe treatment options for managing OA symptoms, as well as the necessity of bridging the existing gaps in knowledge and practical application of evidence-based practices.
These results have been published online in the journal Osteoarthritis and Cartilage.
The research was funded by various organizations, including the Swedish Research Council (2022-01507), the Greta and Johan Kock foundation, the Hjalmar Svensson foundation, Österlund Foundation, Gustaf V 80-Year Birthday Foundation, Governmental Funding of Clinical Research within National Health Service (ALF), the Swedish Rheumatism Association, the Foundation for People with Movement Disability in Skåne, the Inger Hultmans foundation, and the National Institute of Health (NIH) (P30 AR072571, K24 AR070892).
