Opioid users show worse baseline knee osteoarthritis and faster progression of degenerative changes: a retrospective case-control study based on data from the Osteoarthritis Initiative (OAI).
Opioid users show worse baseline knee osteoarthritis and faster progression of degenerative changes: a retrospective case-control study based on data from the Osteoarthritis Initiative (OAI).
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DOI：
10.1186/s13075-021-02524-9
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发表时间：
2021-05-22
影响因子：
4.9
通讯作者：
Link TM
中科院分区：
文献类型：
--
作者：
Bodden J;Joseph GB;Schirò S;Lynch JA;Lane NE;McCulloch CE;Nevitt MC;Link TM
阿片类药物经常用于膝关节骨关节炎患者的疼痛控制，尽管目前的指南建议。先前的研究已经研究了不同阿片亚型的软骨毒性。然而，体内阿片类药物对骨关节炎进展的影响尚不清楚。因此，本研究的目的是描述阿片类药物使用与膝关节结构变化和临床结果之间的关系，为期4年。基线使用阿片类药物的参与者（n=181）和在基线和4年随访期间持续使用≥1年的参与者（n=79）被纳入骨关节炎倡议队列，频率与非阿片类药物使用者（对照组）匹配（1:2）。获得全器官磁共振成像评分（WORMS），包括总积分（WORMS总分，范围0-96）和软骨（0-36）、半月板（0-24）、骨髓异常和软骨下囊肿样病变（0-18）的亚评分。膝关节损伤性骨关节炎结局评分（kos）症状、生活质量（QOL）和疼痛也在基线和随访时获得（范围0-100；分数越低表明结果越差）。使用线性回归模型，研究了基线和纵向结果之间的关系。由于疼痛可能改变观察结果，因此对纵向结果进行了敏感性分析。所有的分析都根据性别、BMI、年龄、种族和kelgren - lawrence分级进行了调整。阿片类药物使用者在基线时有更大的结构退化（WORMS total: Coef）。[95% ci], p；7.1[5.5, 8.8], <0.001)， 4年内的增幅更大（4.7[2.9,6.5],<0.001）。与对照组相比，阿片类药物使用者的软骨和半月板评分增加更多（P≤0.001），并且研究结果经受住了基线疼痛调整（P≤0.002）。与对照组相比，阿片类药物使用者的所有基线KOOS评分都较低（P<0.001）。经基线kos疼痛调整后，生活质量损失更大（生活质量为- 6.9[- 11.6,- 2.1],0.005）。阿片类药物使用者有更严重的膝关节结构退化和更快的进展。阿片类药物的使用也与更严重的症状、疼痛和生活质量有关。此外，根据基线KOA疼痛进行调整后，阿片类药物使用者的生活质量损失比对照组更大，这表明阿片类药物可能不适合预防KOA患者的主观疾病进展。
Opioids are frequently prescribed for pain control in knee osteoarthritis patients, despite recommendations by current guidelines. Previous studies have investigated the chondrotoxicity of different opioid subtypes. However, the impact opioids may have on progression of osteoarthritis in vivo remains unknown. The aim of this study was thus to describe the associations between opioid use and knee structural changes and clinical outcomes, over 4 years. Participants with baseline opioid use (n=181) and who continued use for ≥1 year between baseline and 4-year follow-up (n=79) were included from the Osteoarthritis Initiative cohort and frequency matched with non-users (controls) (1:2). Whole-Organ Magnetic Resonance Imaging Scores (WORMS) were obtained, including a total summation score (WORMS total, range 0–96) and subscores for cartilage (0–36), menisci (0–24), and bone marrow abnormalities and subchondral cyst-like lesions (0–18, respectively). Knee Injury Osteoarthritis Outcomes score (KOOS) symptoms, quality of life (QOL), and pain were also obtained at baseline and follow-up (range 0–100; lower scores indicate worse outcomes). Using linear regression models, associations between baseline and longitudinal findings were investigated. As pain may modify observations, a sensitivity analysis was performed for longitudinal findings. All analyses were adjusted for sex, BMI, age, race, and Kellgren-Lawrence grade. Opioid users had greater structural degeneration at baseline (WORMS total: Coef. [95% CI], P; 7.1 [5.5, 8.8], <0.001) and a greater increase over 4 years (4.7 [2.9, 6.5], <0.001), compared to controls. Cartilage and meniscus scores increased greater in opioid users, compared to controls (P≤0.001), and findings withstood the adjustment for baseline pain (P≤0.002). All baseline KOOS scores were lower in opioid users compared to controls (P<0.001). QOL loss was greater, when adjusted for baseline KOOS pain (QOL −6.9 [−11.6, −2.1], 0.005). Opioid users had worse baseline knee structural degeneration and faster progression. Opioid use was also associated with worse symptoms, pain, and QOL. Furthermore, QOL loss was greater in opioid users compared to controls, when adjusted for baseline KOOS pain, indicating that opioids may not be suited to prevent subjective disease progression in KOA patients.
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4.6
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通讯作者：
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