Background/Purpose: Knee osteoarthritis (OA) causes substantial health burden and economic costs including medications and neutraceuticals for pain. The aim of this analysis was to describe contemporary use of medications and nutraceutical products in patients with knee OA.

Methods: Knee OA patients meeting ACR criteria for enrollment into a randomized clinical trial reported their use of prescription and over-the-counter medications and nutraceutical products during the prior 6 months using the HAQ health utilization form. We analyzed the number of pain medications, non-pain medications, and nutraceutical products taken by each patient and WOMAC questionnaire measures of pain and physical function. The T-test, Fisher’s exact test and multivariable ordered logistic regression were used to assess statistical differences between groups and associations. All p-values were two tailed, and results were reported as mean±standard deviation.

Results: In 204 knee OA patients (mean age 60.2 years, 70% female, mean WOMAC pain 254±95 and WOMAC function 899±352), 157 (77%), 166 (81%), 150 (74%) reported taking at least one pain, non-pain medication, or nutraceutical (7% glucosamine), respectively (Table 1). On average, each patient used 1.2±0.9 pain medications, 2.8±2.5 non-pain medication, and 2.4±2.3 nutraceutical products. Nutraceutical product use was higher in Whites (3.0±2.4) than in Blacks (1.8±2.0) or Asians (1.7±2.0). Patients using nutraceuticals were significantly older (+3.9, P=0.02) than those who did not without any significant differences by gender. Similarly patients who using non-pain medications were older than those who did not (+3.7 years, P=0.05. In contrast, pain medication users were significantly younger (-4.4 years, P=0.01) than those did not, and more women used pain medications than men (81% vs. 67%, P=0.05). WOMAC pain and function scores were significantly lower in nutraceutical users than in non-users (pain: 241±97 vs. 291±96, P=0.001; function: 859±357 vs. 1011±316, P=0.006). After controlling for age and sex, a higher number of nutraceuticals was associated with an improved WOMAC pain (P=0.05) and function (P=0.03) scores, but the number of pain and non-pain medications were not significantly associated WOMAC pain or function.

Conclusion: Nutraceutical and pain-medication use in OA patients is quite common and much higher in our patient population than in the Osteoarthritis Initiative (Arthritis Research & Therapy 2013, 15:R106). Concomitant and frequent uses of NSAIDs pain medications, nutraceutical products, and other medications for comorbidities in older knee OA patients is an area of concern, given the increased potential for side effects and drug-drug or drug-nutrient interactions.

Disclosure:  Supported by R01 AT005521 from the National Center for Complementary and Alternative Medicine.

 

 

Table 1. Self-reported uses of non-pain and pain medications, and nutriceutical products in knee OA patients
Nutriceutical products (patient n = 150)	Freq	Percent	Non-pain medication classes (patient n = 166)	Freq	Percent
Vitamin D and/or Calcium	201	41.4%	Hypertension	138	24.2%
Multivitamins & minerals	82	16.9%	Heart disease	112	19.6%
Glucosamine/Chondroitin/MSM	36	7.4%	Hyperlipidemia	47	8.2%
Fish oil	29	6.0%	Depression	36	6.3%
Vitamin B	22	4.5%	Diabetes mellitus	35	6.1%
Flaxseed oil	17	3.5%	Peptic ulcers	30	5.3%
Vitamin C	17	3.5%	Thyroid disorders	19	3.3%
Magnesium	7	1.4%	Insomnia	17	3.0%
Folate	5	1.0%	Respiratory disorders	14	2.5%
Vitamin E	5	1.0%	Constipation	11	1.9%
Coenzyme q10	4	0.8%	Rhinitis	10	1.8%
Probiotic	4	0.8%	Epilepsy	10	1.8%
Biotin	3	0.6%	Glaucoma	9	1.6%
Iron	3	0.6%	Asthma	8	1.4%
Krill oil	3	0.6%	Psychosis	8	1.4%
Tumeric	3	0.6%	HIV	7	1.2%
Chromium	2	0.4%	Anxiety	7	1.2%
Garlic	2	0.4%	Muscle spasm	7	1.2%
L-lysine	2	0.4%	Gout/hyperuricemia	6	1.1%
Red yeast rice	2	0.4%	Cancer	5	0.9%
Ubiquinol	2	0.4%	Rheumatoid arthritis	4	0.7%
Zinc	2	0.4%	Hypokalemia	4	0.7%
Miscellaneous nutraceuticals	31*		Neurologic disorders	3	0.5%
Subtotal	483	100%	Prostatic hyperplasia	3	0.5%
			Gastrointestinal disorders	2	0.4%
			Xerostomia	2	0.4%
Pain medications (patient n = 157)	Freq	Percent	Migraine	2	0.4%
NSAIDs	147	58.6%	Incontinence	2	0.4%
Acetaminophen	88	35.1%	Osteoporosis	2	0.4%
Opioids	16	6.4%	Miscellaneous non-pain medications	8*
Subtotal	251	100%	Subtotal	567	100%
Legends: Freq = Frequency; MSM = Methylsulfonylmethane. *Total number of unique miscellaneous nutraceuticals and non-pain medications that was reported once in our study population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nutraceutical-products-and-pain-or-non-pain-medications-use-in-patients-with-knee-osteoarthritis/