COX-2 selective NSAIDS and risk of hip/knee arthroplasty: A population-based case-control study

Introduction: Disease models of osteoarthritis (OA) have shown that COX-2 selective non-steroidal anti-inflammatory drugs (NSAIDs; coxibs) may have beneficial effects on cartilage. Clinical or epidemiological evidence for this potential association is scarce. The objective of this study was to evaluate the risk of hip or knee replacement in users of coxibs as compared to non-selective NSAIDs. Methods: A population-based case-control study was conducted using the Dutch PHARMO Record Linkage System. Cases (n=26,202) had a first replacement of the hip or knee after enrolment (2001-2009). Two controls (without hip or knee replacement) were matched by age, gender and geographical location. Odds ratios (ORs) compared longterm (≥one year) non-selective NSAIDs users with coxib users. Analyses were statistically adjusted for disease and drug history. Results: Long-term use of nonselective NSAIDs was not associated with an increased risk of hip replacement (adjusted OR 0.89; 95% confidence interval (CI): 0.65-1.22) or knee replacement (adjusted OR 0.74; 95% CI: 0.49-1.11) as compared to long-term coxib use. Results were not different after stratification to gender, age, cardiovascular or gastrointestinal disease. Conclusions: This study shows that long-term users of non-selective NSAIDs do not have an increased risk of hip or knee replacement as compared to long-term coxib users. Therefore, our results do not support that patients with osteoarthritis should be treated with coxibs, with regard to progression of this disease.