ArticleBMC medicine2026
Associations of centrally acting analgesic use with total joint arthroplasty compared to selective serotonin reuptake inhibitor among osteoarthritis patients in a large prospective cohort.
Article in BMC medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
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Abstract
backgroundCentrally acting analgesics (CAAs) are first-line therapy for neuropathic pain, while selective serotonin reuptake inhibitors (SSRIs) are first-line agents for managing depression, but their effects on osteoarthritis (OA) are unclear. We aimed to evaluate the relation of CAA versus SSRI use to risk of total joint arthroplasty (TJA) among people with OA in a population-based cohort.
methodsWe conducted a propensity score-matched, new-user design, active comparator, population-based cohort study using data from IQVIA Medical Record Database (IMRD), limited to people with OA aged between 40 and 89. We identified incident CAA and SSRI users and propensity-score matched them 1:1 using one-year cohort accrual blocks. We compared the risk of TJA among CAA initiators to SSRI initiators using Cox proportional hazards regression. We conducted subgroup analyses limited to those with both OA and depression. We repeated analyses accounting for the competing risk of death using a Fine-Gray model.
resultsCAA initiators (n = 11,734) had a higher risk of knee/hip arthroplasty compared with SSRI initiators (n = 11,734), with the propensity score-matched hazard ratio (HR) of 1.81 (95% CI 1.59, 2.07). When additionally adjusted for confounders and when accounting for competing risk of death and drug discontinuation, the effect estimate was slightly reduced (HR 1.48; 95% CI 1.22, 1.80). Subgroup analysis limited to those with both OA and depression demonstrated a positive but non-significant effect estimate.
conclusionsCAA initiation was associated with higher risk of TJA compared with SSRI initiation. These results may suggest that agents that predominantly impact depression may also have beneficial effects on knee OA progression.
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