Fluctuating and persistent knee pain over 1 year predicts accelerated cartilage loss as well as an increased risk for incident and progressive radiographic osteoarthritis, according to data published in Arthritis Research & Therapy.
Healio December 5, 2018
“There have been data supporting the notion that knee pain is not only a consequence of structural deterioration in OA, but also contributes to structural progression,” Yuanyuan Wang MD PhD MBBS, of Monash University, Melbourne, Australia, told Healio Rheumatology. “Clarifying this is important because if this is the case, targeting the factors causing knee pain may offer a potential strategy for slowing the disease progression of OA.”
While previous studies have predominantly focused on whether structural changes predict knee pain in people with knee OA, the relatively few studies examining whether knee pain is a predictor of structural progression of knee OA have shown conflicting results,” she added. “The inconclusive results may be due to differences in study population, sample size, assessment of knee pain, duration of follow-up, and measures of structural progression.”
To determine whether knee pain over a period of 1 year was a predictor of cartilage loss, as well as the incidence and progression of radiographic OA, the researchers extracted data from the NIH Osteoarthritis Initiative (OAI), which contains data on 4,796 patients with or at risk for knee OA at baseline. Wang and colleagues focused on 2,249 participants with radiographic OA and 2,120 without.
The researchers assessed knee pain at baseline and 1 year using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients were categorized based on knee pain, with the groups including “no pain,” with a WOMAC score of less than 5 at baseline and 1 year; “fluctuating pain,” with a WOMAC score greater than 5 at either time point; and “persistent pain,” denoting a WOMAC score greater than 5 at both time points. Cartilage volume, as well as the incidence and progression of radiographic OA, were evaluated using MRI and X-rays at baseline and 4 years.
According to the researchers, among patients with and without radiographic OA, greater baseline WOMAC knee pain scores were associated with increased medial and lateral cartilage volume loss (P .001), as well as the incidence (OR = 1.07; 95% CI, 1.01-1.13) and progression (OR = 1.07; 95% CI, 1.03-1.1) of radiographic OA. In addition, patients with and without radiographic OA, with fluctuating and persistent knee pain, demonstrated increased cartilage volume loss, compared with those with no pain (P .01).
Knee pain as a predictor of structural progression over 4 years: data from the Osteoarthritis Initiative, a prospective cohort study, Yuanyuan Wang, Andrew J. Teichtahl, François Abram, Sultana Monira Hussain, Jean-Pierre Pelletier, Flavia M. Cicuttini and Johanne Martel-Pelletier. Arthritis Research & Therapy 2018 20:250. https://doi.org/10.1186/s13075-018-1751-4
Higher physical activity and lower pain levels before surgery predict non-improvement of knee pain 1 year after TKA, Kornilov N, Lindberg MF, Gay C, Saraev A, Kuliaba T, Rosseland LA, Lerdal A. Knee Surg Sports Traumatol Arthrosc. 2018 Jun;26(6):1698-1708. doi: 10.1007/s00167-017-4713-5. Epub 2017 Sep 15.
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