Defining knee pain trajectories in early symptomatic knee osteoarthritis in primary care: 5-year results from a nationwide prospective cohort study (CHECK)

Abstract

BackgroundGPs have high consultation rates for symptoms related to knee osteoarthritis (OA). Many risk factors for symptomatic knee OA progression remain unknown. AimTo define distinct knee pain trajectories in individuals with early symptomatic knee OA and determine the risk factors for these pain trajectories. Design and settingData were obtained from the multicentre prospective Cohort Hip and Cohort Knee study in the Netherlands. Participants with knee OA, according to the clinical criteria of the American College of Rheumatology, and a completed 5-year follow-up were included. MethodBaseline demographic, anamnestic, and physical examination characteristics were assessed. Outcome was annually assessed by the Numeric Rating Scale for pain. Pain trajectories were retrieved by latent class growth analysis. Multinomial logistic regression was used to calculate relative risk ratios. ResultsIn total, 705 participants were included. Six distinct pain trajectories were identified with favourable and unfavourable courses. Statistically significant differences were found in baseline characteristics, including body mass index (BMI), symptom severity, and pain coping strategies between the different trajectories. Higher BMI, lower level of education, greater comorbidity, higher activity limitation scores, and joint space tenderness were more often associated with trajectories characterised by more pain at first presentation and pain progression -compared with the reference group with a mild pain trajectory. No association was found for baseline radiographic features. ConclusionThese results can help differentiate those patients who require more specific monitoring in the management of early symptomatic knee OA from those for whom a 'wait-and-see' policy seems justifiable. Radiography provided no additional benefit over clinical diagnosis of early symptomatic knee OA in general practice.Keywords disease progression; knee osteoarthritis; knee pain; pain trajectories; primary health care.e32 British Journal of General Practice, January 2016• aged 45-65 years; and• never consulted a physician for these symptoms, or had done so <6 months prior to recruitment to the study.Participants were excluded from the CHECK study if they had:• other pathological conditions that could explain the existing complaints (for example, other rheumatic disease, previous hip or knee joint replacement, congenital dysplasia, osteochondritis dissecans, intraarticular fractures, septic arthritis, Perthes disease, ligament or meniscus injury, plica syndrome, Baker's cyst);• comorbidity that would not allow physical evaluation during 10 years' follow-up;• malignancy in the past 5 years; and• inability to understand Dutch.For the analyses of the current study participants were included if, at baseline, they:• reported knee pain; and• were considered to have knee OA according to the clinical criteria of the American College of Rheumatology. 4,11If a participant had two affected knees, the knee with the worse score based on pain, Kellgren-Lawrenc...

Pain Susceptibility Phenotypes in Those Free of Knee Pain With or at Risk of Knee Osteoarthritis: The Multicenter Osteoarthritis Study

“…We focused on subjects who were free of persistent pain to evaluate which grouping or cluster of features tended to occur together, as well as their relationship to the development of PKP. In studies of symptomatic groups, there is disagreement as to whether trajectories of pain change or stay stable over periods of 5–6 years . Our results, while not trajectory based, indicate that the group with the highest proportion with sensitization, as reflected by local, extrasegmental, and distant pressure pain sensitivity, is at higher risk of developing PKP compared with those who have a relative absence of sensitization as reflected by pressure pain sensitivity.…”

Predictors of pain severity trajectory in older adults: a 10.7-year follow-up study

“…Although Nicholls et al 10 identified five WOMAC pain trajectories over 6-year with stable, improving and progressive among adults aged over 50 years with knee pain, they failed to identify improving and progressive pain trajectories in a matched sample of participants from the OAI. Wesseling et al 11 identified three stable pain trajectories among participants aged 45e64 years with early symptomatic knee OA, but subsequently they identified six pain trajectories with stable, improving and worsening from the same cohort 12 . Taken together, these findings appear to support that pain trajectory is mostly stable once established.…”

“…In this context, there have been some attempts to identify knee OA pain trajectories and their risk factors over periods of 5e8 years 9e14 . These studies identified at least three trajectories with the most common factors related to pain trajectories being higher body mass index (BMI) 9e12 , lower education level 9e12 , presence of psychological problems 9e12 and comorbidities 9,11,12 . Although peripheral structural factors have traditionally thought to be an important factor in the genesis of pain, results about the association between radiographic severity and knee pain trajectories have been mixed.…”

A patient with osteoarthritis out of a doctor's field of vision: how should joint pain be controlled within the concept of responsible self-treatment?

“…Так, А. Bastick и соавт. [23] в рамках проекта CHECK (Cohort Hip and Cohort Knee study) оценили 5-летнюю динамику боли, нарушения функции, отечности и скованности в суставах у 705 больных ОА коленного сустава. Длительное наблюдение позволило ученым выделить пять основных типов течения («траектории») болезни: с медленным улучшением, с быстрым улучшением, с быстрым прогрессированием, с медленным прогрессированием и с постоянным тяжелым течением.…”