Pain‐Related Risk Factors Among Radiologic Stages of Knee Osteoarthritis: Data From the Osteoarthritis Initiative

Abstract

Objective To investigate whether risk factors related to pain vary at different stages of knee osteoarthritis (OA). Methods Individuals from the Osteoarthritis Initiative with available Kellgren/Lawrence (K/L) grade and numerical rating scale (NRS) data at baseline were included in this study. Pain severity was classified into 3 categories based on NRS scores: no pain, mild pain, and moderate/severe pain. Knee OA severity was stratified into 4 categories according to the K/L system. Pain risk factors were evaluated using generalized ordinal logistic regression analysis, and a heatmap was created to compare differences in standardized regression coefficients between subgroups of patients with different knee OA severities. Results A total of 4,446 subjects were included in this study: 1,574 individuals without pain (35.4%), 1,138 individuals with mild pain (25.6%), and 1,734 individuals with moderate/severe pain (39.0%). For the entire population and subjects in the premorbid‐stage subgroup, knee injury history, diabetes mellitus, depression, use of nonsteroidal anti‐inflammatory drugs (NSAIDs), and valgus malaligned knees were associated with more severe pain. Older age and stronger quadriceps muscles were associated with milder pain. As the disease progressed, the number of significant risk factors decreased. Only age and quadriceps muscle force remained significant in end‐stage disease. Conclusion Multiple factors are associated with pain in patients with knee OA. As the disease progresses, the number of significant risk factors gradually reduces. These findings suggest that strategies for managing pain related to knee OA should vary depending on radiographic grades.

Osteoarthritis and Depression Update: 2023-Can the Stress and Coping Model Help?

“…Hence it is possible this sub group of adults might be effectively targeted by early efforts to avert excess depressive consequences such as negative affect, sleep, and pain found to accurately predict 6-week opioid use [39]. Depression is also associated with early knee osteoarthritis mild to moderate pain complaints [40], plus poorer outcomes after surgery to replace the osteoarthritis hip joint even when the expected pain relief is forthcoming. Diamond et al [41] further show that patients with depressive disorders undergoing primary reverse surgical shoulder replacement for the treatment of shoulder osteoarthritis have longer in-hospital stays, higher complication rates, and increased care costs.…”