Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip

Summers, Mary N.; Haley, William E.; Reveille, John D.; Alarcóan, Graciela S.

doi:10.1002/art.1780310208

Cited by 243 publications

(167 citation statements)

References 26 publications

(22 reference statements)

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“…A relationship between depressive symptoms and physical function has been described in longitudinal studies not limited to individuals with arthritis, as summarized by Ormel et al (46), and in cross-sectional studies of knee OA (31,34,47,48). The demonstration in the current study that the status of mental health predicts subsequent physical function is important, given how function assessment might be biased by depressive symptoms.…”

supporting

confidence: 51%

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Sharma

Cahue

Song

et al. 2003

Arthritis & Rheumatism

411

351

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Objective. To identify factors that predict a poor physical function outcome over 3 years in individuals with knee osteoarthritis (OA), in an effort to aid in the development of strategies to prevent such functional limitations and consequential disability.Methods. Community-recruited individuals with knee OA underwent baseline, 18-month, and 3-year assessments of candidate risk factors and physical function. Risk factors were age, body mass index (BMI), knee pain intensity (on a visual analog scale [VAS]), local mechanical and neuromuscular factors (varusvalgus laxity, malalignment, proprioceptive inaccuracy, quadriceps strength, hamstring strength), activity level (Physical Activity Scale for the Elderly, amount of aerobic exercise), and psychosocial factors (Short-Form 36 [SF-36] mental health and role-functioning emotional subscales, self-efficacy using the Arthritis SelfEfficacy Scale physical function subscale, and social support using the Medical Outcomes Study Social Support Survey). Outcome was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function scale and rate of chair-stand performance. Participants were grouped by quintile of baseline WOMAC score. The baseline to 3-year outcome was considered "good" when function improved by 1 or more quintiles or remained within the 2 highest function groups, and was considered "poor" when function declined by 1 or more quintiles or remained within the 3 lowest function groups. The same approach was taken for chair-stand outcome. Logistic regression was used to evaluate both the baseline level and the baseline to 18-month change in each factor as a predictor of physical function outcome over 3 years, adjusting for age, BMI, knee pain intensity, disease severity, and additional potential confounders. Results. Factors that significantly increased the likelihood of a poor WOMAC outcome were baseline laxity (crude odds ratio

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supporting

confidence: 51%

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Sharma

Cahue

Song

et al. 2003

Arthritis & Rheumatism

411

351

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“…Third, we could not consider all factors which potentially confound the correlation between symptom and radiographic severities because this study was performed as a cross-sectional survey in a large cohort. Previous studies suggest many factors including quadriceps power, range of motion, psychosocial factors, comorbidities, or pain medication could influence symptom manifestations of osteoarthritic knees [10,14,28,29,35,37,44]. Fourth, subjects with K/L Grade 4 and severe knee symptoms might have had knee arthroplasty and were not recruited into the study.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in the Correlation between Symptom and Radiographic Severity in Patients with Knee Osteoarthritis

Cho

Chang

Yoo

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The effects of gender on the relationship between symptom manifestations and radiographic grades of knee osteoarthritis are not well understood. Questions/purposes We therefore determined the increments of symptom progression with regard to radiographic grades of knee osteoarthritis and asked if those increments differed by gender and whether symptom severity was differentially manifested by gender within the same grade. Methods We recruited 660 community residents; 368 (56%) women and 292 (44%) men. The mean subject age was 71.5 years (range, 65-91 years). Severity of symptoms was measured using the WOMAC and SF-36 scales, and the radiographic severity using Kellgren-Lawrence grades. Incremental changes in WOMAC and SF-36 scores were compared between adjacent Kellgren-Lawrence grades separately in men and women, and in the overall population. We compared symptom severity between men and women with the same radiographic grade. Results For the entire cohort, the mean incremental change in symptom severity was not gradual between the adjacent radiographic grades but was greater between Kellgren-Lawrence Grades 1 and 2 and Grades 2 and 3 than between Grades 0 and 1 or Grades 3 and 4. The patterns of incremental changes in symptom severity differed between men and women: women had more severe symptom progression between Kellgren-Lawrence Grades 2 and 3 and Grades 3 and 4 than men. Furthermore, women had worse mean WOMAC and SF-36 scores than men with the same radiographic grade of knee osteoarthritis. Conclusions These data suggest symptom progression is not gradual between adjacent radiographic grades, and for the same radiographic grade, symptoms are worse in women.

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“…Although elderly subjects are vulnerable to OA pain, previous studies have not shown any significant difference between subgroups of OA patients stratified by age (<65 vs >65 years) (18,77), and other researchers have failed to find an association between age and physical function or the presence or severity of pain in OA (78)(79)(80).…”

Section: Agementioning

confidence: 99%

The sources of pain in osteoarthritis: a pathophysiological review

2014

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summaryThe pain of osteoarthritis (OA) has multifaceted etiologies within and outside the joint. It is believed to be driven by both nociceptive and neuropathic mechanisms, as well as abnormal excitability in the pain pathways of the peripheral and central nervous system. Inflammation in the joint triggers a cascade of events that leads to peripheral sensitization, increased sensitivity of nociceptive primary afferent neurons, and hyperexcitability of the nociceptive neurons in the central nervous system. Pain receptors have been found in the synovium, ligaments, capsule, subchondral bone and surrounding tissues, with the exception of articular cartilage. The bone-related causes of pain in OA include subchondral microfractures, bone stretching with elevation of the periosteum due to osteophyte growth, bone remodeling and repair, bone marrow lesions, and bone angina caused by decreased blood flow and increased intra-osseous pressure. Central factors alter pain processing by setting the gain in such a way that, when a peripheral input is present, it is processed against a background of central factors that can enhance or diminish the experience of pain. As a complex phenomenon with a strong subjective component, pain can also be influenced by the nature of the underlying disease, personal predisposition (biological and psychological), and environmental and psychosocial factors. This review examines the current literature regarding the sources and mechanisms of pain in OA.

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Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip

Cited by 243 publications

References 26 publications

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Physical functioning over three years in knee osteoarthritis: Role of psychosocial, local mechanical, and neuromuscular factors

Gender Differences in the Correlation between Symptom and Radiographic Severity in Patients with Knee Osteoarthritis

The sources of pain in osteoarthritis: a pathophysiological review

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