The association of socio-economic and psychological factors with limitations in day-to-day activity over 7 years in newly diagnosed osteoarthritis patients

Abstract

Previous research has established links between chronic pain and impaired cognitive ability, as well as between chronic pain and anxiety, in osteoarthritis. Furthermore, there is evidence linking risk of osteoarthritis to lower educational attainment. However, the inter-play of these factors with key social factors (e.g., social deprivation) at the early stages of osteoarthritis are not understood. Here, we used data from waves 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 971) and selected a subsample of respondents who initially did not report a diagnosis of osteoarthritis until wave 6. We used path models to test how social deprivation, education and anxiety, before diagnosis (waves 4 and 5), affect the relationship between cognitive ability, pain and limitations in activities of daily living following diagnosis (waves 6 and 7). We show that high social deprivation before diagnosis predicts greater limitations in activities of daily living after diagnosis, with this effect partly mediated by impaired cognitive ability. We also find that higher educational attainment before diagnosis may protect against limitations in activities of daily living after diagnosis via better cognitive ability and lower anxiety. Therefore, improving cognitive ability and managing anxiety may mitigate the associations of social deprivation and low educational attainment with limitations in activities of daily living.

No evidence for cognitive impairment in an experimental rat model of knee osteoarthritis and associated chronic pain

“…The absence of impairments in hippocampal learning and memory function in the present study is consistent with human neuroimaging findings, suggesting that knee OA impacts the hippocampus less than other chronic pain conditions [41]. However, there is also evidence that chronic pain caused by knee OA causes forebrain changes [4,5,23], and recent studies in human participants support that OA pain may contribute to cognitive impairments, reflected in measures of verbal recall and fluency, subtraction ability and attention [24,27]. These measures may partly depend on similar neurocognitive mechanisms as those assessed in the present study, although it remains to be examined if human participants with chronic OA pain are impaired on translational behavioural assays that correspond more directly to the ones used in the present study, such as a virtual DMP test [10] and CANTAB assays of executive functions, including behavioural flexibility [3].…”

“…First, ageing is a key contributor to cognitive decline [16]. This is of relevance as OA is an age-associated disorder [13], and the average age of participants in the two recent studies showing a negative impact of chronic OA pain on cognition in human participants was > 60 years at the start of data collection [24,27]. Therefore, ageing may interact with chronic OA pain to impair cognitive function.…”

“…suggesting that the cognitive functions associated with these brain regions may also become more vulnerable to chronic pain with age. Second, social deprivation and education have recently been reported to interact with chronic pain to affect cognitive ability in people with OA [27]. Third, prescribed OA pain medication may contribute to cognitive impairments [40].…”

“…Osteoarthritis (OA) is a very common chronic pain condition, estimated to affect 250 million people worldwide, with knee OA having the highest prevalence [21]. Recent longitudinal studies show that OA pain is associated with cognitive impairments, reflected in measures of verbal recall and fluency, subtraction ability, and attention [24,27]. Moreover, grey matter changes [4] and functional reorganisation [5,23] across cortical and subcortical regions have been identified in OA patients.…”

New insight on the pathophysiology of osteoarthritis: A narrative review

“…Since OA is a chronic disease, the accompanying chronic pain can be intermittent but generally severe or intense, or persistent. 57…”