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Sethi V, Anand C, Della Pasqua O. Clinical Assessment of Osteoarthritis Pain: Contemporary Scenario, Challenges, and Future Perspectives. Pain Ther 2024; 13:391-408. [PMID: 38662319 PMCID: PMC11111648 DOI: 10.1007/s40122-024-00592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
The multifaceted nature of osteoarthritis (OA) pain presents a challenge in understanding and managing the condition. The diverse pain experiences, progression rates, individual responses to treatments, and complex disease mechanisms contribute to heterogeneity in the clinical studies outcomes. The lack of a standardized methodology for assessing and classifying OA pain challenges healthcare practitioners. This complicates the establishment of universally applicable protocols or standardized guidelines for treatment. This article explores the heterogeneity observed in clinical studies evaluating OA pain treatments, highlighting the necessity for refined methodologies, personalized patient categorization, and consistent outcome measures. It discusses the role of the multidimensional nature of OA pain, underlying pain mechanisms, and other contributing factors to the heterogeneity in outcome measures. Addressing these variations is crucial to establishing a more consistent framework for evidence-based treatments and advancing care of the patient with OA pain.
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Affiliation(s)
- Vidhu Sethi
- Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, Singapore, 139234, Singapore.
| | - Chetan Anand
- Advanced Pain Management Centre, Hackettstown, NJ, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
- Clinical Pharmacology and Therapeutics Group, University College London, BMA House, Tavistock Square, London, UK
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Ma C, Searle D, Tian J, Cervo MM, Scott D, Hebert JR, Oddy WH, Cicuttini F, Jones G, Pan F. Dietary Inflammatory Index and Magnetic Resonance Imaging-Detected Knee Structural Change and Pain: A 10.7-Year Follow-up Study. Arthritis Care Res (Hoboken) 2024; 76:813-820. [PMID: 38282547 DOI: 10.1002/acr.25307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To determine whether the dietary inflammatory index (DII) scores were associated with knee structural changes and pain over a 10.7-year follow-up. METHODS This study used data from a prospective population-based cohort study (mean age 63 years, 51% female) in which 1,099, 875, 768, and 566 participants completed assessments at baseline, 2.6, 5.1, and 10.7 years, respectively. T1-weighted and T2-weighted magnetic resonance imaging was performed to measure cartilage volume (CV) and bone marrow lesions (BMLs) at baseline and 10.7 years. The Western Ontario and McMaster Universities Osteoarthritis Index pain questionnaire was used to measure knee pain at each visit. Pain trajectories ("minimal pain," "mild pain," and "moderate pain") were previously identified. Baseline energy-adjusted DII (E-DII) scores were calculated. Linear, log-binomial regression, linear mixed-effects modeling, and multi-nominal logistic regression were used for analyses. RESULTS The mean ± SD E-DII score at baseline was -0.48 ± 1.39. In multivariable analyses, higher E-DII scores were not associated with tibial CV loss or BML size increase except for medial tibial BML size increase. Higher E-DII scores were associated with a higher pain score (β = 0.21; 95% confidence interval [CI] 0.004-0.43) and an increased risk of belonging to the "moderate pain" compared to the "minimal pain" trajectory group (relative risk ratio 1.19; 95% CI 1.02-1.39). CONCLUSION A proinflammatory diet, as indicated by a higher DII score, may be associated with a greater pain score and higher risk of more severe pain trajectory over 10 years. However, inconsistent findings related to structural changes suggest a discordance between the potential impact of diet on structural damage and pain in knee OA.
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Affiliation(s)
- Canchen Ma
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, and Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Daniel Searle
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Mavil May Cervo
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - David Scott
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia, and School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - James R Hebert
- Cancer Prevention and Control Program, and Arnold School of Public Health, University of South Carolina, Columbia
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Saxer F, Hollinger A, Bjurström M, Conaghan P, Neogi T, Schieker M, Berenbaum F. Pain-phenotyping in osteoarthritis: Current concepts, evidence, and considerations towards a comprehensive framework for assessment and treatment. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100433. [PMID: 38225987 PMCID: PMC10788802 DOI: 10.1016/j.ocarto.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024] Open
Abstract
Objectives Pain as central symptom of osteoarthritis (OA) needs to be addressed as part of successful treatment. The assessment of pain as feature of disease or outcome in clinical practice and drug development remains a challenge due to its multidimensionality and the plethora of confounders. This article aims at providing insights into our understanding of OA pain-phenotypes and suggests a framework for systematic and comprehensive assessments. Methods This narrative review is based on a search of current literature for various combinations of the search terms "pain-phenotype" and "knee OA" and summarizes current knowledge on OA pain-phenotypes, putting OA pain and its assessment into perspective of current research efforts. Results Pain is a complex phenomenon, not necessarily associated with tissue damage. Various pain-phenotypes have been described in knee OA. Among those, a phenotype with high pain levels not necessarily matching structural changes and a phenotype with low pain levels and impact are relatively consistent. Further subgroups can be differentiated based on patient reported outcome measures, assessments of comorbidities, anxiety and depression, sleep, activity and objective measures such as quantitative sensory testing. Conclusions The complexity of both OA as disease and pain in OA prompt the definition of a set of variables that facilitate assessments comparable across studies to maximize our understanding of pain, as central concern for the patient.
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Affiliation(s)
- F. Saxer
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Medical Faculty, University of Basel, 4002, Basel, Switzerland
| | - A. Hollinger
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - M.F. Bjurström
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - P.G. Conaghan
- Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, UK
| | - T. Neogi
- Clinical Epidemiology Research and Training Unit and Rheumatology, Boston University School of Medicine Epidemiology, Boston University School of Public Health, United States
| | - M. Schieker
- Novartis Biomedical Research, Novartis Campus, 4002, Basel, Switzerland
- Medical Faculty, Ludwig-Maximilians-University, Munich, 80336, Germany
| | - F. Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hopital Saint Antoine, Paris, France
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Neelapala YVR, Neogi T, Kumar D, Jarraya M, Macedo L, Kobsar D, Hanna S, Frey-Law LA, Lewis CE, Nevitt M, Appleton T, Birmingham T, Carlesso LC. Exploring different models of pain phenotypes and their association with pain worsening in people with early knee osteoarthritis: The MOST cohort study. Osteoarthritis Cartilage 2024; 32:210-219. [PMID: 37709187 PMCID: PMC10903761 DOI: 10.1016/j.joca.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To determine i) pain phenotypes (PP) in people with early-stage knee osteoarthritis (EKOA); ii) the longitudinal association between the phenotypes and pain worsening at two years. DESIGN We studied participants with EKOA from the Multicenter Osteoarthritis Study defined as pain intensity ≤3/10, Kellgren and Lawrence grade ≤2, intermittent pain none to sometimes, and no constant pain. Two models of PP were explored. Model A included pressure pain thresholds, temporal summation, conditioned pain modulation, pain catastrophizing, sleep quality, depression, and widespread pain (WSP). In Model B, gait characteristics, quadriceps strength, comorbidities, and magnetic resonance imaging features were added to Model A. Latent Class Analysis was used to create phenotypes, and logistic regression was used to determine their association with pain worsening. RESULTS 750 individuals (60% females), mean age [standard deviation (SD)]: 60.3 (9.4) were included in Model A and 333 individuals (60% females), mean age (SD): 59.4 (8.1) in Model B. 3-class and 4-class solutions were chosen for Model A and Model B. In Model A, the most "severe" phenotype was dominated by psychosocial factors, WSP, and measures of nervous system sensitization. Similarly in Model B, the Model A phenotype plus gait variables, quadriceps strength, and comorbidities were dominant. Surprisingly, none of the phenotypes in either model had a significant relationship with pain worsening. CONCLUSION Phenotypes based upon various factors thought to be important for the pain experience were identified in those with EKOA but were not significantly related to pain worsening. These phenotypes require validation with clinically relevant endpoints.
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Affiliation(s)
| | - Tuhina Neogi
- Department of Medicine, Chobanian & Avedisian Boston University School of Medicine, United States.
| | - Deepak Kumar
- Boston University College of Health & Rehabilitation Sciences, Sargent College, United States.
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, United States.
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
| | - Dylan Kobsar
- Department of Kinesiology, McMaster University, Hamilton, Canada.
| | - Steven Hanna
- Department of Health Research Methods, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - Laura A Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, United States.
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, United States.
| | - Michael Nevitt
- Epidemiology & Biostatistics, University of California San Francisco, United States.
| | - Tom Appleton
- Department of Medicine and Physiology & Pharmacology, Western University, Canada.
| | | | - Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.
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Altamirano S, Jansen MP, Oberski DL, Eijkemans MJC, Mastbergen SC, Lafeber FPJG, van Spil WE, Welsing PMJ. Identifying multivariate disease trajectories and potential phenotypes of early knee osteoarthritis in the CHECK cohort. PLoS One 2023; 18:e0283717. [PMID: 37450467 PMCID: PMC10348540 DOI: 10.1371/journal.pone.0283717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/15/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To gain better understanding of osteoarthritis (OA) heterogeneity and its predictors for distinguishing OA phenotypes. This could provide the opportunity to tailor prevention and treatment strategies and thus improve care. DESIGN Ten year follow-up data from CHECK (1002 early-OA subjects with first general practitioner visit for complaints ≤6 months before inclusion) was used. Data were collected on WOMAC (pain, function, stiffness), quantitative radiographic tibiofemoral (TF) OA characteristics, and semi-quantitative radiographic patellofemoral (PF) OA characteristics. Using functional data analysis, distinctive sets of trajectories were identified for WOMAC, TF and PF characteristics, based on model fit and clinical interpretation. The probabilities of knee membership to each trajectory were used in hierarchical cluster analyses to derive knee OA phenotypes. The number and composition of potential phenotypes was selected again based on model fit (silhouette score) and clinical interpretation. RESULTS Five trajectories representing different constant levels or changing WOMAC scores were identified. For TF and PF OA, eight and six trajectories respectively were identified based on (changes in) joint space narrowing, osteophytes and sclerosis. Combining the probabilities of knees belonging to these different trajectories resulted in six clusters ('phenotypes') of knees with different degrees of functional (WOMAC) and radiographic (PF) parameters; TF parameters were found not to significantly contribute to clustering. Including baseline characteristics as well resulted in eight clusters of knees, dominated by sex, menopausal status and WOMAC scores, with only limited contribution of PF features. CONCLUSIONS Several stable and progressive trajectories of OA symptoms and radiographic features were identified, resulting in phenotypes with relatively independent symptomatic and radiographic features. Sex and menopausal status may be especially important when phenotyping knee OA patients, while radiographic features contributed less. Possible phenotypes were identified that, after validation, could aid personalized treatments and patients selection.
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Affiliation(s)
- Sara Altamirano
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniel L Oberski
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Data Science and Biostatistics, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marinus J C Eijkemans
- Department of Data Science and Biostatistics, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem E van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Rheumatology, Dijklander Hospital, Hoorn, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Tan BY, Goh ZZS, Lim CJ, Pereira MJ, Yang SY, Tan KG, Tan ACK, Liang P, Abbott JH, Briggs AM, Hunter DJ, Skou ST, Thumboo J, Car J. Singapore KneE osTeoarthritis CoHort (SKETCH): protocol for a multi-centre prospective cohort study. BMC Musculoskelet Disord 2023; 24:104. [PMID: 36750930 PMCID: PMC9903549 DOI: 10.1186/s12891-023-06207-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading cause of global disability. The understanding of the role of psychosocial factors in knee OA outcomes is still evolving particularly in an Asian context. The primary aim of this study is to explore psychosocial factors that prognosticate short and long-term clinical outcomes, productivity, and healthcare utilization in patients with knee OA. Secondary aims are to explore the mediation and directional relationships and the role it plays in predicting the discordance between self-reported measures (SRM), physical-performance measures (PPMs) and objective clinical parameters. METHODS A multi-centre prospective cohort study of community ambulant knee OA patients seeking treatment in the tertiary healthcare institutions in Singapore will be conducted. Patients with secondary arthritis, significant cognitive impairment, severe medical comorbidities or previous knee arthroplasty will be excluded. Primary clinical outcome measure is the Knee injury and OA Outcome Score-12 (KOOS-12). Baseline characteristics include sociodemographic status, arthritis status including symptom duration and radiographic severity, comorbidities and functional status through Charlson Comorbidities Index (CCI), Barthel Index (BI) and Parker Mobility Score (PMS). Psychosocial variables include social support, kinesiophobia, negative affect, self-efficacy, injustice, chronic illness shame and the built environment. Clinical outcomes include quality of life, physical performance, global assessment, satisfaction and physical activity levels. Productivity and healthcare utilization will be assessed by a modified OA Cost and Consequences Questionnaire (OCC-Q) and the Work Productivity and Activity Impairment Questionnaire (WPAI). Variables will be collected at baseline, 4, 12 months and yearly thereafter. Regression, mediation and structural equation modelling will be used for analysis. DISCUSSION Results will allow contextualization, identification, and phenotyping of the critical (and potentially modifiable) psychosocial parameters that predict positive clinical outcomes in the OA population to guide optimization and refinement of healthcare and community. This will facilitate: 1. identification of high-risk knee OA subpopulations that will likely experience poor outcomes and 2. formulation of targeted multidisciplinary comprehensive approaches to address these psychosocial factors to optimize non-surgical treatment care, maximize functional outcomes and create more value-based care model for knee OA. ETHICS AND DISSEMINATION The study has been registered under clinicaltrials.gov registry (Identifier: NCT04942236).
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Affiliation(s)
- Bryan Yijia Tan
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Department of Orthopaedic Surgery, Woodlands Health, National Healthcare Group, Singapore, Singapore.
| | | | - Chien Joo Lim
- Department of Orthopaedic Surgery, Woodlands Health, Singapore, Singapore
| | | | - Su-Yin Yang
- Psychology Service, Woodlands Health, Singapore, Singapore
| | - Kelvin Guoping Tan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Alvin Chin Kwong Tan
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Phyllis Liang
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew M Briggs
- Faculty of Health Sciences, Curtin School of Allied Health and Curtin enAble Institute, Curtin University, Perth, WA, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Soren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Johnson AJ, Buchanan T, Laffitte Nodarse C, Valdes Hernandez PA, Huo Z, Cole JH, Buford TW, Fillingim RB, Cruz-Almeida Y. Cross-Sectional Brain-Predicted Age Differences in Community-Dwelling Middle-Aged and Older Adults with High Impact Knee Pain. J Pain Res 2022; 15:3575-3587. [PMID: 36415658 PMCID: PMC9676000 DOI: 10.2147/jpr.s384229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Knee OA-related pain varies in impact across individuals and may relate to central nervous system alterations like accelerated brain aging processes. We previously reported that older adults with chronic musculoskeletal pain had a significantly greater brain-predicted age, compared to pain-free controls, indicating an "older" appearing brain. Yet this association is not well understood. This cross-sectional study examines brain-predicted age differences associated with chronic knee osteoarthritis pain, in a larger, more demographically diverse sample with consideration for pain's impact. Patients and Methods Participants (mean age = 57.8 ± 8.0 years) with/without knee OA-related pain were classified according to pain's impact on daily function (ie, impact): low-impact (n=111), and high-impact (n=60) pain, and pain-free controls (n=31). Participants completed demographic, pain, and psychosocial assessments, and T1-weighted magnetic resonance imaging. Brain-predicted age difference (brain-PAD) was compared across groups using analysis of covariance. Partial correlations examined associations of brain-PAD with pain and psychosocial variables. Results Individuals with high-impact chronic knee pain had significantly "older" brains for their age compared to individuals with low-impact knee pain (p < 0.05). Brain-PAD was also significantly associated with clinical pain, negative affect, passive coping, and pain catastrophizing (p's<0.05). Conclusion Our findings suggest that high impact chronic knee pain is associated with an older appearing brain on MRI. Future studies are needed to determine the impact of pain-related interference and pain management on somatosensory processing and brain aging biomarkers for high-risk populations and effective intervention strategies.
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Affiliation(s)
- Alisa J Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Taylor Buchanan
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Chavier Laffitte Nodarse
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Pedro A Valdes Hernandez
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions College of Medicine, University of Florida, Gainesville, FL, USA
| | - James H Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK,Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Thomas W Buford
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA,Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA,Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA,Correspondence: Yenisel Cruz-Almeida, University of Florida, PO Box 103628, 1329 SW 16th Street, Ste 5180, Gainesville, FL, 32608, USA, Tel +1 352-294-8584, Fax +1 352-273-5985, Email
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Devine M, Ma C, Tian J, Antony B, Cicuttini F, Jones G, Pan F. Association of Pain Phenotypes with Risk of Falls and Incident Fractures. Biomedicines 2022; 10:biomedicines10112924. [PMID: 36428490 PMCID: PMC9687743 DOI: 10.3390/biomedicines10112924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To compare whether falls risk score and incident fracture over 10.7 years were different among three previously identified pain phenotypes. Methods: Data on 915 participants (mean age 63 years) from a population-based cohort study were studied at baseline and follow-ups at 2.6, 5.1 and 10.7 years. Three pain phenotypes were previously identified using the latent class analysis: Class 1: high prevalence of emotional problems and low prevalence of structural damage; Class 2: high prevalence of structural damage and low prevalence of emotional problems; Class 3: low prevalence of emotional problems and low prevalence of structural damage. Fractures were self-reported and falls risk score was measured using the Physiological Profile Assessment. Generalized estimating equations model and linear mixed-effects model were used to compare differences in incident fractures and falls risk score over 10.7 years between pain phenotypes, respectively. Results: There were 3 new hip, 19 vertebral, and 121 non-vertebral fractures, and 138 any site fractures during 10.7-year follow-up. Compared with Class 3, Class 1 had a higher risk of vertebral (relative risk (RR) = 2.44, 95% CI: 1.22-4.91), non-vertebral fractures (RR = 1.20, 95% CI: 1.01-1.42), and any site fractures (RR = 1.24, 95% CI: 1.04-1.46) after controlling for covariates, bone mineral density and falls risk score. Class 2 had a higher risk of non-vertebral and any site fracture relative to those in Class 3 (non-vertebral: RR = 1.41, 95% CI: 1.17-1.71; any site: RR = 1.44, 95% CI: 1.20-1.73), but not vertebral fracture. Compared with Class 3, Class 1 had a higher falls risk score at baseline (β = 0.16, 95% CI: 0.09-0.23) and over 10.7-year (β = 0.03, 95% CI: 0.01-0.04). Conclusions: Class 1 and/or Class 2 had a higher risk of incident fractures and falls risk score than Class 3, highlighting that targeted preventive strategies for fractures and falls are needed in pain population.
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Affiliation(s)
- Maxim Devine
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Canchen Ma
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne 3181, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart 7000, Australia
- Correspondence: ; Tel.: +61-3-6226-7700; Fax: +61-3-6226-7704
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Study protocol for a randomised controlled trial of diacerein versus placebo to treat knee osteoarthritis with effusion-synovitis (DICKENS). Trials 2022; 23:768. [PMID: 36089595 PMCID: PMC9464426 DOI: 10.1186/s13063-022-06715-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is an unmet need for treatments for knee osteoarthritis (OA). Effusion-synovitis is a common inflammatory phenotype of knee OA and predicts knee pain and structural degradation. Anti-inflammatory therapies, such as diacerein, may be effective for this phenotype. While diacerein is recommended for alleviating pain in OA patients, evidence for its effectiveness is inconsistent, possibly because studies have not targeted patients with an inflammatory phenotype. Therefore, we will conduct a multi-centre, randomised, placebo-controlled double-blind trial to determine the effect of diacerein on changes in knee pain and effusion-synovitis over 24 weeks in patients with knee OA and magnetic resonance imaging (MRI)-defined effusion-synovitis.
Methods
We will recruit 260 patients with clinical knee OA, significant knee pain, and MRI-detected effusion-synovitis in Hobart, Melbourne, Adelaide, and Perth, Australia. They will be randomly allocated to receive either diacerein (50mg twice daily) or identical placebo for 24 weeks. MRI of the study knee will be performed at screening and after 24 weeks of intervention. The primary outcome is improvement in knee pain at 24 weeks as assessed by a 100-mm visual analogue scale (VAS). Secondary outcomes include improvement in volumetric (ml) and semi-quantitative (Whole-Organ Magnetic Resonance Imaging Score, 0–3) measurements of effusion-synovitis using MRI over 24 weeks, and improvement in knee pain (VAS) at 4, 8, 12, 16, and 20 weeks. Intention-to-treat analyses of primary and secondary outcomes will be performed as the primary analyses. Per protocol analyses will be performed as the secondary analyses.
Discussion
This study will provide high-quality evidence to determine whether diacerein improves pain, changes disease trajectory, and slows disease progression in OA patients with effusion-synovitis. If diacerein proves effective, this has the potential to significantly benefit the substantial proportion (up to 60%) of knee OA patients with an inflammatory phenotype.
Trial registration
Australian and New Zealand Clinical Trial Registry ACTRN12618001656224. Registered on 08 October 2018.
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Carlesso LC, Feldman DE, Vendittoli PA, LaVoie F, Choinière M, Bolduc MÈ, Fernandes J, Newman N, Sabouret P. Use of IMMPACT Recommendations to Explore Pain Phenotypes in People with Knee Osteoarthritis. PAIN MEDICINE 2022; 23:1708-1716. [PMID: 35266543 DOI: 10.1093/pm/pnac044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a disease of multiple phenotypes of which a chronic pain phenotype (PP) is known. Previous PP studies have focused on one domain of pain and included heterogenous variables. We sought to identify multidimensional PPs using the IMMPACT recommendations and their relationship to clinical outcomes. METHODS Participants >40 years of age with knee OA having a first-time orthopaedic consultation at five university affiliated hospitals in Montreal, Quebec and Hamilton (Canada) were recruited. Latent profile analysis was used to determine PPs (classes) using variables recommended by IMMPACT. This included pain variability, intensity and qualities, somatization, anxiodepressive symptoms, sleep, fatigue, pain catastrophizing, neuropathic pain, and quantitative sensory tests. We used MANOVA and Chi-square tests to assess differences in participant characteristics across the classes and linear and Poisson regression to evaluate the association of classes to outcomes of physical performance tests, self-reported function and provincial healthcare data. RESULTS 343 participants were included (mean age 64 years, 64% female). Three classes were identified with increasing pain burden (class3 > class1), characterized by significant differences across most self-report measures and temporal summation, and differed in terms of female sex, younger age, lower optimism and pain self-efficacy. Participants in class2 and class3 had significantly worse self-reported function, stair climb and 40m walk tests, and higher rates of healthcare usage compared to those in class1. CONCLUSIONS Three distinct PPs guided by IMMPACT recommendations were identified, predominated by self-report measures and temporal summation. Using this standardized approach may improve PP study variability and comparison.
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Affiliation(s)
- Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Associate, Research Institute St. Joseph's Hamilton, Canada; School of Rehabilitation, Université de Montreal, Montreal, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, School of Public Health, Department of Social and Preventive Medicine, Université de Montreal,Centre for interdisciplinary research in rehabilitation,Institute of Public Health Research,Université de Montréal, Montreal, Canada
| | - Pascal-André Vendittoli
- Département de Chirurgie, Hôpital Maisonneuve-Rosemont,Université de Montréal, Montréal, QC, Canada
| | - Frédéric LaVoie
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada; Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-Ève Bolduc
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julio Fernandes
- Department of Orthopaedic Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada; Faculty of Medicine, Université de Montréal, Montréal, Canada; Department of Orthopaedic Surgery, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Nicholas Newman
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pierre Sabouret
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Chen F, Gao W, Hu J, Yang X, Chai X, Wang D. Preoperative angiotensin II type 2 receptor is a predictor for developing chronic post-surgical pain after total knee arthroplasty surgery. Life Sci 2021; 278:119654. [PMID: 34043993 DOI: 10.1016/j.lfs.2021.119654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This study aimed to explore whether preoperative angiotensin II type 2 receptor (AT2R) level in knee osteoarthritis (OA) patients was an independent risk factor for chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). METHODS A total of 220 patients who had undergone unilateral TKA were enrolled from October 2019 to January 2020. Quantitative sensory testing (QST), PainDETECT questionnaires (PD-Q), the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), the hospital anxiety and depression (HAD) and serum AT2R were collected preoperatively. The primary outcome was the incidence of CPSP, which was defined as the visual analogue scale (VAS) score ≥ 4 in the ipsilateral knee joint six months after operation. RESULTS The prevalence of CPSP was 13.6% (n = 30). Multiple logistic regression analysis showed that patients with higher AT2R level (OR: 1.007, 95% CI: 1.003-1.011) and PD-Q score (OR: 1.146, 95% CI: 1.008-1.298) before surgery had an increased risk of CPSP after surgery, and a combination of preoperative AT2R and PD-Q (Akaike information criterion: 147.2; area under receiver operating characteristic (ROC) curve: 0.890) was able to correctly classify 90.16% of patients into CPSP positive or negative groups. CONCLUSION Our findings suggest that patients with higher preoperative AT2R level are at increased risk of developing CPSP following TKA. AT2R may serve as a candidate predictor for phenotyping CPSP in OA patients.
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Affiliation(s)
- Fan Chen
- Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China; Department of Anesthesiology, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
| | - Wei Gao
- Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China; Department of Anesthesiology, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
| | - Jicheng Hu
- Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China; Department of Anesthesiology, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
| | - Xinlu Yang
- Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China; Department of Anesthesiology, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China
| | - Xiaoqing Chai
- Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China; Department of Anesthesiology, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China.
| | - Di Wang
- Department of Anesthesiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China; Department of Anesthesiology, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, China.
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Obbarius A, Fischer F, Liegl G, Obbarius N, van Bebber J, Hofmann T, Rose M. A Step Towards a Better Understanding of Pain Phenotypes: Latent Class Analysis in Chronic Pain Patients Receiving Multimodal Inpatient Treatment. J Pain Res 2020; 13:1023-1038. [PMID: 32523372 PMCID: PMC7234963 DOI: 10.2147/jpr.s223092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 03/13/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose The number of non-responders to treatment among patients with chronic pain (CP) is high, although intensive multimodal treatment is broadly accessible. One reason is the large variability in manifestations of CP. To facilitate the development of tailored treatment approaches, phenotypes of CP must be identified. In this study, we aim to identify subgroups in patients with CP based on several aspects of self-reported health. Patients and Methods A latent class analysis (LCA) was carried out in retrospective data from 411 patients with CP of different origins. All patients experienced severe physical and psychosocial consequences and were therefore undergoing multimodal inpatient pain treatment. Self-reported measures of pain (visual analogue scales for pain intensity, frequency, and impairment; Pain Perception Scale), emotional distress (Patient Health Questionnaire, PHQ-9; Generalized Anxiety Disorder Scale, GAD-7) and physical health (Short Form Health Survey; SF-8) were collected immediately after admission and before discharge. Instruments assessed at admission were used as input to the LCA. Resulting classes were compared in terms of patient characteristics and treatment outcome. Results A model with four latent classes demonstrated the best model fit and interpretability. Classes 1 to 4 included patients with high (54.7%), extreme (17.0%), moderate (15.6%), and low (12.7%) pain burden, respectively. Patients in class 4 showed high levels of emotional distress, whereas emotional distress in the other classes corresponded to the levels of pain burden. While pain as well as physical and mental health improved in class 1, only the levels of depression and anxiety improved in patients in the other groups during multimodal treatment. Conclusion The specific needs of these subgroups should be taken into account when developing individualized treatment programs. However, the retrospective design limits the significance of the results and replication in prospective studies is desirable.
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Affiliation(s)
- Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gregor Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan van Bebber
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Hofmann
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA
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Do Knee Pain Phenotypes Have Different Risks of Total Knee Replacement? J Clin Med 2020; 9:jcm9030632. [PMID: 32120890 PMCID: PMC7141124 DOI: 10.3390/jcm9030632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/13/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023] Open
Abstract
Pain is the main impetus for osteoarthritis (OA) patients to seek healthcare including joint replacement. The pain experience in OA is heterogeneous and affected by factors across multiple domains—peripheral, psychological, and neurological. This indicates the existence of homogenous subgroups/phenotypes within OA patients with pain. We recently identified three pain phenotypes using a wide spectrum of pain-related factors, including structural damage on magnetic resonance imaging (MRI), emotional problems, number of painful sites, sex, body mass index, education level and comorbidities (i.e., Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%); Class 2: low prevalence of emotional problems and high prevalence of structural damage (20%); Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%)). This study was to examine whether the total knee replacement (TKR) risk over 12 years was different among these three pain phenotypes. Data on 963 participants (mean age 62.8 ± 7.4 years) from a population-based cohort study were utilised. Data on socio-demographic, psychological and comorbidities were collected. MRI of the right knee structural pathology was performed. TKR history was ascertained by linking to the Australian Orthopedic Association National Joint Replacement Registry. Latent class analysis and the Cox proportional hazards model were applied for the analysis. During the follow-up period, 41 right and 44 left TKRs in 67 participants were identified. In multivariable analyses, participants in Class 1 and 2 had a higher risk of having a TKR (Class 1 vs. Class 3, HR (hazard ratio) 4.81, 95%CI (confidence interval) 2.33–9.93; Class 2 vs. Class 3, HR 9.23, 95%CI 4.66–18.30). These associations were stronger in the imaged right knee but were also significant in the left knee. Participants within distinct pain phenotypes have different risks of TKR, suggesting that the identified phenotypes reflect distinct clinical subgroups with different prognoses. The risk for TKR was higher in Class 1 than that in Class 3, suggesting that pain/emotional status is a stronger driver for TKR than structural damage, and that selecting patients for TKR needs to be optimized in clinical practice.
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Carlesso LC, Neogi T. Understanding the Complexity of Pain in Osteoarthritis Through the Use of Pain Phenotyping: Current Evidence. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00144-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Munugoda IP, Pan F, Wills K, Mattap SM, Cicuttini F, Graves SE, Lorimer M, Jones G, Callisaya ML, Aitken D. Identifying subgroups of community-dwelling older adults and their prospective associations with long-term knee osteoarthritis outcomes. Clin Rheumatol 2020; 39:1429-1437. [PMID: 31912407 DOI: 10.1007/s10067-019-04920-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/21/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To identify subgroups of community-dwelling older adults and to assess their longitudinal associations with long-term osteoarthritis (OA) outcomes. METHODS 1046 older adults aged 50-80 years were studied. At baseline, body mass index (BMI), pedometer-measured ambulatory activity (AA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) determined knee pain and information on comorbidities were obtained. Tibial cartilage volume and bone-marrow lesions (BMLs) were assessed using MRI at baseline and 10 years and total knee replacements (TKR) by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Latent class analysis was used to determine participant subgroups, considering baseline BMI, AA, pain and comorbidities, and linear mixed-effects or log-binomial models were used to assess the associations. RESULTS Three subgroups/classes were identified: subgroup 1 (43%): Normal/overweight participants with higher AA, lower pain and lower comorbidities; subgroup 2 (32%): Overweight participants with lower AA, mild pain and higher comorbidities; subgroup 3 (25%): Obese participants with lower AA, mild pain and higher comorbidities. Subgroup 3 had greater cartilage volume loss (β - 60.56 mm3, 95% CI - 105.91, - 15.21) and a higher risk of TKR (RR 3.19, 95% CI 1.75, 5.81), compared to subgroup 1. Subgroup 2 was not associated with cartilage volume change (β 13.06 mm3, 95% CI - 30.87, 57.00) or risk of TKR (RR 1.16, 95% CI 0.56, 2.36), compared to subgroup 1. Subgroup membership was not associated with worsening BMLs. CONCLUSIONS Our findings suggest the existence of homogeneous subgroups of participants and support the utility of identifying patterns of characteristics/risk factors that may cluster together and using them to identify subgroups of people who may be at a higher risk of developing and/or progressing OA. Key Points • Complex interplay among characteristics/factors leads to conflicting evidence between ambulatory activity and knee osteoarthritis. • Distinct subgroups are identifiable based on ambulatory activity, body mass index, knee pain, and comorbidities. • Identifying subgroups can be used to determine those who are at risk of developing/progressing osteoarthritis.
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Affiliation(s)
- Ishanka P Munugoda
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Siti M Mattap
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Pan F, Jones G. Clinical Perspective on Pain and Pain Phenotypes in Osteoarthritis. Curr Rheumatol Rep 2018; 20:79. [DOI: 10.1007/s11926-018-0796-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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