Background/Purpose:

Osteoarthritis (OA) is the most common form of arthritis and affects nearly 30 million Americans. Chronic pain is the major symptom in OA and patients often also live with other comorbidities, most notably insomnia and depression. Female sex has been shown to be an important risk factor for development of OA but few studies have examined its association with other comorbidities in persons with OA. The purpose of this study was to examine associations between sex and pain, insomnia and depression in older adults with OA. We hypothesized that the strength of any sex-related association would be increased with increasing numbers of comorbidities.

Methods:

8,057 participants aged 60+ with an electronic medical record OA diagnosis were mailed a screening questionnaire which asked about their pain, sleep disturbance, and depressive symptoms. Pain intensity, persistence, and interference were assessed by the Graded Chronic Pain Scale (GCPS). Insomnia severity was measured by the Insomnia Severity Index (ISI), and daytime dysfunction related to sleep was assessed by asking if participants had residual problems related to trouble sleeping, such as tiredness or poor concentration. Depression was measured by the Patient Health Questionnaire depression scale (PHQ-8). Cut points were determined based on upper tertiles of each comorbidity severity (GCPS ≥ 2, ISI ≥ 10, daytime dysfunction ≥ 4, and PHQ ≥ 6) to ensure equivalent comparisons. The Charlson Comorbidity Index was calculated from medical records of participants who had granted research access. Logistic regression analysis was conducted to examine the associations between sex and OA comorbidities.

Results:

3,321 participants completed the questionnaire. Overall, they were older (Mean = 72 yrs) and highly educated, with 81.6% completing at least community college. The majority were female (66.6%) and about 80% had one or more daytime problems related to trouble sleeping. The top four problems were trouble concentrating (13.8%), memory problems (13.7%), tiredness (12.5%), and upset stomach (11.3%). Females had a higher odds ratio of having pain and insomnia simultaneously than males (OR = 1.66, 95% CI = 1.37, 2.02), controlling for age, education, and comorbidity index. Similarly, females tended to have higher rates of pain with depression than males (OR = 1.63, 95% CI = 1.35, 1.99), and higher rates of comorbid insomnia and depression (OR = 1.57, 95% CI = 1.30, 1.88). As predicted, the association with sex appeared to be the strongest when considering the presence of the three comorbidities together (OR = 1.73, 95% CI = 1.40, 2.15), although the strength of association was similar.  Females also had a higher odds ratio of daytime dysfunction related to sleep than males (OR = 1.59, 95% CI = 1.35, 1.87).

Conclusion:

Sex differences are associated with comorbid pain, insomnia, and depression in older adults with OA. Specifically, females are more likely to suffer these comorbid symptoms compared to males. In addition, the strength of this association increases with increasing comorbidity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-between-sex-differences-pain-insomnia-and-depression-in-older-adults-with-osteoarthritis-a-cross-sectional-study/