Session Information
Date: Monday, October 22, 2018
Session Title: Osteoarthritis – Clinical Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Cumulative evidence suggests central sensitization contributes to a neuropathic-like phenotype in a subset of patients with knee osteoarthritis (OA). Using a variety of validated neuropathic pain (NP) questionnaires in musculoskeletal patient cohorts, factors including gender, body mass index, depression, insomnia and pain catastrophizing have been associated with neuropathic symptoms. In the current study, the modified painDetect Questionnaire (mPDQ) was administered to subjects enrolled in the Osteoarthritis Initiative (OAI), a well-established, longitudinal knee OA cohort, with the aim of further exploring the prevalence and correlates of NP specific to knee OA. A better understanding of the factors associated with NP in knee OA can help identify affected patients who may benefit from alternative treatment approaches that target NP pathways.
Methods: The mPDQ was administered to 699 subjects enrolled in the Baltimore OAI cohort during their scheduled 72-month follow up visit. Standard demographic, clinical, and radiographic data were collected as per the OAI study protocol. The presence of NP was determined using a previously defined mPDQ cut-point. Correlates of NP were evaluated through univariate analysis and logistic regression, and included factors relating to demographics, knee OA symptom severity, markers of chronic pain and pain intensity, psychological factors, functional disability, medical comorbidities and concurrent medication usage.
Results: Of the 699 subjects in the cohort, 476 were eligible for the analysis; 99 (21%) subjects were found to have NP symptoms (mPDQ score ≥ 13). Knee Injury and Osteoarthritis (KOOS) pain score, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, WOMAC physical function score, Von Korff pain score (VKP) and the Late Life Disability Instrument (LLDI) – limitation dimension were shown to be different between patients with and without NP (p< 0.01). Independent correlates (p<0.01) of NP were: WOMAC total score (OR=1.93), coping strategies – pain catastrophizing subscale (OR=1.23), VKP (OR=1.06), WOMAC physical function score (OR=1.02) and LLDI – limitation dimension (OR=0.98). Multivariate modelling found WOMAC total score (OR=2.07, p=0.018), coping strategies – pain catastrophizing subscale (OR=1.22, p=0.035) and VKP (OR=1.07, p<0.001) to be significant predictors of NP.
Conclusion: Similar to other studies, a subset of the Baltimore OAI knee OA cohort had a NP phenotype, which was associated with more pain catastrophizing and greater symptom burden. This study additionally found that a NP phenotype was associated with greater disability. Further studies are needed to determine if treatment targeted to the NP phenotype reduces knee OA symptom severity and functional impairment in affected individuals.
|
Domain |
Variable |
NP+ Median (Range) |
NP– Median (Range) |
NP+ Odds Ratio (95% CI) |
NP+ (p-value) |
|
Demographics |
Age |
63 (52-83) |
65 (51-85) |
0.98 (0.96-1.01) |
0.159 |
|
Knee OA Symptom Severity |
KOOS: Pain Score |
83.3 (18.8-100) |
91.7 (0-100) |
0.99 (0.98-1.00) |
0.014 |
|
WOMAC: Total Score |
15.35 (0-75.4) |
7 (0-76) |
1.01 (1.00-1.03) |
0.013 |
|
|
WOMAC: Pain Score |
3 (0-15) |
1 (0-20) |
1.05 (0.99-1.10) |
0.085 |
|
|
Pain Intensity |
Von Korff Pain Score |
63.33 (10-100) |
26.67 (0-100) |
1.06 (1.05-1.08) |
< 0.001** |
|
Psychological Factors |
Coping Strategies – Pain Catastrophizing Subscale |
1 (0-6) |
0 (0-6) |
1.23 (1.08-1.40) |
0.002* |
|
Center for Epidemiologic Studies Depression Scale Score |
8 (0-36) |
5.50 (0-40) |
1.03 (1.00-1.05) |
0.023 |
|
|
KOOS: Quality of Life Score |
68.8 (6.3-100) |
68.8 (0-100) |
0.99 (0.98-1.00) |
0.017 |
|
|
Functional Disability |
Late Life Disability Instrument: Frequency Dimension |
52.23 (35.23-70.61) |
53.71 (37.39-76.31) |
0.96 (0.93-1.00) |
0.046 |
|
Late Life Disability Instrument: Limitation Dimension |
68.19 (39.63-100) |
77.57 (41.54-100) |
0.98 (0.97-0.99) |
0.003* |
|
|
WOMAC: Physical Function Score |
10.1 (0-54.4) |
4.3 (0-53.1) |
1.02 (1.01-1.04) |
0.005* |
|
|
Domain |
Variable |
NP+ Frequency (%) |
NP– Frequency (%) |
NP+ Odds Ratio (95% CI) |
NP+ (p-value) |
|
Demographics |
Gender (female) |
68 (68.7) |
218 (57.8) |
1.6 (1.00-2.56) |
0.051 |
|
Knee OA Symptom Severity |
WOMAC: Total Score, (≥ 17) |
48 (48.5) |
172 (36.1) |
1.93 (1.23-3.03) |
0.004* |
|
Psychological Factors |
Center for Epidemiologic Studies Depression Scale Score (≥ 16) |
26 (26.3) |
84 (17.7) |
1.96 (1.15-3.32) |
0.013 |
Table 1: Variables associated with neuropathic pain. *p<0.01; **p<0.001
To cite this abstract in AMA style:
Bernick J, Hopman WM, Hochberg MC, Hochman J. Correlates of Neuropathic Pain in Knee Osteoarthritis: The Modified Paindetect Questionnaire and the Osteoarthritis Initiative [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/correlates-of-neuropathic-pain-in-knee-osteoarthritis-the-modified-paindetect-questionnaire-and-the-osteoarthritis-initiative/. Accessed January 25, 2021.« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/correlates-of-neuropathic-pain-in-knee-osteoarthritis-the-modified-paindetect-questionnaire-and-the-osteoarthritis-initiative/