Background/Purpose: Widespread pain (WSP) may be present in individuals for numerous reasons, and its presence may affect the degree to which people engage in activities. How the presence of WSP affects the risk of developing knee pain or knee osteoarthritis (OA) is unknown and could enhance the understanding of pain mechanisms in OA. For example, people with WSP may have a lower risk of developing knee OA due to less frequent loading of the knee or they may have an increased risk due to maladaptive movement patterns. The purpose of this study was to determine if WSP is associated with future consistent frequent knee pain (CFKP) or radiographic OA (ROA) two years later.

Methods: Subjects from the Multicenter Osteoarthritis (MOST) study, a NIH-funded longitudinal prospective cohort of older adults with or at risk of knee OA were assessed at the 60-month (baseline) and 84-month (follow up) visits. WSP was defined at baseline as pain on both sides of the body, above and below the waist, and axial pain, using a standard homunculus, with the exception that the knees were not included in defining WSP. Incident CFKP was defined as reporting knee pain on most days during the past month at the 84-month telephone interview and again during the clinic visit that occurred on average one month later among participants who were free of CFKP at 60 months. Incident ROA was defined as presence of Kellgren & Lawrence grade 2 or knee replacement of either knee at follow-up among those who were free of ROA (and knee replacement) at baseline. We assessed the relation of WSP to risk of CFKP and ROA respectively, using multinomial regression adjusting for baseline age, sex, BMI, comorbidities, physical activity and clinic site; the model was also adjusted for depressive symptoms, pain catastrophizing, fatigue and ROA when CFKP was the outcome, and for WOMAC pain severity when ROA was the outcome.

Results:

There were 923 eligible subjects for analysis of incident CFKP (mean age (SD); 67.4 (7.5); BMI 30.0 (5.6) kg/m², 56% women, 19% WSP), and 675 for incident ROA (age 65.6 (7.4); BMI 28.9 (4.7) kg/m², 60% women, 30% WSP). Baseline presence of WSP was associated with a non-significant 59% increased risk of incident CFKP compared with those without WSP (adjusted OR 1.59, 95% CI 0.94-2.68, p=0.08). Baseline WSP was associated with a non-significant 14% lower risk of incident ROA, (adjusted OR 0.86, 95% CI 0.46-1.63, p=0.65). WSP was associated with a non-significant 65% increased risk of unilateral CFKP vs. no CFKP (adjusted OR 1.65, 95% CI 0.92-2.96, p=0.09) and with a non-significant 35% increased risk of bilateral CFKP vs. no CFKP (adjusted OR 1.35, 95% CI 0.49-3.73, p=0.56). For both incident unilateral and bilateral ROA vs. no ROA, WSP was not statistically significantly associated; unilateral ROA had 1% lower risk (adjusted OR 0.99, 95% CI 0.51-1.92, p=0.97), and bilateral ROA had 77% lower risk (adjusted OR 0.23, 95% CI 0.02-2.53, p=0.23).

Conclusion: WSP was not significantly associated with either incident CFKP or ROA. Development of knee pain and ROA does not appear to be influenced by underlying WSP, suggesting that screening for or managing WSP will not have a meaningful influence on the development of knee pain or ROA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effect-of-widespread-pain-on-incident-knee-pain-and-knee-osteoarthritis-the-multicenter-osteoarthritis-most-study/