Contribution of central and peripheral risk factors to prevalence, incidence and progression of knee pain: a community-based cohort study

A Sarmanova,G.S Fernandes,H Richardson,A.M Valdes,D.A Walsh,W Zhang,M Doherty

doi:10.1016/j.joca.2018.07.013

A Sarmanova, G.S Fernandes + Show 5 more

Open Access

https://doi.org/10.1016/j.joca.2018.07.013

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Abstract

SummaryAimTo explore risk factors that may influence knee pain (KP) through central or peripheral mechanisms.MethodsA questionnaire-based prospective community cohort study with KP defined as pain in or around a knee on most days for at least a month. Baseline prevalence, and one year incidence and progression (KP worsening) were examined. Central (e.g., Pain Catastrophizing Scale (PCS)) and peripheral (e.g., significant injury) risk factors were examined. Adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression. Proportional risk contribution (PRC) was estimated using receiver-operator-characteristic (ROC) analysis.ResultsOf 9506 baseline participants, 4288 (45%) had KP (men 1826; women, 2462). KP incidence was 12% (men 11%, women 13%), and KP progression 19% (men 16%, women 21%) at one year. While both central and peripheral factors contributed to prevalence, central factors contributed more to progression, and peripheral factors more to incidence of KP. For example, although PCS (OR 2.06, 95% CI 1.88–2.25) and injury (5.62, 4.92–6.42) associated with KP prevalence, PCS associated with progression (2.27, 1.83–2.83) but not incidence (1.14, 0.86–1.52), whereas injury more strongly associated with incidence (69.27, 24.15–198.7) than progression (2.52, 1.48–4.30). The PRC of central and peripheral factors were 19% and 23% for prevalence, 14% and 29% for incidence, and 29% and 5% for progression, respectively.ConclusionsBoth central and peripheral risk factors influence KP but relative contributions may differ in terms of development (mainly peripheral) and progression (mainly central). Further study of such relative contributions may inform primary and secondary prevention strategies.

Highlights

The contribution from peripheral factors to knee pain (KP) worsening was much smaller (PRC 1⁄4 5%) than that from central factors (PRC 1⁄4 29%) (Fig. 1). This is the first community-based cohort study to investigate the contribution of central and peripheral risk factors associated with KP prevalence, incidence and progression
The main findings are[1]: both central and peripheral risk factors associated with prevalence of KP2; peripheral risk factors such as knee injury contributed more to incidence of KP; and[3] central risk factors such as Pain Catastrophizing Scale (PCS) contributed more to KP progression
We examined central (e.g., widespread pain (WSP), anxiety, depression, catastrophizing), peripheral and other risk factors and confirm that many of these associate with KP (Table II)

Summary

Introduction

25% of people aged over 55 have chronic knee pain (KP)[1]. KP is multifactorial and may be caused predominantly by peripheral risk factors such as knee osteoarthritis (OA)[2], or by alteration in central pain modulatory pathways as in fibromyalgia[3]. KP is a clinical malady related to but not fully explained by knee OA in middle-aged and older adults4e6. This may explain in part the common discordance between KP and structural knee OA7. Risk factors for KP and knee OA may differ, and consideration of both peripheral and central risk factors is important in clinical assessment and to inform the management plan[8]

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