Pain Trajectories in Knee Osteoarthritis-A Systematic Review and Best Evidence Synthesis on Pain Predictors.

Davide Previtali,Christian Candrian,Giuseppe Filardo,Stefano Zaffagnini,Angelo Boffa,Giorgio Di Laura Frattura,Luca Andriolo

doi:10.3390/jcm9092828

Abstract

Different profiles of pain progression have been reported in patients with knee osteoarthritis (OA), but the determinants of this heterogeneity are still to be sought. The aim of this systematic review was to analyze all studies providing information about knee OA pain trajectories to delineate, according to patients’ characteristics, an evidence-based evolution pattern of this disabling disease, which is key for a more personalized and effective management of knee OA. A literature search was performed on PubMed, Web of Science, Cochrane Library, and grey literature databases. The Cochrane Collaboration’s tool for assessing risk of bias was used, and a best-evidence synthesis was performed to define the predictors of pain evolution. Seven articles on 7747 patients affected by knee OA (mainly early/moderate) were included. Daily knee OA pain trajectories were unstable in almost half of the patients. In the mid-term, knee OA had a steady pain trajectory in 85% of the patients, 8% experienced pain reduction, while 7% experienced pain worsening. Low education, comorbidities, and depression were patient-related predictors of severe/worsening knee OA pain. Conversely, age, alcohol, smoking, pain coping strategies, and medications were unrelated to pain evolution. Conflicting/no evidence was found for all joint-related factors, such as baseline radiographic severity.

Highlights

Knee osteoarthritis (OA) is, according to the World Health Organization (WHO), the eleventh leading cause of long-term disability worldwide [1]
A meta-analysis of proportions was attempted to quantify the prevalence of the different pain trajectories in patients with knee OA, as planned
Of the remaining 263, 249 were excluded according to the eligibility criteria, being studies without information on pain evolution or without discrete data for patients with knee OA, studies on patients treated with total knee arthroplasty (TKA) or other surgical and non-surgical treatments, expert opinions, reviews, systematic reviews and meta-analyses, or preclinical or ex vivo studies

Summary

Introduction

Knee osteoarthritis (OA) is, according to the World Health Organization (WHO), the eleventh leading cause of long-term disability worldwide [1]. Each strategy is applied to the broad category of OA patients, without being able to distinguish from patients with different symptom patterns and evolution. This impairs the possibility for a personalized approach to effectively manage OA patients. In this light, the identification of specific OA patterns could help to better target rehabilitation protocols and conservative procedures, allowing to postpone the need for more invasive surgeries in responsive patients, while leaving surgery as an option for patients where less benefit is expected from less invasive strategies

Results

Discussion

Conclusion