Abstract
ObjectiveTo identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future ‘stratification tool’ for OA development or progression.DesignSystematic review and meta-analysis.MethodsAn electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990–February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and hip OA were included. Where data and study heterogeneity permitted, meta-analyses presenting mean difference (MD) and ORs with corresponding 95% CIs were undertaken. Where this was not possible, a narrative analysis was undertaken. The Downs & Black tool assessed methodological quality of selected studies before data extraction. Pooled analysis outcomes were assessed and reported using the Grading of Reccomendation, Assessment, Development and Evaluation (GRADE) approach.Results82 studies (41 810 participants) were included. On meta-analysis: there was moderate quality evidence that knee OA pain was associated with factors including: Kellgren and Lawrence≥2 (MD: 2.04, 95% CI 1.48 to 2.81; p<0.01), increasing age (MD: 1.46, 95% CI 0.26 to 2.66; p=0.02) and whole-organ MRI scoring method (WORMS) knee effusion score ≥1 (OR: 1.35, 95% CI 0.99 to 1.83; p=0.05). On narrative analysis: knee OA pain was associated with factors including WORMS meniscal damage ≥1 (OR: 1.83). Predictors of joint pain in hip OA were large acetabular bone marrow lesions (BML; OR: 5.23), chronic widespread pain (OR: 5.02) and large hip BMLs (OR: 4.43).ConclusionsOur study identified risk factors for clinical pain in OA by imaging measures that can assist in predicting and stratifying people with knee/hip OA. A ‘stratification tool’ combining verified risk factors that we have identified would allow selective stratification based on pain and structural outcomes in OA.PROSPERO registration numberCRD42018117643.
Highlights
It has been reported that over 30.8 million US adults suffer from osteoarthritis (OA).[1]
Knee OA Narrative review Findings from the narrative analysis found the following were predictors for worsening joint pain: KL3 or 4 in women (OR: 11.3; 95% CI 6.2 to 20.4), a whole-organ MRI scoring method (WORMS) lateral meniscal cyst (MC) score of 1 (OR: 4.3; 95% CI 1.2 to 15.4), presence of chronic widespread pain (CWP; or in women (OR): 3.2; 95% CI 1.9 to 5.3), increase of ≥2 in WORMS bone marrow lesions (BML)
We found that the following were the highest predictors of worsening function in people with knee OA: Kellgren and Lawrence (KL) of
Summary
►► This study has been reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting checklist. There remains a need to identify risk factors for pain and structural damage in OA so that potential interventions can be studied in a timely manner. The purpose of this systematic review was to identify risk factors for pain, worsening function and structural damage that can predict knee/hip OA development and progression. By identifying risk factors for OA pain and structural damage, tools for stratifying specific disease groups could be developed in the future. The 27-item randomised controlled trial (RCT) version was used for RCTs while the 18-item non-R CT version was used for non-R CT designs (online supplementary file 2) Both 18-item and 27-item tools have been demonstrated to be valid and reliable tools to assess RCT and non-R CT papers.[14] Critical appraisal was performed by one reviewer (SS) and verified by a second (KT).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
