Specific manifestations of knee osteoarthritis predict depression and anxiety years in the future: Vancouver Longitudinal Study of Early Knee Osteoarthritis

Eric C Sayre,Savvas Nicolaou,Anona Thorne,Jolanda Cibere,Ali Guermazi,John M Esdaile,Joel Singer,Jacek A Kopec,Hubert Wong

doi:10.1186/s12891-020-03496-8

Eric C Sayre, Savvas Nicolaou + Show 7 more

Open Access

https://doi.org/10.1186/s12891-020-03496-8

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Abstract

BackgroundTo evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models.MethodsA population-based cohort (n = 122) with knee pain, aged 40–79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike’s information criterion.ResultsBaseline depression model: sex (female OR = 0.27; 0.10, 0.76) and KL grade (KL 1 OR = 4.21; 1.31, 13.48). Three-year depression model: KL grade (KL 1 OR = 18.92; 1.73, 206.25). Seven-year depression model: WOMAC stiffness ≥25 (OR = 3.49; 1.02, 11.94) and flexion contracture ≥1 degree (OR = 0.23; 0.07, 0.81). Baseline anxiety model: knee swelling (OR = 4.11; 1.51, 11.13) and age (50–59 vs. 40–49 OR = 0.31 [0.11, 0.85]; 60–69 OR = 0.07 [0.01, 0.42]). Three-year anxiety model: WOMAC stiffness ≥25 (OR = 5.80; 1.23, 27.29) and KL grade (KL 1 OR = 6.25; 1.04, 37.65). Seven-year anxiety model: sex (female OR = 2.71; 0.87, 8.46).ConclusionSpecific knee OA-related manifestations predict depression and anxiety cross-sectionally, 3 years in the future, and for depression, 7 years in the future. This information may prove useful to clinicians in helping to identify patients most at risk of present or future depression and anxiety, thus facilitating preemptive discussions that may help counter that risk.

Highlights

To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models
Subjects were excluded both at baseline and/or at follow-up if any of the following applied, as described in Cibere et al [20]: inflammatory arthritis, knee arthroplasty, knee injury or surgery within the past 6 months, knee pain referred from hips or back, or unable to undergo Magnetic resonance imaging (MRI)
The 3.2-year depression model (AUC 0.742; 95% confidence intervals (CIs) = 0.622, 0.862) included KL grade

Summary

Introduction

To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models. Osteoarthritis (OA) is a highly prevalent, disabling and costly condition. In the province of British Columbia, Canada, 11% of the adult (18+) population were reported to have OA in a study evaluating administrative data [1]. Symptomatic radiographic knee OA affects 9.5% of elderly adults aged 63 years and older [3]. OA is more prevalent with older age and in obese people and OA constitutes an increasing public health burden. In Canada, the total economic burden for OA, including direct and indirect costs, was estimated at $27.5 billion in 2010, and the cumulative economic burden between 2010 and 2040 is estimated to be $1.45 trillion [4]

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