The Association of Diabetes with Knee Pain Severity and Distribution in People with Knee Osteoarthritis using Data from the Osteoarthritis Initiative

Aqeel M Alenazi,Jason Rucker,Mohammed M Alshehri,Patricia M Kluding,Shaima Alothman,Neil A Segal,Saad M Bindawas,Neena Sharma,Bader A Alqahtani

doi:10.1038/s41598-020-60989-1

Abstract

Limited research has examined the association between diabetes mellitus (DM) and knee pain in people with osteoarthritis (OA). Therefore, this study aimed at examining the association between DM and knee pain severity, and to explore the association between DM and knee pain distribution (unilateral or bilateral versus no pain) in subjects with knee OA. This is a cross-sectional analysis of the baseline visit of individuals who were enrolled in the Osteoarthritis Initiative. Data of participants with knee OA were used for this analysis (n = 1319), and grouped into subjects with both knee OA and DM (n = 148) or knee OA only without DM (n = 1171). Pain severity was measured using a numeric rating scale from 0 to 10 over the past 7 and 30 days for each knee, and the more symptomatic knee with higher pain severity was chosen for analysis. DM was significantly associated with increased knee pain severity over 7 days (B 0.68; 95% CI 0.25–1.11) and over 30 days (B 0.59; 95% CI 0.17–1.01) after adjustments for all covariates, including age, gender, BMI, race, depression symptoms, composite OA score, use of pain medications, and knee injections. Multinomial regression showed that participants with knee OA and DM had 2.45 (95% CI 1.07–5.61) to 2.55 (95% CI 1.12–5.79) times higher likelihood of having unilateral and bilateral knee pain than those without DM and without knee pain. This study found that DM was associated with higher pain severity and unilateral and bilateral knee pain distribution.

Highlights

Knee Osteoarthritis (OA) is the most common cause of chronic pain affecting approximately 14% of the general population[1]
body mass index (BMI) was significantly higher in knee OA and diabetes mellitus (DM) group compared to knee OA only group
Model 2 shows that DM was significantly associated with increased knee pain severity over 7 days (B 0.68; 95% confidence interval (CI) 0.25–1.11) and over 30 days (B 0.59; 95% CI 0.17–1.01) after adjustments for age, gender, race, BMI, depression symptoms, composite OA score, pain medications, and knee injections

Summary

Introduction

Knee Osteoarthritis (OA) is the most common cause of chronic pain affecting approximately 14% of the general population[1]. Previous research has shown that the number of comorbidities is associated with higher knee pain[4] Among these comorbidities, metabolic syndrome, including diabetes mellitus (DM), hypertension, dyslipidemia and obesity have been related to increased pain severity among individuals with OA of knee joint[5,6]. Knee OA progression and severity have been linked to higher body mass index[18,19,20], www.nature.com/scientificreports prior research has found an association between obesity and OA in non-weight bearing joints that may suggest a systemic pathway[21,22] Examining associated comorbidities such as DM in people with OA is necessary to identify an increased risk of pain and multiple joint distributions, as well as to develop preventative interventions. We hypothesized that DM would be associated with a higher pain severity and more widespread distribution (e.g. bilateral knee pain) in subjects with knee OA

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