We might be getting it wrong if we do not consider genetics in osteoarthritis and back pain: insights from twin studies

Abstract

Purpose: To investigate the potential risk factors associated with the development of osteoarthritis/low back pain, after considering genetics as a potential confounder. Methods: An extensive body of research, including systematic reviews of non-twin studies and randomised control trials involving twins, was conducted by our group. Our study findings were compared to systematic reviews conducted under the Cochrane framework. Results: Our systematic review of non-twin studies has shown that depression is a risk factor for back pain (pooled OR = 1.59; 95%CI: 1.26 to 2.01), however the risk is significantly attenuated and disappears when the effects of genetics on the depression-low back pain relationship is considered in twin studies (OR = 0.92; 95%CI: 0.42 to 2.05). Not surprisingly, the results of systematic reviews conducted under the Cochrane framework investigating the effects of anti-depressants for back pain have shown no effects (pooled effect = -0.04; 95%CI:−0.25 to 0.17). Our research using twins has shown that the risk of developing back pain in people with poor sleep quality is more pronounced when the effects of genetics on the sleep-low back pain relationship is considered (OR = 2.2; 95%CI:1.2 to 3.7) as opposed to when it is not (OR = 2.0; 95%CI:1.6 to 2.5). Conclusions: Our research has shown that when a more robust and precise analysis is undertaken to consider the confounding effects of genetics, other potential modifiable risk factors associated with osteoarthritis and back pain may emerge and be more pronounced. Therefore, further research should take into consideration people's genetic predisposition to the development of osteoarthritis/back pain or the related risk factors. Ultimately, a more precise identification of the factors that prevent or cause recurrent osteoarthritis and low back pain will be a significant breakthrough, and will inform the design of effective prevention and treatment strategies. This will have significant impact to the individual and society.