Higher WOMAC Pain Scores Research Articles

Is there a relationship between venous insufficiency and knee osteoarthritis?

This study aims to evaluate whether there is a relationship between venous insufficiency (VI) and knee osteoarthritis (OA). Between February 2012 and May 2013, a total of 206 knees of 103 participants (14 males, 89 females; mean age 48.6±8.6 years; range, 30 to 69 years) were enrolled. The study group included 59 patients who were diagnosed with knee OA and the control group included 44 healthy volunteers without any complaint in their knee joints. Demographic and clinical characteristics of all participants were recorded. Venous system of the lower extremities was evaluated by Doppler ultrasonography. All knees were evaluated using conventional radiography based on the Kellgren-Lawrence (K&L) grading system and ultrasonography. Pain severity was evaluated using Likert pain scale and functioning was evaluated using Western Ontorio and McMaster Universities Osteoarthritis Index (WOMAC). Venous insufficiency was detected in 40.6% of the OA group and 15.9% of the control group (p=0.007). There was no statistically significant difference in the cartilage thicknesses and K&L grading regarding the presence of VI (p>0.05); however, the percentage of the radiographic medial tibial sclerosis was higher in patients with VI (60%) in the OA group (p>0.05). The WOMAC total scores were similar in both groups, while the WOMAC pain scores were higher in the patients with deep VI (p>0.05). Increased radiographic medial tibial sclerosis and higher WOMAC pain scores in patients with venous involvement in OA may lead to the hypothesis that venous system pathologies can affect the intraosseous microenvironment of the bone, resulting in pain and early subchondral bone involvement, consequently presenting as subchondral sclerosis.

Tossing and turning with degenerative arthropathy: an assessment of poor sleep quality in knee osteoarthritis.

ObjectivesTo determine the frequency and predictors of sleep abnormalities among patients with knee osteoarthritis (OA) in Nigeria.Material and methodsA multi-centre, hospital-based, cross-sectional study, involving 250 knee OA patients. Consenting patients 18 years and above, who satisfied the American College of Rheumatology (ACR) criteria for knee OA were recruited from five Nigerian tertiary centres over 3 months. An interviewer-administered questionnaire was used to collect demographic and relevant clinical information. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality with scores ≥ 5 indicating poor sleep. Other variables assessed were pain, depression, functional class and family functioning. Data were summarized using appropriate measures of central tendency and dispersion. Multiple logistic regression analysis was done to identify predictors of poor sleep. Analysis was done using SPSS version 21.0 with p < 0.05 considered significant. Study approval was obtained from the ethical committees of each of the study sites.ResultsParticipants included 209 females (83.6%) with mean age 59.9 ±10.6 years. One hundred and forty-one participants (56.4%) had PSQI scores ≥ 5 (poor sleep). This was significantly associated with depression (p < 0.001), level of education (p = 0.001), higher pain scores (p < 0.001), body mass index (p = 0.040), medial knee OA (p = 0.032) and patello-femoral OA (p = 0.002). Higher level of education, worse depression scores and higher WOMAC pain scores were the best predictors of poor sleep quality.ConclusionSleep quality was poor in over half of our knee OA patients and best predicted by depression, pain and level of education. Regular sleep quality assessment for knee OA patients is recommended.

Significant pain variability in persons with, or at high risk of, knee osteoarthritis: preliminary investigation based on secondary analysis of cohort data

BackgroundWhile knee osteoarthritis (OA) is characterised as a slowly progressive disease, acute flares, episodes of severe pain, and substantial fluctuations in pain intensity appear to be part of the natural history for some patients. We sought to estimate what proportion of symptomatic community-dwelling adults might be affected, and to identify patient and problem characteristics associated with higher risk of such variability in pain.MethodsWe analysed data collected at baseline, 18, 36, 54, and 72 month follow-up of a prospective cohort of symptomatic adults aged over 50 years with current/recent knee pain. At each time point we estimated the proportion of participants reporting 'significant pain variability' (defined as worst pain intensity in the past 6 months ≥5/10 and ≥2 points higher than average pain intensity during the same 6-month period). The associations between significant pain variability and demographic, socioeconomic, lifestyle, clinical, radiographic, and healthcare utilisation factors measured at baseline were estimated by adjusted odds ratios and 95% confidence intervals (aOR; 95%CI) from multivariable discrete-time survival analysis.ResultsSeven hundred and nineteen participants were included in the final analysis. At each time point, 23–32% of participants were classed as reporting significant pain variability. Associated factors included: younger age (aOR (per year): 0.96; 95% CI 0.94, 0.97), higher BMI (per kg/m2:1.03; 1.01, 1.06), higher WOMAC Pain score (per unit: 1.06; 1.03, 1.10), longer time since onset (e.g. 1–5 years vs < 1 year: 1.79; 1.16, 2.75) and morning stiffness (≤30 min vs none: 1.43; 1.10, 1.85). The models accounting for multiple periods of significant symptom variability found similar associations.ConclusionsOur findings are consistent with studies showing that, for some patients OA symptoms are significantly variable over time. Future prospective studies on the nature and frequency of flare ups are needed to help determine triggers and their underlying pathophysiology in order to suggest new avenues for effective episode management of OA to complement long-term behaviour change.

Associations among meniscal damage, meniscal symptoms and knee pain severity.

Meniscal tears occur frequently in patients with knee osteoarthritis (OA). The aim of our study was to determine whether meniscal damage identified on magnetic resonance imaging (MRI) is associated with the severity of knee pain or the frequency of meniscal symptoms in patients with knee OA. We performed a cross-sectional study using data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial. We characterized meniscal damage hierarchically as: root tear; maceration; long and short complex or horizontal tears; and simple tears. Subjects completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale and a survey of frequency of meniscal symptoms. We used multivariable general linear models to assess the relationships between meniscal damage and 1) pain severity; and 2) meniscal symptoms, after adjusting for demographic and radiographic features. In further analysis root tear was considered as a binary variable. Analysis included 227 knees. Root tears were present in 19%, maceration in 14%, long complex or horizontal tears in 22%, short complex or horizontal tears in 30%, and simple tears in 14%. Root tears were associated with higher WOMAC pain scores. The adjusted mean WOMAC pain score was 45.2 (standard error (SE) 2.7) for those with root tear and 38.7 (SE 1.2) for subjects without root tear (P=0.03). We did not find statistically significant associations between meniscal morphology and frequency of meniscal symptoms. Root tears were associated with greater pain than meniscal tears or maceration. We did not find a relationship between meniscal damage and meniscal symptoms.

Exploring the relationship between disease-related pain and cortisol levels in women with osteoarthritis

To determine if (1) Osteoarthritis (OA)-related pain is associated with the diurnal cortisol pattern and cortisol levels; (2) the diurnal pattern of cortisol varies with severity of OA pain and (3) the association between OA pain and cortisol is mediated by daily experience variables (DEV). In a community-based study of changes in regional and widespread pain among women with OA, participants (n=31) completed daily diaries and collected three saliva samples daily for 7 days. Severity of OA-related pain was assessed by the validated Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Multilevel regression analyses estimated associations between OA pain and diurnal cortisol levels and slopes, controlling for body mass index (BMI), medication use, time and day. Mediation analyses examined DEV as potential mediators of the association between OA pain and cortisol. The mean age was 57 years and average BMI 31kg/m2. Mean WOMAC pain subscale score was 8.8. Women with higher WOMAC pain scores had higher cortisol throughout the day. The estimated association of WOMAC with cortisol [β 0.083(0.02, 0.15) P=0.009] represents a ∼9% increase in cortisol for every unit increase in WOMAC pain score. Women with WOMAC pain scores ≥9 had higher cortisol levels than those with scores <9. Examination of DEV revealed no significant mediated associations between these relationships at the daily level. In women with OA, disease-related pain is positively associated with cortisol production, particularly with greater pain severity. Future studies should explore biologic mediating variables between OA pain and cortisol.

Serum biochemical markers of joint metabolism and inflammation in relation to clinical symptoms and physical function in adults with symptomatic knee osteoarthritis

Purpose: To date, the majority of osteoarthritis (OA) biomarker research has examined associations between biomarker levels and radiographic parameters. While radiography provides information on the structural burden of disease, it is insensitive to small changes in cartilage metabolism and does not always correlate with the most significant clinical expression in OA, pain. The purpose of this study was to investigate the associations between joint metabolism and inflammation with pain and physical function in adults with painful knee OA. This is in support of qualifying burden of disease biomarkers with clinical variables to support the study, management, and understanding of disease pathology in OA. Methods: The study used baseline data from 54 adults with knee OA participating in a nutrition intervention study. The 100 mm visual analogue scale version of theWestern Ontario andMcMaster University Osteoarthritis Index (WOMAC) was used to assess pain, stiffness, and physical disability. A minimumWOMAC pain score of 125 was used as a cutoff for participant inclusion. Physical functionwas assessed with a 6minute walk test (:6MWT) and stair climb task (SCT). Serum concentrations of biomarkers included measures of cartilage degradation (cartilage oligomeric matrix protein [COMP]), cartilage synthesis (typeIIA collagen N-propeptide [PIIANP]), synovial metabolism (hyaluronic acid [HA]), cartilage degrading enzyme levels (matrix metalloproteinase 3 [MMP-3]), and inflammation (C-reactive protein [CRP]). COMP, PIIANP, HA, and MMP-3 were measured by enzyme-linked immunosorbent assay and CRP was measured by an immunoturbidimetric assay. Correlations between biomarkers and clinical variables were assessed using Spearman correlation coefficients. Results: Participants (38 females and 16 males) had a mean age of 60 11.9 years, BMI of 32.6 7.5 kg/m2, disease duration of 86.6 112.2 months, and WOMAC pain score of 193.4 94.04 mm. Higher serum MMP-3 levels were significantly associated with higher WOMAC pain scores (R 1⁄4 0.27, p 1⁄4 0.05), controlling for age and body mass index (BMI). Higher levels of serum HA were significantly associated with decreased walking distance in the :6MWT (R 1⁄4 -0.35, p 1⁄4 0.01) and longer time taken in the SCT (R 1⁄4 0.31, p 1⁄4 0.02), when controlling for age and BMI. Higher CRP levels were significantly associated with higher WOMAC physical disability score (R 1⁄4 0.34, p 1⁄4 0.01) and worse performance in the :6MWT (R1⁄4 -0.38, p1⁄4 0.005) and SCT (R1⁄4 0.44, p1⁄4 0.001) when age was controlled for, but these associations were not significant when BMI was controlled for. COMP and PIIANP were not significantly associated with any clinical variables analyzed. Conclusion: SerumMMP-3 levels were associated with pain and serum HA levels were associated with physical functioning in adults who suffer from mild to moderate pain and impaired physical functioning from knee OA. Previous studies have shown that HA and MMP-3 are related to structural knee parameters in OA. Therefore, results from this study demonstrate that serum HA and MMP-3 also have potential as qualified burden of disease biomarkers that are clinically meaningful. (Research supported by the Ontario Ministry of Agriculture, Food and Rural Affairs, project #200121).

Total Knee Replacement as a Knee Osteoarthritis Outcome: Predictors Derived from a 4-Year Long-Term Observation following a Randomized Clinical Trial Using Chondroitin Sulfate.

Objective. To predict, using clinical and qMRI data, the incidence of total knee replacement (TKR) during the long-term follow-up of knee osteoarthritis (OA) patients who formerly received chondroitin sulfate (CS) or placebo treatment. Design. A post hoc intention-to-treat analysis to evaluate the incidence of TKR was done on knee OA patients who had participated in a 12-month trial evaluating the impact of CS (800 mg/d) versus placebo for 6 months, followed by a 6-month open-phase in which all patients received CS. Additionally, the clinical and qMRI predictors of TKR were determined. Results. Thirteen TKRs were performed in the population after a 4-year follow-up. More TKRs were performed in the placebo group than in the CS group (69% vs. 31%, P = 0.150, logistic regression). The statistically significant predictors of TKRs were, at baseline, higher WOMAC pain and function scores, presence of bone marrow lesions (BMLs), and higher C-reactive protein levels. Loss of medial cartilage volume and increase in WOMAC pain and function at one-year were also predictors of TKR. Multivariate analyses revealed that baseline presence of BML and higher WOMAC pain score were independent predictors. Time to occurrence of the TKR also favored the CS group versus placebo (log-rank, P = 0.094). Conclusion. Symptoms such as knee pain and function, presence of BML, and cartilage volume loss predict the long-term occurrence of a “hard” outcome such as TKR.

Aplicação da análise de componentes principais na cinemática da marcha de idosas com osteoartrite de joelho

The applicability of gait analysis has been implemented with the introduction of the principal component analysis (PCA), a statistical data reduction technique that allows the comparison of the whole cycle between groups of individuals. Applying PCA, to compare the kinematics of the knee joint during gait, in the frontal and sagittal planes, between a group of elderly women with and without diagnosis in the initial and moderate stages of Osteoarthritis (OA). A total of 38 elderly women (69.6±8.1 years) with knee OA and 40 asymptomatic (70.3±7.7 years) participated on this study. The kinematics was obtained using the Qualisys Pro-reflex system. The OA group showed decreased gait velocity and stride length (p<0.05) and was characterized with higher WOMAC pain score. In the frontal plane, the between-group differences of the components were not significant. In the sagittal plane, three principal components explained 99.7% of the data variance. Discriminant analysis indicated that component 2 and 3 could classify correctly 71.8% of the individuals. However, CP3, which captures the difference in the flexion knee angle magnitude during gait, was the variable with higher discrimination power between groups. PCA is an effective multivariate statistical technique to analyse the kinematic gait waveform during the gait cycle. The smaller knee flexion angle in the OA group was appointed as a discriminatory factor between groups, therefore, it should be considered in the physical therapy evaluation and treatment of elderly women with knee OA.