INVESTIGATION OF CLINICAL FACTORS AFFECTING PERCEIVED PAIN INTENSITY IN FEMALE PATIENTS WITH KNEE OSTEOARTHRITIS

Öz

Objective: The present study aimed to identify the clinical variables influencing perceived pain intensity at rest, during activity, and at night in female patients with knee osteoarthritis (OA). Method: One hundred-six female patients with knee OA (mean age, 58.50±9.48 years; mean BMI, 30.73±5.53 kg/m2) were included. The Visual Analogue Scale (VAS), active range of motion (AROM), strength of the iliopsoas, gluteus medius, quadriceps femoris, and hamstring muscles, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-12 (SF-12) were outcome measures. A multivariate or univariate regression analysis was conducted to examine the relationship between the VAS ratings and AROM, muscle strength, WOMAC, SF-12, and Kellgren-Lawrence classification. Results: The mean values for VAS-rest, VAS-activity, and VAS-night were 3.02±2.32, 6.62±1.96, and 3.89±2.72, respectively. A significant correlation was found between VAS-rest and quadriceps femoris muscle strength, as well as the WOMAC score. Similarly, VAS-activity showed a significant association with hip flexion and knee extension AROM, quadriceps femoris muscle strength, Grade 3 or Grade 4 OA, physical component score of SF-12, and WOMAC score (p<0.05). There was also a significant association between VAS-activity and age (β:-0.194, 95%CI:-0.043 - 0.021, p=0.04). Conclusion: The quadriceps femoris muscle strength and functional level of the patients with knee OA significantly predict both pain intensity at rest and during activity. In addition, pain intensity during activity was found to be associated with hip flexion and knee extension AROM, Kellgren-Lawrence grading, the physical component of quality of life, and age.

Anahtar Kelimeler

• Function
• Knee
• Osteoarthritis
• Pain
• Regression

Kaynakça

1. Corti MC, Rigon C. Epidemiology of osteoarthritis: prevalence, risk factors and functional impact. Aging Clin Exp Res. 2003;15(5):359-363.
2. Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis. 2013;5(2):77-94.
3. Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis Cartilage. 2022;30(2):184-195.
4. Brophy RH, Fillingham YA. AAOS clinical practice guideline summary: management of osteoarthritis of the knee (Nonarthroplasty), Third Edition. J Am Acad Orthop Surg. 2022;30(9):e721-e729.
5. Sanchez-Lopez E, Coras R, Torres A, et al. Synovial inflammation in osteoarthritis progression. Nat Rev Rheumatol. 2022;18(5):258-275.
6. Szilagyi IA, Waarsing JH, Schiphof D, et al. Towards sex-specific osteoarthritis risk models: evaluation of risk factors for knee osteoarthritis in males and females. Rheumatology (Oxford). 2022;61(2):648-657.
7. Cicuttini FM, Proietto J, Lim YZ. Our biology working against us in obesity: A narrative review on implications for management of osteoarthritis. Osteoarthr Cartil Open. 2023;5(4):100407.
8. Aubourg G, Rice SJ, Bruce-Wootton P, et al. Genetics of osteoarthritis. Osteoarthritis Cartilage. 2022;30(5):636-649.

9. Wang X, Perry TA, Arden N, et al. Occupational risk in knee osteoarthritis: a systematic review and meta-analysis of observational studies. Arthritis Care Res (Hoboken). 2020;72(9):1213-1223.
10. Werner DM, Golightly YM, Tao M, et al. Environmental risk factors for osteoarthritis: the impact on individuals with knee joint ınjury. Rheum Dis Clin North Am. 2022;48(4):907-930.
11. Vaishya R, Vijay V, Lama P, et al. Does vitamin D deficiency influence the incidence and progression of knee osteoarthritis? - A literature review. J Clin Orthop Trauma. 2019;10(1):9-15.
12. Bacon K, LaValley MP, Jafarzadeh SR, et al. Does cartilage loss cause pain in osteoarthritis and if so, how much? Ann Rheum Dis. 2020;79(8):1105-1110.
13. Tan JS, Tikoft E, O'Sullivan P, et al. The relationship between changes in movement and activity limitation or pain in people with knee osteoarthritis: a systematic review. J Orthop Sports Phys Ther. 2021;51(10):492-502.
14. Hunter DJ, McDougall JJ, Keefe FJ. The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin North Am. 2008;34(3):623-643.
15. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013;21(9):1145-1153.
16. Hawker GA, Stewart L, French MR, et al. Understanding the pain experience in hip and knee osteoarthritis-an OARSI/OMERACT initiative. Osteoarthritis Cartilage. 2008;16(4):415-422.
17. Allen KD, Coffman CJ, Golightly YM, et al. Daily pain variations among patients with hand, hip, and knee osteoarthritis. Osteoarthritis Cartilage. 2009;17(10):1275-1282.
18. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494-502.
19. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8):1039-1049.
20. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers;1988:412.
21. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983;16(1):87-101.
22. Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2009.
23. Mentiplay BF, Perraton LG, Bower KJ, et al. Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PLoS One. 2015;10(10):e0140822.
24. Tüzün EH, Eker L, Aytar A, et al. Acceptability, reliability, validity and responsiveness of the Turkish version of the WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005;13(1):28-33.
25. Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15(12):1833-1840.
26. Kocyigit H, Aydemir O, Olmez N, et al. Reliability and validity of the Turkish version of Short-Form-36 (SF-36). Turkish J Drugs Therap 1999;12:102-106.
27. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996;34(3):220-233.
28. Petrov ME, Goodin BR, Cruz-Almeida Y, et al. Disrupted sleep is associated with altered pain processing by sex and ethnicity in knee osteoarthritis. J Pain. 2015;16(5):478-490.
29. Dai Z, Neogi T, Brown C, et al. Sleep Quality Is Related to Worsening Knee Pain in Those with Widespread Pain: The Multicenter Osteoarthritis Study. J Rheumatol. 2020;47(7):1019-1025.
30. Woolhead G, Gooberman-Hill R, Dieppe P, et al. Night pain in hip and knee osteoarthritis: a focus group study. Arthritis Care Res (Hoboken). 2010;62(7):944-949.
31. Bjerre-Bastos JJ, Miller CP, Li Y, et al. Associations between single-question Visual Analogue Scale pain score and weight-bearing and non-weight-bearing domains of Western Ontario and McMaster Universities Arthritis Index pain: data from 2 phase 3 clinical trials. Pain Rep. 2022;7(5):1017.
32. Fu K, Robbins SR, McDougall JJ. Osteoarthritis: the genesis of pain. Rheumatology (Oxford). 2018;57(suppl 4):iv43-iv50.
33. Hensor EM, Dube B, Kingsbury SR, et al. Toward a clinical definition of early osteoarthritis: onset of patient-reported knee pain begins on stairs. Data from the osteoarthritis initiative. Arthritis Care Res (Hoboken). 2015;67(1):40-47.
34. Lautenbacher S, Peters JH, Heesen M, et al. Age changes in pain perception: A systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev. 2017;75:104-113.
35. Atukorala I, Hunter DJ. A review of quality-of-life in elderly osteoarthritis. Expert Rev Pharmacoecon Outcomes Res. 2023;23(4):365-381.
36. Sulaiman S. Understanding chronic pain among people with knee osteoarthritis. Int J Care Schol. 2021;4(2):93-94.
37. Tayfur B, Charuphongsa C, Morrissey D, et al. Neuromuscular joint function in knee osteoarthritis: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2023;66(2):101662.
38. Alghadir AH, Anwer S, Iqbal A, et al. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018;11:851-856.
39. Steultjens MP, Dekker J, van Baar ME, et al. Range of joint motion and disability in patients with osteoarthritis of the knee or hip. Rheumatology (Oxford). 2000;39(9):955-961.