Absence of pain in subjects with advanced radiographic knee osteoarthritis
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RESEARCH ARTICLE
Open Access
Absence of pain in subjects with advanced radiographic knee osteoarthritis Kyeong Min Son1†, Jeong Im Hong2†, Dong-Hyun Kim3, Dae-Gyu Jang4, Michel D. Crema5 and Hyun Ah Kim2*
Abstract Background: To investigate the frequency of pain among subjects with advanced radiographic knee osteoarthritis (OA) defined as Kellgren–Lawrence (KL) grade 4 and clinical features associated with pain. Methods: Subjects from the Hallym Aging Study (HAS), the Korean National Health and Nutrition Examination Survey (KNHANES), and the Osteoarthritis Initiative (OAI) were included. Participants were asked knee-specific questions regarding the presence of knee pain. Clinical characteristics associated with the presence of pain were evaluated with multivariable logistic regression analysis. Results: The study population consisted of 504, 10,152 and 4796 subjects from HAS, KNHANES, and OAI, respectively. KL grade 4 OA was identified in 9.3, 7.6, and 11.5% of subjects, while pain was absent in 23.5, 31.2, and 5.9% of subjects in KL grade 4 knee OA, respectively. After multivariable analysis, female gender showed a significant association with pain in the KNHANES group, while in the OAI group, younger age did. Advanced knee OA patients without pain did not differ from non-OA subjects in most items of SF-12 in both Korean and OAI subjects. Total WOMAC score was not significantly different between non-OA and advanced knee OA subjects without pain in the OAI. Conclusions: Our study showed that a considerable number of subjects with KL grade 4 OA did not report pain. In patients whose pain arises from causes other than structural damage of the joint, therapeutic decision based on knee X-ray would lead to suboptimal result. In addition, treatment options focusing solely on cartilage engineering, should be viewed with caution. Keywords: Osteoarthritis, Pain, Knee
Background Osteoarthritis (OA) is the most common form of arthritis affecting the elderly, and was ranked as the 11th leading cause of years lived with disability (YLD) globally, with higher rank (6th) especially among Asian countries [1]. In addition, YLD due to knee OA increased by 64% from 1990 to 2010, reflecting aging of the population [1]. Knee pain due to OA is a key symptom influencing the decision to seek medical attention, and previous reports have suggested that knee pain is a * Correspondence: [email protected] † Kyeong Min Son and Jeong Im Hong contributed equally to this work. 2 Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Kyunggi, South Korea Full list of author information is available at the end of the article
better predictor of disability than radiographic changes [2, 3]. Radiographic OA changes are poorly correlated with pain and physical function, and the risk factors for radiographic knee OA may not be the same as those for knee pain [4–6]. Although radiography has long been used for evaluation of knee OA and knee pain, caution is required in its use to guide therapeutic
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