Defining knee pain trajectories in early symptomatic knee osteoarthritis in primary care

This is a brief version of the full publication which is observing a 5 year Cohort Study – the outline is below & full published document can be found in our “Published Documents Section”

KEYNOTES

  • 289 are moderate to severe at 5 years  (roughly 30%)
  • 416 are mild to moderate at 5 years
    Therefore by the age of 60;
    60% of the population will have OA of which 30% will be moderate to severe.

STUDY NOTES BELOW

The physical examination assessed:

  • knee pain;
  • range of motion;
  • crepitus;
  • joint space tenderness;
  • palpable warmth; and
  • bony enlargement.

The figures show groups with different types of pain trajectories:

  • constant mild pain (group A, n= 186);
  • moderate pain regression (group C, n= 207);
  • major pain regression (group E, n= 23);
  • severe pain progression (group B, n= 35);
  • moderate pain progression (group D, n= 180); and
  • constant severe pain (group F, n= 74)

 

The mildest trajectory group (group A) was set as the reference group. Compared with this group, participants with a higher BMI, lower level of education, greater comorbidity, higher WOMAC physical function score, and knee joint space tenderness had increased risks for pain trajectories characterised by greater pain.

graph

For patients with moderate, severe, or progressing pain, it seems justifiable to maintain a proactive management plan and offer re-assessments of pain and function limitations after at least 1 year. In that way, GPs can better assess which pain trajectory the patient is most likely to follow and can act accordingly — by promoting weight loss, prescribing pain medication, or referring patients for specialist treatment.

REF: Bastick et al. Defining knee pain trajectories in early symptomatic knee osteoarthritis in primary care: 5-year results from a nationwide prospective cohort study (CHECK). British Journal of General Practice, Online First 2015