Neuropathic-like symptoms and the association with joint-specific function and quality of life in patients with hip and knee osteoarthritis

Abstract

Objective: There is an association between osteoarthritis-related pain severity and function, yet clear evidence about the sole influence of neuropathic-like symptoms on joint function and health-related quality of life (HRQoL) is lacking. Previous studies among knee OA patients show an association between neuropathic-like symptoms, lower functional status and lower quality of life, however analyses were unadjusted or had limited adjustment for influential covariates like pain intensity. The aim of this study was therefore to determine the influence of neuropathic-like symptoms-adjusted for multiple influential covariates-on joint-specific function and HRQoL in hip and knee OA patients.

Methods: In this observational study 255 patients (117 with hip OA and 138 with knee OA) completed the modified painDETECT questionnaire (mPDQ) to identify subjects with neuropathic-like symptoms (mPDQ score>12, possible neuropathic pain [NP] phenotype). The WOMAC and the RAND-36 were used to asses respectively function and HRQoL. Results were adjusted stepwise for age, sex and BMI (Model 1); back disorder, painful body regions, comorbidities and previous surgery (Model 2); and pain intensity and analgesic usage (Model 3).

Results: A possible NP phenotype was experienced by 37% of hip and 46% of knee OA patients. Final model 3 analysis revealed that hip OA patients with neuropathic-like symptoms scored significantly lower on pain-related aspects of HRQoL (ΔRAND-36 bodily pain: 6.8 points, p = 0.047) compared to patients with the unlikely NP phenotype. In knee OA patients, a possible NP phenotype was associated with diminished joint function (ΔWOMAC domains ranging 7.1 to 10.5 points, p<0.05) and more deficits on the physical functional aspect of HRQoL (ΔRAND-36 physical functioning: 6.8 points, p = 0.016).

Conclusion: Neuropathic-like symptoms deteriorate the subjective rating of pain-related quality of life in hip OA patients and significantly influence function in knee OA patients.

Fig 1. Study recruitment diagram (flowchart).

Fig 2. Hip OA Model 3: Fully ANCOVA adjusted WOMAC scores.

NP-: unlikely neuropathic pain phenotype (mPDQ≤12). NP±: possible neuropathic pain phenotype (NP±, mPDQ>12). WOMAC score 100 indicates no symptoms/problems and 0 indicates extreme symptoms/problems. Error bar represents the 95% CI (lower-upper limits) of the adjusted mean. Mean adjusted difference is displayed numerically. *: p<0.05.

Fig 3. Knee OA Model 3: Fully ANCOVA adjusted WOMAC scores.

NP-: unlikely neuropathic pain phenotype (mPDQ≤12). NP±: possible neuropathic pain phenotype (NP±, mPDQ>12). WOMAC score 100 indicates no symptoms/problems and 0 indicates extreme symptoms/problems. Error bar represents the 95% CI (lower-upper limits) of the adjusted mean. Mean adjusted difference is displayed numerically. *: p<0.05.