Phenotypes of osteoarthritis-related knee pain and their transition over time: data from the osteoarthritis initiative

Abstract

Background: Identification of knee osteoarthritis (OA) pain phenotypes, their transition patterns, and risk factors for worse phenotypes, may guide prognosis and targeted treatment; however, few studies have described them. We aimed to investigate different pain phenotypes, their transition patterns, and potential risk factors for worse pain phenotypes.

Methods: Utilizing data from the Osteoarthritis Initiative (OAI), pain severity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. We identified the activity-related pain phenotypes and estimated the transition probabilities of pain phenotypes from baseline to the 24-month using latent transition analysis. We examined the risk factors at baseline with the 24-month pain phenotypes and the transition of pain phenotypes.

Results: In 4796 participants, we identified four distinct knee pain phenotypes at both baseline and 24-month follow-up: no pain, mild pain during activity (Mild P-A), mild pain during both rest and activity (Mild P-R-A), and moderate pain during both rest and activity (Mod P-R-A). 82.9% knees with no pain at baseline stayed the same at 24-month follow-up, 17.1% progressed to worse pain phenotypes. Among "Mild P-A" at baseline, 32.0% converted to no-pain, 12.8% progressed to "Mild P-R-A", and 53.2% remained. Approximately 46.1% of "Mild P-R-A" and 54.5% of "Mod P-R-A" at baseline experienced remission by 24-month. Female, non-whites, participants with higher depression score, higher body mass index (BMI), higher Kellgren and Lawrence (KL) grade, and knee injury history were more likely to be in the worse pain phenotypes, while participants aged 65 years or older and with higher education were less likely to be in worse pain phenotypes at 24-month follow-up visit. Risk factors for greater transition probability to worse pain phenotypes at 24-month included being female, non-whites, participants with higher depression score, higher BMI, and higher KL grade.

Conclusions: We identified four distinct knee pain phenotypes. While the pain phenotypes remained stable in the majority of knees over 24 months period, substantial proportion of knees switched to different pain phenotypes. Several socio-demographics as well as radiographic lesions at baseline are associated with worse pain phenotypes at 24-month follow-up visit and transition of pain phenotypes.

Keywords: Osteoarthritis; Pain; Phenotype; Risk factors.

Fig. 1

Path diagram for pain phenotype transition from baseline to 24-month follow-up through latent transition model. Five WOMAC items at baseline and 24-month follow-up were used to distinguish different pain phenotypes at baseline and 24-month follow-up, respectively. Baseline characteristics (e.g., sex, age and BMI) were used in the log binomial model and latent transition model for analyzing the factors associated with the 24-month pain phenotype and phenotype transitions. BMI, body mass index; CES-D, Center for Epidemiological Studies-Depression; KL garde, Kellgren and Lawrence grade; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index

Fig. 2

Proportions of individuals in each phenotype for all items among total knees. Mild P-A, mild pain during activity; Mild P-R-A, mild pain during both rest and activity; Mod P-R-A, moderate pain during both rest and activity

Fig. 3

Probabilities of status membership at baseline and 24-month follow-up. Mild P-A, mild pain during activity; Mild P-R-A, mild pain during both rest and activity; Mod P-R-A, moderate pain during both rest and activity