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. 2024 Aug;32(8):963-971.
doi: 10.1016/j.joca.2024.04.011. Epub 2024 Apr 30.

Hand osteoarthritis phenotypes based on a biopsychosocial approach, and their associations with cross-sectional and longitudinal pain

Elisabeth Mulrooney  1 , Tuhina Neogi  2 , Hanne Dagfinrud  3 , Hilde B Hammer  3 , Pernille S Pettersen  3 , Tore K Kvien  3 , Karin Magnusson  4 , Ida K Haugen  5
Affiliations

Hand osteoarthritis phenotypes based on a biopsychosocial approach, and their associations with cross-sectional and longitudinal pain

Elisabeth Mulrooney et al. Osteoarthritis Cartilage. 2024 Aug.

Abstract

Objective: Hand osteoarthritis (OA) pain is characterized as heterogeneous and multifactorial. Differences in pain may be explained by underlying phenotypes, which have not been previously explored DESIGN: Latent class analysis determined classes of participants with hand OA from the Nor-Hand study baseline examination (2016-17) based on a biopsychosocial framework. Outcomes were hand and overall bodily pain intensity (Numeric Rating Scale, 0-10) at baseline and follow-up (2019-21), The relations of the classes to pain outcomes at baseline, follow-up, and change over time were analysed in separate models by linear regression, using the overall healthiest class as reference.

Results: Five classes differing in radiographic hand OA burden and OA burden in the lower extremities by ultrasound, demographic factors, psychosocial burden and pain sensitization was identified. Persons with the least severe OA but higher burden of biopsychosocial factors reported the most hand pain (beta 3.65, 95% CI 2.53, 4.75). Pain was less pronounced in persons with the most severe hand OA but low burden of biopsychosocial factors (beta 1.03, 95% CI 0.41, 1.65). Results were similar for overall bodily pain and at follow-up. Changes in pain were small, but the association between a separate class defined by higher levels of biopsychosocial burden and pain changes was significant.

Conclusion: The five hand OA phenotypes were associated with pain at baseline and 3.5 years later. The phenotype with the least OA severity, but higher burden of biopsychosocial factors reported more pain than the phenotype with the most severe OA, reflecting the symptom-structure discordance of the hand OA pain experience.

Keywords: Hand osteoarthritis; Osteoarthritis; Pain; Pain sensitization; Phenotypes.

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Figures

Fig. 1
Fig. 1
The biopsychosocial variables used for defining classes, and their outcome measures.
Fig. 2
Fig. 2
Characteristics of biopsychosocial factors across the proposed hand OA phenotypes. Indicator variables* are presented as Z-scores, which indicates how many standard deviations the data point is below or above the study population mean, where the mean = 0 and one SD= 1. Higher values indicate higher burden.
Fig. 3
Fig. 3
Distribution of women across the hand OA phenotypes. Data presented as percentages (%).
Fig. 4
Fig. 4
Differences in pain intensity across the hand OA phenotypes. Data presented as mean (SD). * Significant difference between the classes, p < 0.001.
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