Background & Aims

There are many contributors to the pain experience in knee OA and understanding pain phenotypes (PPs) can help tailor treatments. Studies of PP have been conducted in those with existing radiographically defined knee osteoarthritis (KOA). However, little is known regarding PPs among people with minimal symptoms and no KOA, nor the stability or transition of PPs over time. Such knowledge may inform whether some cluster of features in some people are static or change over time. The objective of the current study was to identify the transition of PPs in people free of symptomatic KOA using pain-related variables and to profile participant characteristics.

Methods

Individuals with pain intensity ?30/100 and Kellgren-Lawrence (KL) grade 0 were selected from the Multicenter Osteoarthritis (MOST) Study. PP indicator variables included measures of pain sensitization pressure pain thresholds (PPTs), temporal summation (TS), depressive symptoms (DS), pain catastrophizing (PC), sleep quality (SLP), and widespread pain (WSP); all treated as dichotomized variables. Data from the 5-, 7- and 12-year visits were used, referred to as timepoint 1 (T1), 2 (T2) and 3 (T3) respectively. The method for measuring TS changed at T3. Latent Transition Analysis was conducted to identify the transition of phenotypes. Bayesian Information criteria (BIC) informed selection of class numbers. Unconstrained, constrained (probabilities fixed across time), and modified constrained model (probabilities fixed except for TS) were compared for fit. Age, sex, body mass index, race, education, comorbidities, and KL grade were used to profile class membership.

Results

348 individuals (59% females), mean age (SD): 59.3 (6.7) met the inclusion criteria. BIC values indicated a 3-class solution was optimal for T1-T3 with modified constrained model having a superior fit. The classes were similar except for TS at T3. Class 1 included participants with lower probabilities for all the indicator variables (normal group), whereas class 2 had participants with higher probability of positive PPTs (more sensitivity), and class 3 is comprised of those with moderate PPTs, higher PC, and WSP. 86% of the participants remained in the same class and only 14% transitioned to a different class. Participants age, and female sex at all three timepoints were associated with class membership.

Conclusions

People with no or minimal pain and free of KOA initially, demonstrated relatively similar phenotypic characteristics over 7 years except for an increase in TS at T3. This change must be interpreted with caution given the change in TS measurement. Understanding the relationship of these phenotypes and their transitions to incident symptomatic KOA could provide mechanistic insight for treatment targets.

References

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Presenting Author

YV Raghava Neelapala

Poster Authors

Y V Raghava Neelapala

PT

School of Rehabilitation Science, McMaster University, India

Lead Author

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Rheumatology, Arthritis, and Other