The factors associated with pain severity in patients with knee osteoarthritis vary according to the radiographic disease severity: a cross-sectional study

Abstract

Objectives: Knee osteoarthritis (OA) pain is suggested to be associated with inflammation and detrimental mechanical loading across the joint. In this cross-sectional study, we simultaneously examined the inflammation and alignment of the lower limb and examined how the pain components varied depending on the disease progression.

Design: One-hundred sixty female medial type of early- [n = 74 in Kellgren-Lawrence (K/L) 2] to advanced-stage (n = 96 in K/L >2) knee OA subjects (70.5 years on average) were enrolled. Knee pain was evaluated using a pain visual analog scale (VAS) and the pain-related subcategory of the Japanese Knee Osteoarthritis Measure (JKOM-pain). The serum interleukin (sIL)-6 level reflecting synovitis, and the high sensitivity C-reactive protein (hs-CRP) level were measured to evaluate the severity of inflammation. The anatomical axis angle (AAA) was measured as an alignment index. The β-coefficient was estimated after adjusting for age and the body mass index (BMI) using a multiple linear regression analysis.

Results: Multiple linear regression analyses showed that the sIL-6 levels, but not AAA, associated with the pain VAS [β = 10.77 (95% confidence interval (CI): 4.14-17.40), P < 0.01] and JKOM-pain scores [β = 3.19 (95% CI: 1.93-4.44), P < 0.001] in the early stage. Conversely, AAA, but not the sIL-6 levels, was found to be associated with the pain VAS [β = -1.29 (95% CI: -2.51 to -0.08), P < 0.05] and JKOM-pain scores [β = -0.49 (95% CI: -0.82 to -0.16), P < 0.01] in the advanced stage.

Conclusions: The presence of a higher level of sIL-6 and the varus alignment of the joint is associated with pain in early- and advanced-stage knee OA patients, respectively.

Keywords: Alignment; Interleukin-6; JKOM (Japanese Knee Osteoarthritis Measure); Knee osteoarthritis; Pain; Synovitis.