Risk factors for pain and functional impairment in people with knee and hip osteoarthritis: a systematic review and meta-analysis.

ABSTRACT: OBJECTIVE:To identify risk factors for pain and functional deterioration in people with knee and hip osteoarthritis (OA) to form the basis of a future 'stratification tool' for OA development or progression. DESIGN:Systematic review and meta-analysis. METHODS:An electronic search of the literature databases, Medline, Embase, CINAHL, and Web of Science (1990-February 2020), was conducted. Studies that identified risk factors for pain and functional deterioration to knee and hip OA were included. Where data and study heterogeneity permitted, meta-analyses presenting mean difference (MD) and ORs with corresponding 95% CIs were undertaken. Where this was not possible, a narrative analysis was undertaken. The Downs & Black tool assessed methodological quality of selected studies before data extraction. Pooled analysis outcomes were assessed and reported using the Grading of Reccomendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS:82 studies (41?810 participants) were included. On meta-analysis: there was moderate quality evidence that knee OA pain was associated with factors including: Kellgren and Lawrence?2 (MD: 2.04, 95%?CI 1.48 to 2.81; p<0.01), increasing age (MD: 1.46, 95%?CI 0.26 to 2.66; p=0.02) and whole-organ MRI scoring method (WORMS) knee effusion score ?1 (OR: 1.35, 95%?CI 0.99 to 1.83; p=0.05). On narrative analysis: knee OA pain was associated with factors including WORMS meniscal damage ?1 (OR: 1.83). Predictors of joint pain in hip OA were large acetabular bone marrow lesions (BML; OR: 5.23), chronic widespread pain (OR: 5.02) and large hip BMLs (OR: 4.43). CONCLUSIONS:Our study identified risk factors for clinical pain in OA by imaging measures that can assist in predicting and stratifying people with knee/hip OA. A 'stratification tool' combining verified risk factors that we have identified would allow selective stratification based on pain and structural outcomes in OA. PROSPERO REGISTRATION NUMBER:CRD42018117643.

SUBMITTER: Sandhar S 

PROVIDER: S-EPMC7418691 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature