Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, Nottingham City Hospital, University of Nottingham, Clinical Sciences Building, Nottingham, NG5 1PB, UK.
Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
Arthritis Res Ther. 2018 Sep 27;20(1):215. doi: 10.1186/s13075-018-1717-6.
Neuropathic-like knee pain (NKP) is often reported in individuals with knee pain (KP), but the contribution of specific central and peripheral risk factors to NKP has not been studied previously. The aims of the present study were to determine the prevalence of NKP in a community-derived sample with KP and to identify risk factors associated with NKP.
A cross-sectional study was undertaken (n = 9506) in the East Midlands community among responders (aged 40+ years) to a postal questionnaire. Questions included KP severity (numerical rating scale) and type (neuropathic versus nociceptive) using the modified painDETECT questionnaire, as well as age, body mass index (BMI), significant knee injury, widespread pain, pain catastrophising and fatigue. Multinomial regression analysis was used to determine ORs and 95% CIs. Risk factors were categorised into central and peripheral, and proportional risk contribution (PRC) and 95% CI were estimated using ROC.
KP was reported in 28.2% of responders, of whom 13.65% had NKP (i.e., 3.9% of the total population). Women reported more NKP. After adjustment for age, gender, BMI and pain severity, definite NKP showed associations (aOR, 95% CI) with fibromyalgia (4.07, 2.49-6.66), widespread pain (1.93, 1.46-2.53), nodal osteoarthritis (1.80, 1.28-2.53), injury (1.50, 1.12-2.00), pain catastrophising (5.37, 2.93-9.84) and fatigue (5.37, 3.08-9.35) compared with non-NKP participants. Although only central risk factors contributed to NKP (PRC 8%, 95% CI 2.5-12.5 for central vs. PRC 3%, 95% CI -0.25 to 7.5 for peripheral), both central and peripheral risk factors contributed equally to non-NKP (PRC 10%, 95% CI 5-20 for both).
NKP appears to be driven largely by central risk factors and may require different prevention/treatment strategies.
ClinicalTrials.gov , NCT02098070 . Registered on 27 March 2014.
神经病理性膝痛（NKP）在膝痛（KP）患者中经常被报告，但特定的中枢和外周危险因素对 NKP 的贡献尚未被研究过。本研究的目的是确定社区来源的 KP 患者中 NKP 的患病率，并确定与 NKP 相关的危险因素。
在东米德兰兹社区对邮寄问卷的应答者（年龄≥40 岁）进行了一项横断面研究（n=9506）。问题包括 KP 严重程度（数字评分量表）和类型（神经病理性与伤害感受性），使用改良疼痛 DETECT 问卷，以及年龄、体重指数（BMI）、膝关节重大损伤、广泛疼痛、疼痛灾难化和疲劳。使用多变量回归分析确定比值比（OR）和 95%置信区间（CI）。危险因素分为中枢和外周，并使用 ROC 估计比例风险贡献（PRC）和 95%CI。
在应答者中，28.2%报告有 KP，其中 13.65%有 NKP（即总人口的 3.9%）。女性报告有更多的 NKP。在调整年龄、性别、BMI 和疼痛严重程度后，明确 NKP 与纤维肌痛（4.07，2.49-6.66）、广泛疼痛（1.93，1.46-2.53）、节点性骨关节炎（1.80，1.28-2.53）、损伤（1.50，1.12-2.00）、疼痛灾难化（5.37，2.93-9.84）和疲劳（5.37，3.08-9.35）之间存在关联（调整后的 OR，95%CI）。尽管只有中枢危险因素对 NKP 有贡献（PRC 8%，95%CI 2.5-12.5 为中枢 vs. PRC 3%，95%CI-0.25 至 7.5 为外周），但中枢和外周危险因素对非 NKP 都有同等贡献（PRC 10%，95%CI 5-20 为两者）。
NKP 似乎主要由中枢危险因素驱动，可能需要不同的预防/治疗策略。
ClinicalTrials.gov，NCT02098070。于 2014 年 3 月 27 日注册。
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