Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada.
University of Kansas Medical Center, Kansas City.
Arthritis Rheumatol. 2019 Apr;71(4):542-549. doi: 10.1002/art.40752. Epub 2019 Feb 7.
It is not clear why some individuals develop pain with knee osteoarthritis (OA). We undertook this study to identify pain susceptibility phenotypes (PSPs) and their relationship to incident persistent knee pain (PKP) 2 years later.
We identified individuals free of PKP from the Multicenter Osteoarthritis Study, a longitudinal cohort of older adults with or at risk of knee OA. Latent class analysis was used to determine PSPs that may contribute to development of PKP apart from structural pathology. These included widespread pain, poor sleep, and psychological factors as well as pressure pain threshold and temporal summation (TS) as determined by quantitative sensory testing (QST). We used logistic regression to evaluate the association of sociodemographic factors with PSPs and the relationship of PSPs to the development of PKP over 2 years.
A total of 852 participants were included (mean age 67 years, body mass index 29.5 kg/m , 55% women). Four PSPs were identified, primarily characterized by varying proportions (low/absent, moderate, or high) of the presence of pressure pain sensitivity and of facilitated TS, reflecting different measures of sensitization. Subjects in the PSP with a high proportion of pressure pain sensitivity and a moderate proportion of facilitated TS were twice as likely to develop incident PKP over 2 years (odds ratio 1.98 [95% confidence interval 1.07-3.68]) compared with subjects in the PSP having a low proportion of sensitization by both measures.
Four PSPs were identified, 3 of which were predominated by QST evidence of sensitization and 1 of which was associated with developing PKP 2 years later. Prevention or amelioration of sensitization may be a novel approach to preventing onset of PKP in OA.
尚不清楚为何有些人会出现膝骨关节炎（OA）疼痛。我们开展此项研究，旨在确定疼痛易感性表型（PSP）及其与 2 年后持续性膝痛（PKP）发病的关系。
我们从多中心骨关节炎研究中筛选出无 PKP 的个体，该研究为一个有或有膝关节 OA 风险的老年人群的纵向队列。采用潜在类别分析确定 PSP，这些 PSP 可能与结构病理学无关，有助于 PKP 的发生。这些 PSP 包括广泛疼痛、睡眠质量差和心理因素，以及定量感觉测试（QST）确定的压力疼痛阈值和时间总和（TS）。我们采用逻辑回归评估社会人口因素与 PSP 的关系，以及 PSP 与 2 年内 PKP 发生的关系。
共纳入 852 名参与者（平均年龄 67 岁，体重指数 29.5kg/m，55%为女性）。确定了 4 种 PSP，主要特征为压力疼痛敏感性和易化 TS 的存在比例（低/不存在、中度或高）不同，反映了不同的敏化程度。与 PSP 中压力疼痛敏感性和易化 TS 比例均较低的个体相比，PSP 中压力疼痛敏感性和易化 TS 比例较高的个体在 2 年内发生新发 PKP 的可能性增加了两倍（优势比 1.98[95%置信区间 1.07-3.68]）。
确定了 4 种 PSP，其中 3 种主要表现为 QST 敏化证据，1 种与 2 年后发生 PKP 相关。预防或减轻敏化可能是预防 OA 中 PKP 发病的一种新方法。
