EA4360 Apemac, Université de Lorraine, Nancy.
Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris.
Rheumatology (Oxford). 2020 Nov 1;59(11):3488-3498. doi: 10.1093/rheumatology/keaa148.
The aims of this study were to identify homogeneous subgroups of knee and/or hip OA patients with distinct trajectories of the combination of pain and physical function (PF) over time and to determine the baseline factors associated with these trajectories.
We used data from the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) cohort, a French population-based cohort of 878 patients with symptomatic knee and/or hip OA. Pain and PF were measured annually over 5 years with the Medical Outcomes Study Short Form 36 questionnaire. First, trajectory models were estimated with varying numbers of groups for each of the outcomes separately then fitted into a multi-trajectory model. We used multinomial logistic regression to determine the baseline characteristics associated with each trajectory.
Univariate four-class models were identified as most appropriate for pain and PF. Comparison of separate trajectories showed that 41% of patients included in the severe functional limitations trajectory did not belong to the more severe pain trajectory (Cramér's V statistic = 0.45). Group-based multi-trajectory modelling revealed four distinct trajectories of pain and PF. On multivariate analyses, female sex, older age, high Kellgren grade, low physical activity intensity, low psychosocial distress score (high distress) and low vitality score were associated with the more severe symptoms trajectory.
Over 5 years, we identified four distinct trajectories combining pain and PF. Management of weight, fatigue and psychosocial distress and the practice of physical activity seem important to maintain function and limit pain in patients with lower-limb OA.
本研究旨在识别膝关节和/或髋关节骨关节炎（OA）患者在疼痛和身体功能（PF）随时间变化的综合表现方面具有不同轨迹的同质亚组，并确定与这些轨迹相关的基线因素。
我们使用了 Knee and Hip Osteoarthritis Long-term Assessment（KHOALA）队列的资料，这是一个法国基于人群的 878 例有症状的膝关节和/或髋关节 OA 患者队列。疼痛和 PF 使用 Medical Outcomes Study Short Form 36 问卷每年测量 5 年。首先，针对每个结局分别估计了具有不同分组数量的轨迹模型，然后将其拟合到多轨迹模型中。我们使用多项逻辑回归来确定与每个轨迹相关的基线特征。
单变量四组模型被认为最适合疼痛和 PF。单独轨迹的比较表明，严重功能受限轨迹中包含的 41%的患者不属于更严重疼痛轨迹（Cramér's V 统计量=0.45）。基于群组的多轨迹建模显示了疼痛和 PF 的四个不同轨迹。在多变量分析中，女性、年龄较大、较高的 Kellgren 分级、较低的身体活动强度、较高的心理社会困扰评分（高困扰）和较低的活力评分与更严重的症状轨迹相关。
在 5 年内，我们确定了疼痛和 PF 相结合的四个不同轨迹。管理体重、疲劳和心理社会困扰以及进行身体活动对于维持下肢 OA 患者的功能和减轻疼痛似乎很重要。
