Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
Medicine, University of British Columbia, Vancouver, BC, Canada.
BMC Musculoskelet Disord. 2020 Jul 16;21(1):467. doi: 10.1186/s12891-020-03496-8.
To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models.
A population-based cohort (n = 122) with knee pain, aged 40-79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike's information criterion.
Baseline depression model: sex (female OR = 0.27; 0.10, 0.76) and KL grade (KL 1 OR = 4.21; 1.31, 13.48). Three-year depression model: KL grade (KL 1 OR = 18.92; 1.73, 206.25). Seven-year depression model: WOMAC stiffness ≥25 (OR = 3.49; 1.02, 11.94) and flexion contracture ≥1 degree (OR = 0.23; 0.07, 0.81). Baseline anxiety model: knee swelling (OR = 4.11; 1.51, 11.13) and age (50-59 vs. 40-49 OR = 0.31 [0.11, 0.85]; 60-69 OR = 0.07 [0.01, 0.42]). Three-year anxiety model: WOMAC stiffness ≥25 (OR = 5.80; 1.23, 27.29) and KL grade (KL 1 OR = 6.25; 1.04, 37.65). Seven-year anxiety model: sex (female OR = 2.71; 0.87, 8.46).
Specific knee OA-related manifestations predict depression and anxiety cross-sectionally, 3 years in the future, and for depression, 7 years in the future. This information may prove useful to clinicians in helping to identify patients most at risk of present or future depression and anxiety, thus facilitating preemptive discussions that may help counter that risk.
使用横断面和纵向预测模型评估膝关节骨关节炎（OA）表现是否预测抑郁和焦虑。
一项基于人群的队列研究（n=122）纳入了膝关节疼痛、年龄在 40-79 岁之间的患者，在基线、3 年和 7 年时进行评估。基线预测因素包括：年龄十年；性别；BMI≥25；体格检查膝关节积液；弹响；关节对线不良；股四头肌萎缩；屈曲；屈曲挛缩；Kellgren-Lawrence（KL）X 射线分级（0/1/2/3+）；WOMAC 疼痛≥25；WOMAC 僵硬≥25；自我报告的膝关节肿胀；以及膝关节 OA 诊断（无/可能/明确）。通过医院焦虑和抑郁量表测量抑郁和焦虑的切点分别为 5+和 7+。我们在每个周期使用多变量模型通过最低 Akaike 信息标准选择的模型进行逻辑回归模型拟合。
基线抑郁模型：性别（女性 OR=0.27；0.10，0.76）和 KL 分级（KL 1 OR=4.21；1.31，13.48）。三年抑郁模型：KL 分级（KL 1 OR=18.92；1.73，206.25）。七年抑郁模型：WOMAC 僵硬≥25（OR=3.49；1.02，11.94）和屈曲挛缩≥1 度（OR=0.23；0.07，0.81）。基线焦虑模型：膝关节肿胀（OR=4.11；1.51，11.13）和年龄（50-59 岁 vs. 40-49 岁 OR=0.31 [0.11，0.85]；60-69 岁 OR=0.07 [0.01，0.42]）。三年焦虑模型：WOMAC 僵硬≥25（OR=5.80；1.23，27.29）和 KL 分级（KL 1 OR=6.25；1.04，37.65）。七年焦虑模型：性别（女性 OR=2.71；0.87，8.46）。
特定的膝关节 OA 相关表现可预测抑郁和焦虑的横断面、3 年和 7 年未来情况。这些信息可能对临床医生帮助识别当前或未来抑郁和焦虑风险最高的患者有用，从而促进预防性讨论，这可能有助于降低这种风险。
