Previtali Davide, Andriolo Luca, Di Laura Frattura Giorgio, Boffa Angelo, Candrian Christian, Zaffagnini Stefano, Filardo Giuseppe
Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, 6900 Lugano, Switzerland.
Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy.
J Clin Med. 2020 Sep 1;9(9):2828. doi: 10.3390/jcm9092828.
Different profiles of pain progression have been reported in patients with knee osteoarthritis (OA), but the determinants of this heterogeneity are still to be sought. The aim of this systematic review was to analyze all studies providing information about knee OA pain trajectories to delineate, according to patients' characteristics, an evidence-based evolution pattern of this disabling disease, which is key for a more personalized and effective management of knee OA. A literature search was performed on PubMed, Web of Science, Cochrane Library, and grey literature databases. The Cochrane Collaboration's tool for assessing risk of bias was used, and a best-evidence synthesis was performed to define the predictors of pain evolution. Seven articles on 7747 patients affected by knee OA (mainly early/moderate) were included. Daily knee OA pain trajectories were unstable in almost half of the patients. In the mid-term, knee OA had a steady pain trajectory in 85% of the patients, 8% experienced pain reduction, while 7% experienced pain worsening. Low education, comorbidities, and depression were patient-related predictors of severe/worsening knee OA pain. Conversely, age, alcohol, smoking, pain coping strategies, and medications were unrelated to pain evolution. Conflicting/no evidence was found for all joint-related factors, such as baseline radiographic severity.
已有报道称膝关节骨关节炎（OA）患者存在不同的疼痛进展情况，但这种异质性的决定因素仍有待探寻。本系统评价的目的是分析所有提供膝关节OA疼痛轨迹信息的研究，以便根据患者特征描绘出这种致残性疾病基于证据的演变模式，这对于更个性化、有效地管理膝关节OA至关重要。我们在PubMed、科学网、考克兰图书馆和灰色文献数据库中进行了文献检索。使用考克兰协作网的偏倚风险评估工具，并进行最佳证据综合分析以确定疼痛演变的预测因素。纳入了7篇关于7747例膝关节OA患者（主要为早期/中期）的文章。几乎一半患者的每日膝关节OA疼痛轨迹不稳定。在中期，85%的患者膝关节OA疼痛轨迹稳定，8%的患者疼痛减轻，而7%的患者疼痛加重。低教育水平、合并症和抑郁是与患者相关的膝关节OA疼痛严重/加重的预测因素。相反，年龄、饮酒、吸烟、疼痛应对策略和药物与疼痛演变无关。对于所有关节相关因素，如基线影像学严重程度，均未发现一致的证据或无证据。
