Halliwell Carson, Rayner Sophie E, Waghorn Jocelyn, Feltmate Brett, Moyer Rebecca, O'Brien Myles W
School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
Centre de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada.
Clin Rheumatol. 2025 Jun 26. doi: 10.1007/s10067-025-07546-1.
INTRODUCTION/OBJECTIVES: Knee osteoarthritis is a leading cause of disability in older adults; with treatment complicated by inconsistent associations between radiographic and symptomatic severity. Frailty describes the heterogeneity in aging and is quantified via the accumulation of health deficits. We test if frailty moderates the relation between radiographic and symptomatic knee osteoarthritis.
This cohort study included participants (n = 3,271; 58% female, 45-79 years) from the Osteoarthritis Initiative were included. Radiographic severity was assessed using the Kellgren-Lawrence Grade (KLG). Frailty was quantified via a 31-item frailty index, categorizing participants as non-frail (≤ 0.10), very mild frailty (< 0.1-to- ≤ 0.2), mild frailty (< 0.2-to- ≤ 0.3), and moderate-to-severe frailty (> 0.3). Self-reported pain was assessed via the Knee Injury and Osteoarthritis Outcome Score (KOOS). Moderation models using generalized estimating equations adjusted for age, sex, and body mass index were performed to test the interaction between frailty and KLG on KOOS pain scores.
Radiographic severity (β = -3.82, 95%CI: -4.16:-3.49; p < 0.001) and frailty (β = -4.76, 95%CI: -5.36:-4.17; p < 0.001) were negatively associated with KOOS pain scores. Frailty moderated this relation (interaction term: β = -1.18, 95%CI: -1.63:-0.73, p < 0.001), where higher frailty strengthened the association between radiographic severity and pain. Simple slopes analysis indicated stronger associations between KLG and KOOS pain scores in participants with mild to moderate-to-severe frailty compared to non-frail and very mild frailty (non-frail: β = -2.71, 95%CI: -3.41:-2.02, p < 0.001; moderate-to-severe frailty: β = -5.57, 95%CI: -7.23:-3.87, p < 0.001).
These findings underscore the importance of incorporating frailty assessments into knee osteoarthritis management, as individuals with similar radiographic severity may experience substantially worse pain if they have higher frailty levels.
引言/目的：膝关节骨关节炎是老年人残疾的主要原因；由于影像学严重程度与症状严重程度之间的关联不一致，治疗变得复杂。衰弱描述了衰老过程中的异质性，并通过健康缺陷的积累进行量化。我们测试衰弱是否会调节影像学膝关节骨关节炎与症状性膝关节骨关节炎之间的关系。
这项队列研究纳入了骨关节炎倡议组织的参与者（n = 3271；58%为女性，45 - 79岁）。使用凯尔格伦 - 劳伦斯分级（KLG）评估影像学严重程度。通过一个包含31个项目的衰弱指数对衰弱进行量化，将参与者分为非衰弱（≤0.10）、非常轻度衰弱（<0.1至≤0.2）、轻度衰弱（<0.2至≤0.3）和中度至重度衰弱（>0.3）。通过膝关节损伤和骨关节炎结局评分（KOOS）评估自我报告的疼痛。使用广义估计方程进行调节模型分析，对年龄、性别和体重指数进行调整，以测试衰弱与KLG对KOOS疼痛评分的相互作用。
影像学严重程度（β = -3.82，95%CI：-4.16：-3.49；p < 0.001）和衰弱（β = -4.76，95%CI：-5.36：-4.17；p < 0.001）与KOOS疼痛评分呈负相关。衰弱调节了这种关系（交互项：β = -1.18，95%CI：-1.63：-0.73，p < 0.001），即衰弱程度越高，影像学严重程度与疼痛之间的关联越强。简单斜率分析表明，与非衰弱和非常轻度衰弱的参与者相比，轻度至中度至重度衰弱的参与者中KLG与KOOS疼痛评分之间的关联更强（非衰弱：β = -2.71，95%CI：-3.41：-2.02，p < 0.001；中度至重度衰弱：β = -5.57，95%CI：-7.23：-3.87，p < 0.001）。
这些发现强调了将衰弱评估纳入膝关节骨关节炎管理的重要性，因为具有相似影像学严重程度的个体如果衰弱水平较高，可能会经历明显更严重的疼痛。
