For people with early osteoarthritis in their knee, a new study suggests that worsening symptoms may be tied to rapidly progressing damage in their joint.
INTRODUCTION
Osteoarthritis happens when the protective cartilage on the ends of bones within joints wears down over time. When cartilage is lost the bones rub together. Over time this rubbing can permanently damage the joint, making it painful and unstable. The knee is one of the most common joints affected by osteoarthritis.
This may sound straightforward enough, but the symptoms people get from osteoarthritis don’t always correspond to their amount of joint damage. For example, people who have X-rays showing they have a lot of damage may not have any symptoms. But others, with less-severe damage, may have a lot of pain and problems moving their joint.
This has raised questions about how osteoarthritis progresses and how closely joint damage is linked with worsening symptoms, particularly at the early stages of the disease. Not much research has explored this.
WHAT DID THE RESEARCHERS HOPE TO FIND?
In this study researchers wanted to learn more about how knee osteoarthritis progresses by following people in the early stages of the disease for up to five years.
WHO WAS STUDIED?
The researchers gathered information from two large studies on nearly 2,300 people who had symptoms of early osteoarthritis. All the people were aged 45 to 65 when the studies began.
HOW WAS THE STUDY CONDUCTED?
The people had X-rays to assess their joint damage several times over four or five years. They also regularly completed questionnaires about their symptoms, including their level of pain and what they could do physically (their physical function).
The researchers then looked at how their joint damage and their symptoms changed over time, to see how closely patients’ pain and physical function were related to the actual damage seen in their joints.
WHAT DOES THE NEW STUDY SAY?
Overall, people’s level of pain and physical function stayed fairly stable during the follow-up. However, some people’s symptoms got much worse because the progression of their osteoarthritis was more rapid. The researchers found that people with X-rays showing more extensive new damage reported considerably more pain and had greater declines in their physical function, compared with those showing little or no new damage.
HOW RELIABLE ARE THE FINDINGS?
The researchers used reliable methods to assess people’s symptoms and their level of joint damage. They also took into account several things that might have affected people’s pain and physical function, such as their sex, age, whether they were overweight, the number of hours they usually worked, their racial background, and whether they also had hip pain. This strengthens their findings.
However, they weren’t able to consider whether people had other health problems. This also might have affected the people’s symptoms and how well they coped physically.
WHAT DOES THIS MEAN FOR ME?
This study will probably be more of interest to researchers than to people with knee osteoarthritis. However, its findings are important, as they add to our understanding of how the disease progresses in its early stages. This could one day lead to new treatments to help prevent joint damage and improve osteoarthritis symptoms.
In the meantime there are many treatments that can help if you have knee osteoarthritis, including medicines, physiotherapy, and surgery. Maintaining a healthy weight and taking regular exercise can also make a difference. You can talk to your doctor about what might be best for you.
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Date summary prepared: February 2015
Summary based on research article published on: 15 November 2013
From: Wesseling J, Bierma-Zeinstra SM, Kloppenburg M, et al. Worsening of pain and function over 5 years in individuals with ‘early’ OA is related to structural damage: data from the Osteoarthritis Initiative and CHECK (Cohort Hip & Cohort Knee) study. Ann Rheum Dis 2015;74:347–53. doi:10.1136/annrheumdis-2013- 203829
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