Do Knee Pain Phenotypes Have Different Risks of Total Knee Replacement?
Do Knee Pain Phenotypes Have Different Risks of Total Knee Replacement?
复制标题
膝关节疼痛表型是否有不同的全膝关节置换术风险？
DOI：
10.3390/jcm9030632
复制
发表时间：
2020-03-01
影响因子：
3.9
通讯作者：
Jones, Graeme
中科院分区：
文献类型：
--
作者：
Pan, Feng;Tian, Jing;Jones, Graeme
疼痛是骨关节炎（OA）患者寻求包括关节置换在内的医疗保健的主要动力。OA患者的疼痛体验是异质性的，受多个领域（外周、心理和神经）因素的影响。这表明疼痛OA患者中存在同质亚组/表型。我们最近使用广泛的疼痛相关因素确定了三种疼痛表型，包括磁共振成像（MRI）上的结构损伤、情绪问题、疼痛部位数量、性别、体重指数、教育水平和合并症（即，一级：第二类：情绪问题发生率低，结构性损害发生率高（25%）;第三类：情绪问题发生率低，结构性损害发生率低（20%）;第四类：情绪问题发生率低，结构性损害发生率低（55%）。本研究旨在检查这三种疼痛表型之间12年以上的全膝关节置换（TKR）风险是否不同。使用了来自基于人群的队列研究的963名参与者（平均年龄62.8 ± 7.4岁）的数据。收集了社会人口统计学、心理学和合并症的数据。对右膝结构病理进行MRI检查。通过与澳大利亚骨科协会国家关节置换登记中心联系，确定TKR病史。采用潜在类别分析和考克斯比例风险模型进行分析。在随访期间，在67名参与者中识别出41例右侧和44例左侧TKR。在多变量分析中，1类和2类受试者的TKR风险较高（1类vs. 3类，HR（风险比）4.81，95%CI（置信区间）2.33-9.93; 2类vs. 3类，HR 9.23，95%CI 4.66-18.30）。这些关联在右膝成像中更强，但在左膝中也很明显。不同疼痛表型的受试者具有不同的TKR风险，这表明所识别的表型反映了具有不同疼痛的不同临床亚组。1级患者的TKR风险高于3级患者，表明疼痛/情绪状态是比结构损伤更强的TKR驱动因素，需要在临床实践中优化TKR患者的选择。
Pain is the main impetus for osteoarthritis (OA) patients to seek healthcare including joint replacement. The pain experience in OA is heterogeneous and affected by factors across multiple domains-peripheral, psychological, and neurological. This indicates the existence of homogenous subgroups/phenotypes within OA patients with pain. We recently identified three pain phenotypes using a wide spectrum of pain-related factors, including structural damage on magnetic resonance imaging (MRI), emotional problems, number of painful sites, sex, body mass index, education level and comorbidities (i.e., Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%); Class 2: low prevalence of emotional problems and high prevalence of structural damage (20%); Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%)). This study was to examine whether the total knee replacement (TKR) risk over 12 years was different among these three pain phenotypes. Data on 963 participants (mean age 62.8 +/- 7.4 years) from a population-based cohort study were utilised. Data on socio-demographic, psychological and comorbidities were collected. MRI of the right knee structural pathology was performed. TKR history was ascertained by linking to the Australian Orthopedic Association National Joint Replacement Registry. Latent class analysis and the Cox proportional hazards model were applied for the analysis. During the follow-up period, 41 right and 44 left TKRs in 67 participants were identified. In multivariable analyses, participants in Class 1 and 2 had a higher risk of having a TKR (Class 1 vs. Class 3, HR (hazard ratio) 4.81, 95%CI (confidence interval) 2.33-9.93; Class 2 vs. Class 3, HR 9.23, 95%CI 4.66-18.30). These associations were stronger in the imaged right knee but were also significant in the left knee. Participants within distinct pain phenotypes have different risks of TKR, suggesting that the identified phenotypes reflect distinct clinical subgroups with different prognoses. The risk for TKR was higher in Class 1 than that in Class 3, suggesting that pain/emotional status is a stronger driver for TKR than structural damage, and that selecting patients for TKR needs to be optimized in clinical practice.