kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.3.145 kjhp-16-145 Original Article Factors Associated with Knee Pain with Different Grades of Knee Osteoarthritis among Korean Adults Aged 50 Years or More ChoiEun Young KimMin Jeong Department of Family Medicine, Dankook Univeristy Hospital, Dankook University College of Medicine, Cheonan, Korea Corresponding author: Eun Young Choi, MD, PhD Department of Family Medicine, Dankook Univeristy Hospital, Dankook University College of Medicine, 201 Manghyang‐ro, Dongnam‐gu, Cheonan 31116, Korea Tel: +82‐41‐550‐3998, Fax: +82‐41‐550‐3998 E‐mail: choiey0410@gmail.com 01 2016 20 01 2016 16 3 145 152 27072015 11112015 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

Discordance between knee pain and radiologic osteoarthritis is well‐known. This study was to investigate factors associated with knee pain with different grades of knee osteoarthritis among Korean adults aged 50 years or more.

 Methods

Total 5,978 Korean aged 50 years or more who underwent the radiographs of the knees were analyzed from Korean National Nutrition and Health Examination Survey conducted in 2010‐11. Radiographs of the knees were scored for osteoarthritis using the Kellgren‐Lawrence scale. Multivariate logistic regression analysis adjusting for sociodemographic factors, lifestyle factors, comorbidity and health status was used for analysis.

 Results

The prevalence of knee pain was higher in female compared to that of male (P<0.001), and increased as increasing severity of radiologic knee osteoarthritis. Female was associated with increased risk of knee pain in all of Kellgren‐Lawrence degrees. In most of Kellgren‐Lawrence degrees, depression was associated with increased risk of knee pain, and those with high school diploma or higher were associated with decreased risk of knee pain. A few factors (age, body mass index, and no alcohol drinking) were also associated with increased risk of knee pain for particular grades of radiographic knee osteoarthritis.

 Conclusions

Knee pain increased as increasing severity of radiologic knee osteoarthritis. Although there were differences of risk factors associated with knee pain with different grades of knee osteoarthritis, female, depression were associated with increased of knee pain, and those with high school diploma or higher were associated with decreased risk of knee pain in most of Kellgren‐Lawrence degrees.

 References Shin DW Nam S Bang YS Lee JY Estimation of the prevalence of Korean adults aged 50 years or more with knee osteoarthritis based on the data from fifth Korea National Health and Nutrition Examination Survey J Korean Med Assoc 201356 5): 431‐6. Bedson J Croft PR The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature BMC Musculoskelet Disord 20089 116 Kim IJ Kim HA Seo YI Jung YO Song YW Jeong JY Prevalence of knee pain and its influence on quality of life and physical function in the Korean elderly population: a community based cross‐sectional study J Korean Med Sci 201126 9): 1140‐6. Schiphof D Kerkhof HJ Damen J de Klerk BM Hofman A Koes BW Factors for pain in patients with different grades of knee osteoarthritis Arthritis Care Res (Hoboken) 201365 5): 695‐702. Cho NH Kim S Kim HA Seo YI The prevalence and risk factors of knee and hand osteoarthritis in Korea J Korean Rheum Assoc 200714 4): 354‐62. Kim I Kim HA Seo YI Song YW Jeong JY Kim DH The prevalence of knee osteoarthritis in elderly community residents in Korea J Korean Med Sci 201025 2): 293‐8. Jhun HJ Sung NJ Kim SY Knee pain and its severity in elderly Koreans: prevalence, risk factors and impact on quality of life J Korean Med Sci 201328 12): 1807‐13. Han HS Lee JY Kang SB Chang CB The relationship between the presence of depressive symptoms and the severity of self‐reported knee pain in the middle aged and elderly Knee Surg Sports Traumatol Arthrosc 201624 5): 1634‐42. Cho HJ Chang CB Yoo JH Kim SJ Kim TK Gender differences in the correlation between symptom and radiographic severity in patients with knee osteoarthritis Clin Orthop Relat Res 2010468 7): 1749‐58. Glass N Segal NA Sluka KA Torner JC Nevitt MC Felson DT Examining sex differences in knee pain: the multicenter osteoarthritis study Osteoarthritis Cartilage 201422 8): 1100‐6. Brandt KD Heilman DK Slemenda C Katz BP Mazzuca S Braunstein EM A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis J Rheumatol 200027 8): 1937‐46. Creamer P Lethbridge‐Cejku M Costa P Tobin JD Herbst JH Hochberg MC The relationship of anxiety and depression with self‐reported knee pain in the community: data from the Baltimore Longitudinal Study of Aging Arthritis Care Res 199912 1): 3‐7. van Baar ME Dekker J Lemmens JA Oostendorp RA Bijlsma JW Pain and disability in patients with osteoarthritis of hip or knee: the relationship with articular, kinesiological, and psychological characteristics J Rheumatol 199825 1): 125‐33. Phyomaung PP Dubowitz J Cicuttini FM Fernando S Wluka AE Raaijmaakers P Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review BMC Musculoskelet Disord 201415 10 Yoshimura M Furue H Mechanisms for the anti‐nociceptive actions of the descending noradrenergic and serotonergic systems in the spinal cord J Pharmacol Sci 2006101 2): 107‐17. Leeuw M Goossens ME Linton SJ Crombez G Boersma K Vlaeyen JW The fear‐avoidance model of musculoskeletal pain: current state of scientific evidence J Behav Med 200730 1): 77‐94. Hayley S Poulter MO Merali Z Anisman H The pathogenesis of clinical depression: stressor‐and cytokine‐induced alterations of neuroplasticity Neuroscience 2005135 3): 659‐78. Pereira D Severo M Ramos E Branco J Santos RA Costa L Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis Int J Rheum Dis 2015 May 7 [Epub ahead of print]. Felson DT Zhang Y Hannan MT Naimark A Weissman B Aliabadi P Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study Arthritis Rheum 199740 4): 728‐33. Rogers MW Wilder FV The association of BMI and knee pain among persons with radiographic knee osteoarthritis: a cross‐sectional study BMC Musculoskelet Disord 20089 163 Felson DT Zhang Y Anthony JM Naimark A Anderson JJ Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study Ann Intern Med 1992116 7): 535‐9. Hartz AJ Fischer ME Bril G Kelber S Rupley D Jr. Oken B The association of obesity with joint pain and osteoarthritis in the HANES data J Chronic Dis 198639 4): 311‐9. Griffin TM Guilak F The role of mechanical loading in the onset and progression of osteoarthritis Exerc Sport Sci Rev 200533 4): 195‐200. Visser M Kritchevsky SB Goodpaster BH Newman AB Nevitt M Stamm E Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study J Am Geriatr Soc 200250 5): 897‐904. Cecchi F Mannoni A Molino‐Lova R Ceppatelli S Benvenuti E Bandinelli S Epidemiology of hip and knee pain in a community based sample of Italian persons aged 65 and older Osteoarthritis Cartilage 200816 9): 1039‐46. Davis MA Ettinger WH Neuhaus JM Barclay JD Segal MR Correlates of knee pain among US adults with and without radiographic knee osteoarthritis J Rheumatol 199219 12): 1943‐9. Wesseling J Bastick AN ten Wolde S Kloppenburg M Lafeber F Bierma‐Zeinstra SM Identifying trajectories of pain severity in early symptomatic knee osteoarthritis: a 5‐year followup of the cohort hip and cohort knee (CHECK) study J Rheumatol 201542 8): 1470‐7. Adamson J Ebrahim S Dieppe P Hunt K Prevalence and risk factors for joint pain among men and women in the West of Scotland Twenty‐07 study Ann Rheum Dis 200665 4): 520‐4. Williams JW Jr Mulrow CD Kroenke K Dhanda R Badgett RG Omori D Case‐finding for depression in primary care: a randomized trial Am J Med 1999106 1): 36‐43. Yusuf E Kortekaas MC Watt I Huizinga TW Kloppenburg M Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review Ann Rheum Dis 201170 1): 60‐7. Figures and Tables

Frequency of knee pain according to K‐L grade.

Chacracteristics of participants according to the presence of knee paina

　 Knee pain (‐) Knee pain (+) Pb
N 4,636 1,342  
Female 47.1 (0.7) 75.4 (1.3) <0.001
Age, y 61.1 (0.2) 66.7 (0.4) <0.001
Married 83.0 (0.7) 65.5 (1.9) <0.001
BMI, kg/m2 23.9 (0.1) 24.6 (0.1) <0.001
Education     <0.001
Middle school 60.4 (1.2) 86.0 (1.1)  
High school 26.7 (0.9) 10.6 (1.0)  
University 12.9 (0.9) 3.4 (0.6)  
Alcohol use 51.5 (0.9) 32.9 (1.8) <0.001
Current smoking 21.8 (0.8) 12.6 (1.1) <0.001
Regular exercise 49.0 (1.0) 43.2 (1.8) 0.002
Manual Occupation 37.7 (1.4) 34.6 (2.1) 0.083
Diabetes 16.5 (0.7) 17.8 (1.5) 0.427
Hypertension 48.4 (1.0) 59.3 (1.8) <0.001
Depression 13.3 (0.6) 24.0 (1.4) <0.001
Osteoarthritis 27.0 (0.9) 63.2 (1.6) <0.001
K‐L grade     <0.001
0 48.5 (1.1) 20.3 (1.5)  
1 24.5 (0.8) 16.5 (1.2)  
2 13.4 (0.7) 12.4 (1.1)  
3 or 4 13.5 (0.7) 50.8 (1.7)  

Abbreviations: BMI, body mass index; K‐L grade, Kellgren‐ Lawrence grade.

Data are presented as mean (standard error) or percentage (standard error).

Calculated by chi‐square test or t‐test.

Factors associated with knee paina

  OR P
Sex   <0.001
Male 1.00  
Female 1.98 (1.58‐2.48)  
Age, y 1.03 (1.02‐1.04) <0.001
Marital status   0.810
Unmarried 1.00  
Married 1.02 (0.82‐1.26)  
BMI, kg/m2 1.03 (0.99‐1.06) 0.195
Educationb   <0.001
Middle school 1.00  
High school 0.51 (0.40‐0.65)  
University 0.42 (0.28‐0.63)  
Alcohol use   0.438
No 1.00  
Yes 0.93 (0.76‐1.13)  
Smoking   0.917
No 1.00  
Yes 1.02 (0.77‐1.36)  
Regular exercise   0.273
No 1.00  
Yes 0.97 (0.74‐1.26)  
Occupation   0.215
Office worker 1.00  
Manual worker 1.13 (0.92‐1.37)  
Diabetes   0.707
No 1.00  
Yes 0.94 (0.74‐1.21)  
Hypertension   0.876
No 1.00  
Yes 1.05 (0.85‐1.29)  
Depression   <0.001
No 1.00  
Yes 1.88 (1.51‐2.34)  
K‐L gradeb   <0.001
0 1.00  
1 1.34 (1.01‐1.77)  
2 1.77 (1.34‐2.34)  
3 or 4 4.79 (3.76‐6.12)  

Abbreviations: BMI, body mass index; K‐L grade, Kellgren‐ Lawrence grade.

Calculated by multiple logistic regression analysis mutually adjusted for all variables shown.

Ptrend<0.001.

Factors associated with knee pain according to K‐L gradea

　   K‐L grade  
　 Grade 0 Grade 1 Grade 2 Grade 3‐4
Sex        
Male 1.00 1.00 1.00 1.00
Female 1.73 (1.16‐2.59) 2.24 (1.35‐3.70) 1.73 (1.01‐2.96) 2.15 (1.35‐3.42)
Age, y 1.05 (1.02‐1.07) 1.01 (0.98‐1.04) 1.01 (0.99‐1.04) 1.03 (1.01‐1.05)
Marital status        
Unmarried 1.00 1.00 1.00 1.00
Married 1.00 (0.67‐1.51) 1.19 (0.68‐2.07) 0.73 (0.42‐1.25) 1.11 (0.81‐1.51)
BMI, kg/m2 1.05 (0.98‐1.12) 0.98 (0.91‐1.07) 0.93 (0.85‐1.02) 1.06 (1.01‐1.11)
Education        
Middle school 1.00 1.00 1.00 1.00
High school 0.55 (0.36‐0.86) 0.60 (0.35‐1.03) 0.58 (0.32‐1.05) 0.36 (0.21‐0.61)
University 0.62 (0.34‐1.12) 0.35 (0.15‐0.82) 0.43 (0.14‐1.33) 0.26 (0.11‐0.61)
Alcohol use        
No 1.00 1.00 1.00 1.00
Yes 0.96 (0.68‐1.35) 0.78 (0.49‐1.22) 0.50 (0.33‐0.76) 1.28 (0.88‐1.87)
Smoking        
No 1.00 1.00 1.00 1.00
Yes 0.86 (0.50‐1.48) 1.12 (0.63‐2.01) 1.08 (0.58‐2.00) 1.15 (0.64‐2.10)
Regular exercise        
No 1.00 1.00 1.00 1.00
Yes 0.83 (0.58‐1.18) 1.00 (0.68‐1.48) 0.63 (0.39‐1.01) 0.97 (0.74‐1.26)
Occupation        
Office worker 1.00 1.00 1.00 1.00
Manual worker 1.19 (0.79‐1.78) 0.95 (0.61‐1.48) 1.37 (0.88‐2.15) 1.17 (0.86‐1.57)
Diabetes        
No 1.00 1.00 1.00 1.00
Yes 0.92 (0.54‐1.57) 0.72 (0.42‐1.22) 0.93 (0.54‐1.62) 1.10 (0.76‐1.59)
Hypertension        
No 1.00 1.00 1.00 1.00
Yes 0.86 (0.59‐1.25) 1.11 (0.71‐1.74) 1.12 (0.74‐1.71) 1.20 (0.89‐1.62)
Depression        
No 1.00 1.00 1.00 1.00
Yes 2.16 (1.45‐3.20) 1.44 (0.90‐2.29) 3.18 (1.91‐5.32) 1.62 (1.12‐2.33)

Abbreviations: K‐L grade, Kellgren‐Lawrence grade; BMI, body mass index.

Calculated by multiple logistic regression analysis mutually adjusted for all variables shown.