Factors Associated with Knee Pain with Different Grades of Knee Osteoarthritis among Korean Adults Aged 50 Years or More

Eun Young Choi; Min Jeong Kim

doi:10.15384/kjhp.2016.16.3.145

Korean J Health Promot > Volume 16(3); 2016 > Article

Choi and Kim: Factors Associated with Knee Pain with Different Grades of Knee Osteoarthritis among Korean Adults Aged 50 Years or More

Original Article

Korean Journal of Health Promotion 2016;16(3):145-152.

Published online: January 20, 2016

DOI: https://doi.org/10.15384/kjhp.2016.16.3.145

Factors Associated with Knee Pain with Different Grades of Knee Osteoarthritis among Korean Adults Aged 50 Years or More

Department of Family Medicine, Dankook Univeristy Hospital, Dankook University College of Medicine, Cheonan, Korea

Eun Young Choi, Min Jeong Kim

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

Received July 27, 2015 Accepted November 11, 2015

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.

요약

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.

Figure 1.

Frequency of knee pain according to K‐L grade.

Table 1.

Chacracteristics of participants according to the presence of knee pain^a

	Knee pain (‐)	Knee pain (+)	P^b
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.

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

^b Calculated by chi‐square test or t‐test.

Table 2.

Factors associated with knee pain^a

	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
Education^b		<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 grade^b		<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.

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

^b P_trend<0.001.

Table 3.

Factors associated with knee pain according to K‐L grade^a

		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.

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

References

1. 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 2013;56(5):): 431‐6..

2. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord 2008;9:116.

3. Kim IJ, Kim HA, Seo YI, Jung YO, Song YW, Jeong JY, et al. 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 2011;26(9):): 1140‐6..

4. Schiphof D, Kerkhof HJ, Damen J, de Klerk BM, Hofman A, Koes BW, et al. Factors for pain in patients with different grades of knee osteoarthritis. Arthritis Care Res (Hoboken) 2013;65(5):): 695‐702..

5. Cho NH, Kim S, Kim HA, Seo YI. The prevalence and risk factors of knee and hand osteoarthritis in Korea. J Korean Rheum Assoc 2007;14(4):): 354‐62..

6. 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 2010;25(2):): 293‐8..

7. 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 2013;28(12):): 1807‐13..

8. 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 2016;24(5):): 1634‐42..

9. 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 2010;468(7):): 1749‐58..

10. Glass N, Segal NA, Sluka KA, Torner JC, Nevitt MC, Felson DT, et al. Examining sex differences in knee pain: the multicenter osteoarthritis study. Osteoarthritis Cartilage 2014;22(8):): 1100‐6..

11. Brandt KD, Heilman DK, Slemenda C, Katz BP, Mazzuca S, Braunstein EM, et al. 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 2000;27(8):): 1937‐46..

12. 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 1999;12(1):): 3‐7..

13. 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 1998;25(1):): 125‐33..

14. Phyomaung PP, Dubowitz J, Cicuttini FM, Fernando S, Wluka AE, Raaijmaakers P, et al. Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review. BMC Musculoskelet Disord 2014;15:10.

15. Yoshimura M, Furue H. Mechanisms for the anti‐nociceptive actions of the descending noradrenergic and serotonergic systems in the spinal cord. J Pharmacol Sci 2006;101(2):): 107‐17..

16. 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 2007;30(1):): 77‐94..

17. Hayley S, Poulter MO, Merali Z, Anisman H. The pathogenesis of clinical depression: stressor‐and cytokine‐induced alterations of neuroplasticity. Neuroscience 2005;135(3):): 659‐78..

18. Pereira D, Severo M, Ramos E, Branco J, Santos RA, Costa L, et al. 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]..

19. Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, et al. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum 1997;40(4):): 728‐33..

20. Rogers MW, Wilder FV. The association of BMI and knee pain among persons with radiographic knee osteoarthritis: a cross‐sectional study. BMC Musculoskelet Disord 2008;9:163.

21. 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 1992;116(7):): 535‐9..

22. Hartz AJ, Fischer ME, Bril G, Kelber S, Rupley D, Jr. , Oken B, et al. The association of obesity with joint pain and osteoarthritis in the HANES data. J Chronic Dis 1986;39(4):): 311‐9..

23. Griffin TM, Guilak F. The role of mechanical loading in the onset and progression of osteoarthritis. Exerc Sport Sci Rev 2005;33(4):): 195‐200..

24. Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm E, et al. 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 2002;50(5):): 897‐904..

25. Cecchi F, Mannoni A, Molino‐Lova R, Ceppatelli S, Benvenuti E, Bandinelli S, et al. Epidemiology of hip and knee pain in a community based sample of Italian persons aged 65 and older. Osteoarthritis Cartilage 2008;16(9):): 1039‐46..

26. 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 1992;19(12):): 1943‐9..

27. Wesseling J, Bastick AN, ten Wolde S, Kloppenburg M, Lafeber F, Bierma‐Zeinstra SM, et al. 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 2015;42(8):): 1470‐7..

28. 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 2006;65(4):): 520‐4..

29. Williams JW Jr, Mulrow CD, Kroenke K, Dhanda R, Badgett RG, Omori D, et al. Case‐finding for depression in primary care: a randomized trial. Am J Med 1999;106(1):): 36‐43..

30. 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 2011;70(1):): 60‐7..