March 17, 2020
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Diabetes increases knee OA pain intensity, worsens mental health

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Patients with knee osteoarthritis demonstrated higher average pain intensity and worse physical and mental health if they also have diabetes, according to data published in Arthritis Care & Research.

“Although the mechanisms driving the higher rates of incident and progressive OA in individuals with [diabetes] are unknown, epidemiologic and experimental data have strengthened the concept of a [diabetes]-induced OA phenotype,” Annett Eitner, PhD, of the University Hospital Jena, Friedrich Schiller University, in Germany, and colleagues wrote.

“Since OA pain intensity is not always aligned with radiographic severity, the source of pain is difficult to identify,” they added. “Hence, it is currently unclear whether the greater pain sensation reported by individuals with OA and [diabetes] is due to greater BMI and radiographic OA severity of those with [diabetes], or whether [diabetes] induces a particular phenotype of OA, in which other (pain) mechanisms are in play.”

Eitner and colleagues studied data from the Osteoarthritis Initiative to analyze whether OA knee pain and health status are worse among patients with both OA and diabetes, independent of potential cofounders. The Osteoarthritis Initiative is a longitudinal cohort study comprising information on 4,796 participants aged 45 to 70 years from four clinical centers. For their own study, Eitner and colleagues included 202 patients with OA and diabetes, and 2,279 patients with OA but without diabetes.

Patients with knee osteoarthritis demonstrated higher average pain intensity and worse physical and mental health if they also have diabetes, according to data
Patients with knee OA demonstrated higher average pain intensity and worse physical and mental health if they also have diabetes, according to data.

The researchers analyzed knee pain using the Knee injury and Osteoarthritis Outcome Score (KOOS) and numerical rating scale (NRS). They also evaluated physical and mental status using the Medical Outcomes Study Short Form 12 (SF12) and the Center for Epidemiological StudiesDepression Scale (CESD). The researchers then used linear regression models to determine the influence of diabetes, adjusting for age, sex, BMI and radiographic severity.

According to the researchers, patients with both OA and diabetes reported worse knee pain and greater physical and mental issues, compared with those without diabetes. Further, participants with diabetes demonstrated worse KOOSpain ( = –4.72; –7.22 to –2.23) and NRSpain ( = 0.42; 0.04-0.8) independent of BMI, OA severity, age and sex. Diabetes also had a negative impact on SF12 PCS ( = –3.49; –4.73 to –2.25), SF12 MCS ( = –1.42; –2.57 to –0.26) and CESD ( = 1.08; 0.08 to 2.08).

“Greater joint pain perceived by OA patients with [diabetes]is independent of greater BMI and radiographic severity,” Eitner and colleagues wrote. “Given greater pain and worse physical and mental health status compared with non-[diabetes] OA patients at the same radiographic disease stage, knee OA patients with [diabetes] require particular attention in preventing and managing knee osteoarthritis.” – by Jason Laday

Disclosure: Eitner reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.