Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies

doi:10.1136/bmj.b2844

Published 21 August 2009, doi:10.1136/bmj.b2844
Cite this as: BMJ 2009;339:b2844

Research

Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies

Tuhina Neogi, assistant professor of medicine¹, David Felson, professor of medicine¹, Jingbo Niu, research assistant professor of medicine¹, Michael Nevitt, professor of medicine², Cora E Lewis, professor of medicine³, Piran Aliabadi, professor of medicine⁴, Burt Sack, clinical professor of medicine¹, James Torner, professor of medicine⁵, Lawrence Bradley, professor of medicine³, Yuqing Zhang, professor of medicine¹

¹ Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Boston, MA 02118, USA, ² Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA 94107-1762, USA, ³ Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA, ⁴ Department of Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA, ⁵ University of Iowa, College of Public Health, E107 General Hospital, Iowa City, IA 52242, USA

Correspondence to: T Neogi tneogi{at}bu.edu

Objective To examine the relation of radiographic features ofosteoarthritis to knee pain in people with knees discordantfor knee pain in two cohorts.

Design Within person, knee matched, case-control study.

Setting and participants Participants in the Multicenter Osteoarthritis(MOST) and Framingham Osteoarthritis studies who had knee radiographsand assessments of knee pain.

Main outcome measures Association of each pain measure (frequency,consistency, and severity) with radiographic osteoarthritis,as assessed by Kellgren and Lawrence grade (0-4) and osteophyteand joint space narrowing grades (0-3) among matched sets oftwo knees within individual participants whose knees were discordantfor pain status.

Results 696 people from MOST and 336 people from Framinghamwere included. Kellgren and Lawrence grades were strongly associatedwith frequent knee pain—for example, for Kellgren andLawrence grade 4 v grade 0 the odds ratio for pain was 151 (95%confidence interval 43 to 526) in MOST and 73 (16 to 331) inFramingham (both P<0.001 for trend). Similar results werealso seen for the relation of Kellgren and Lawrence scores toconsistency and severity of knee pain. Joint space narrowingwas more strongly associated with each pain measure than wereosteophytes.

Conclusions Using a method that minimises between person confounding,this study found that radiographic osteoarthritis and individualradiographic features of osteoarthritis were strongly associatedwith knee pain.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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