Depression as a determinant of pain severity and functional limitation in patients with knee osteoarthritis: a cross-sectional study

Mohammad Imtiaz Sultan; Mohammed Taherul Islam; Aparna Deb; Protyay Dey; M. Saiful Arif; Ananya Bhattacharjee; Mohammad Kafil Uddin Chowdher; M. Salman Ibna Zaman; Mrinal Saha; Toufiqul Islam; M. Jaber Abedin

doi:10.18203/2320-6012.ijrms20260867

Authors

Mohammad Imtiaz Sultan Department of Rheumatology, Kurmitola General Hospital, Dhaka, Bangladesh
Mohammed Taherul Islam Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh
Aparna Deb Department of Medicine, Upazila Health Complex, Fatikchari, Chittagong, Bangladesh
Protyay Dey Department of Nephrology, Chittagong Medical College, Chittagong, Bangladesh
M. Saiful Arif Department of Rheumatology, Chittagong Medical College, Chittagong, Bangladesh
Ananya Bhattacharjee Department of Medicine, BIRDEM General Hospital, Shahbagh, Dhaka, Bangladesh
Mohammad Kafil Uddin Chowdher Department of Rheumatology, Kurmitola General Hospital, Dhaka, Bangladesh
M. Salman Ibna Zaman Department of Medicine, Kurmitola General Hospital, Dhaka, Bangladesh
Mrinal Saha Department of Medicine, Upazila Health Complex, Companigonj, Noakhali, Bangladesh
Toufiqul Islam Department of Biochemistry, Chittagong Medical College Hospital, Chittagong, Bangladesh
M. Jaber Abedin Department of Internal Medicine, Feni 250 bed General hospital, Feni, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20260867

Keywords:

Knee osteoarthritis, Depression, PHQ-9, WOMAC, Pain, Functional limitation

Abstract

Background: Knee osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Psychosocial factors especially depression-could greatly affect pain perception and functional outcomes in people who are affected. Objectives were to assess the prevalence of depressive symptoms and their relationship with pain severity and functional limitation in knee OA patients.

Methods: This is a hospital-based cross-sectional study that included 110 adult patients with primary knee OA diagnosed according to American College of Rheumatology Criteria. Depressive symptoms were assessed by the patient health questionnaire-9 (PHQ-9). A cut-off score of ≥10 was considered clinically significant depression. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) assessed pain intensity and physical function. Continuous variables were summarized as mean±SD. Group comparisons were performed with independent t tests and correlations assessed using Spearman’s coefficient.

Results: The prevalence of clinically significant depressive symptoms was 20.9%. Patients with depression had mean WOMAC pain (19.2±8.1 vs 17.1±7.4; p=0·001) and function (67.5±22·5 vs 62.1±21·4; p<0·001) scores significantly higher than non-depressed patients. There was a positive correlation between PHQ-9 scores and WOMAC pain (r=0.33, p=0·002). PHQ-9 scores correlated positively also to function (r=0.41, p<0 ·001). A stepwise increase in pain and disability was observed according to the severity of depression.

Conclusions: Depressive symptoms are common for knee OA patients and significantly associated with high pain intensity level and functional limitation. Routine psychological screening can be performed using validated tools such as the PHQ-9, which may improve comprehensive management of OA.

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References

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163-96. DOI: https://doi.org/10.1016/S0140-6736(12)61729-2

Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59(9):1207-13. DOI: https://doi.org/10.1002/art.24021

Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011;155(11):725-32. DOI: https://doi.org/10.7326/0003-4819-155-11-201112060-00004

Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull. 2013;105:185-99. DOI: https://doi.org/10.1093/bmb/lds038

Palazzo C, Nguyen C, Lefevre-Colau M M, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Ann Physical Rehabilitat Med. 2016;59(3):134-8. DOI: https://doi.org/10.1016/j.rehab.2016.01.006

Rayner L, Hotopf M, Petkova H, Matcham F, Simpson A, McCracken LM. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain. 2016;157(7):1472-9. DOI: https://doi.org/10.1097/j.pain.0000000000000542

Iijima H, Aoyama T, Fukutani N, Isho T, Yamamoto Y, Hiraoka M, et al. Psychological health is associated with knee pain and physical function in patients with knee osteoarthritis: an exploratory cross-sectional study. BMC Psychol. 2018;6(1):19. DOI: https://doi.org/10.1186/s40359-018-0234-3

Sharma A, Kudesia P, Shi Q, Gandhi R. Anxiety and depression in patients with osteoarthritis: impact and management challenges. Open access Rheumatol Res Rev. 2016;8:103-13. DOI: https://doi.org/10.2147/OARRR.S93516

Kim KW, Han JW, Cho HJ, Chang CB, Park JH, Lee JJ, et al. Association between comorbid depression and osteoarthritis symptom severity in patients with knee osteoarthritis. J Bone Joint Surg Am. 2011;93(6):556-63. DOI: https://doi.org/10.2106/JBJS.I.01344

Leite AA, Costa AJ, Lima Bde A, Padilha AV, Albuquerque EC, Marques CD. Comorbidities in patients with osteoarthritis: frequency and impact on pain and physical function. Rev Bras Reumatol. 2011;51(2):118-23. DOI: https://doi.org/10.1590/S0482-50042011000200002

Kadam UT, Croft PR. Clinical comorbidity in osteoarthritis: associations with physical function in older patients in family practice. J Rheumatol. 2007;34(9):1899-904.

Haq SA, Darmawan J, Islam MN, Uddin MZ, Das BB, Rahman F, et al. Prevalence of rheumatic diseases and associated outcomes in rural and urban communities in Bangladesh: a COPCORD study. J Rheumatol. 2005;32(2):348-53.

Holla JF, van der Leeden M, Knol DL, Roorda LD, van der Esch M, Voorneman RE, et al. The association of body-mass index and depressed mood with knee pain and activity limitations in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort. BMC Musculoskelet Disord. 2013;14(1):296. DOI: https://doi.org/10.1186/1471-2474-14-296

Kadam UT, Jordan K, Croft PR. Clinical comorbidity in patients with osteoarthritis: a case-control study of general practice consulters in England and Wales. Ann Rheum Dis. 2004;63(4):408-14. DOI: https://doi.org/10.1136/ard.2003.007526

Zambon S, Siviero P, Denkinger M, Limongi F, Victoria Castell M, van der Pas S, et al. Role of Osteoarthritis, Comorbidity, and Pain in Determining Functional Limitations in Older Populations: European Project on Osteoarthritis. Arthritis Care Res (Hoboken). 2016;68(6):801-10. DOI: https://doi.org/10.1002/acr.22755

Jeong H, Baek SY, Kim SW, Eun YH, Kim IY, Lee J, et al. Comorbidities and healthrelated quality of life in Koreans with knee osteoarthritis: Data from the Korean National Health and Nutrition Examination Survey (KNHANES). PLoS ONE. 2017;12(10):e0186141 DOI: https://doi.org/10.1371/journal.pone.0186141

Dekker J, van Dijk GM, Veenhof C. Risk factors for functional decline in osteoarthritis of the hip or knee. Curr Opin Rheumatol. 2009;21(5):520-4. DOI: https://doi.org/10.1097/BOR.0b013e32832e6eaa

Swain S, Choudhury P. Comorbidity and healthcare utilization in osteoarthritis; a primary care survey from Odisha, India. Clin Epidemiol Global Health. 2019;7(4):661-7. DOI: https://doi.org/10.1016/j.cegh.2019.03.002

Singh JA, Lewallen DG. Time trends in the characteristics of patients undergoing primary total knee arthroplasty. Arthritis Care Res. 2013;66(6):897-906. DOI: https://doi.org/10.1002/acr.22233