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Contribution of central and peripheral risk factors to prevalence, incidence and progression of knee pain: a community-based cohort study

Sarmanova, A.; Fernandes, G.S.; Richardson, H.; Valdes, A.M.; Walsh, D.A.; Zhang, W.; Doherty, M.


A. Sarmanova

G.S. Fernandes

H. Richardson

Professor of Rheumatology

M. Doherty



To explore risk factors that may influence knee pain (KP) through central or peripheral mechanisms.


A questionnaire-based prospective community cohort study with KP defined as pain in or around a knee on most days for at least a month. Baseline prevalence, and one year incidence and progression (KP worsening) were examined. Central (e.g., Pain Catastrophizing Scale (PCS)) and peripheral (e.g., significant injury) risk factors were examined. Adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression. Proportional risk contribution (PRC) was estimated using receiver-operator-characteristic (ROC) analysis.


Of 9506 baseline participants, 4288 (45%) had KP (men 1826; women, 2462). KP incidence was 12% (men 11%, women 13%), and KP progression 19% (men 16%, women 21%) at one year. While both central and peripheral factors contributed to prevalence, central factors contributed more to progression, and peripheral factors more to incidence of KP. For example, although PCS (OR 2.06, 95% CI 1.88–2.25) and injury (5.62, 4.92–6.42) associated with KP prevalence, PCS associated with progression (2.27, 1.83–2.83) but not incidence (1.14, 0.86–1.52), whereas injury more strongly associated with incidence (69.27, 24.15–198.7) than progression (2.52, 1.48–4.30). The PRC of central and peripheral factors were 19% and 23% for prevalence, 14% and 29% for incidence, and 29% and 5% for progression, respectively.


Both central and peripheral risk factors influence KP but relative contributions may differ in terms of development (mainly peripheral) and progression (mainly central). Further study of such relative contributions may inform primary and secondary prevention strategies.


Sarmanova, A., Fernandes, G., Richardson, H., Valdes, A., Walsh, D., Zhang, W., & Doherty, M. (2018). Contribution of central and peripheral risk factors to prevalence, incidence and progression of knee pain: a community-based cohort study. Osteoarthritis and Cartilage, 26(11), 1461-1473.

Journal Article Type Article
Acceptance Date Jul 26, 2018
Online Publication Date Aug 10, 2018
Publication Date Nov 30, 2018
Deposit Date Sep 10, 2018
Publicly Available Date Nov 1, 2018
Journal Osteoarthritis and Cartilage
Print ISSN 1063-4584
Electronic ISSN 1522-9653
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 26
Issue 11
Pages 1461-1473
Keywords Knee pain; Risk factors; Cohort; Incidence; Osteoarthritis
Public URL
Publisher URL


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