Maja R. Radoj?i?
Pain trajectory defines knee osteoarthritis subgroups: a prospective observational study
Radoj?i?, Maja R.; Arden, Nigel K.; Yang, Xiaotian; Strauss, Victoria Y.; Birrell, Fraser; Cooper, Cyrus; Kluzek, Stefan; VIDEO Trial Investigators
Authors
Nigel K. Arden
Xiaotian Yang
Victoria Y. Strauss
Fraser Birrell
Cyrus Cooper
STEFAN KLUZEK Stefan.Kluzek@nottingham.ac.uk
Clinical Associate Professor
VIDEO Trial Investigators
Abstract
Knee osteoarthritis (OA) is a heterogeneous disease, and identification of its subgroups/phenotypes can improve patient treatment and drug development. We aimed to identify homogeneous OA subgroups/phenotypes using pain development over time; to understand the interplay between pain and functional limitation in time course, and to investigate subgroups' responses to available pharmacological and surgical treatments. We used group-based trajectory modelling to identify pain trajectories in the phase-three VIDEO trial (n=474, three-year follow-up) and also in the Osteoarthritis Initiative cohort study (n=4796, nine-year follow-up). We extended trajectory models by (1) fitting dual trajectories to investigate the interplay between pain and functional limitation over time, and (2) including analgesic use as a time-varying covariate. Also, we investigated the relationship between trajectory-groups and knee replacement in regression models. We identified four pain trajectory-groups in the trial and six in the cohort. These overlapped and led us to define four OA phenotypes: low-fluctuating, mild-increasing, moderate-treatment-sensitive and severe-treatment-insensitive pain. Over time, functional knee limitation followed the same trajectory as pain with almost complete concordance (94.3%) between pain and functional limitation trajectory-groups. Notably, we identified a phenotype with severe pain that did not benefit from available treatments, and another one most likely to benefit from knee replacement. Thus, knee OA subgroups/phenotypes can be identified based on patients' pain experiences in studies with long and regular follow-up. We provided a robust approach, reproducible between different study designs that informs clinicians about symptom development and delivery of treatment options and opens a new avenue toward personalized medicine in OA.
Citation
Radojčić, M. R., Arden, N. K., Yang, X., Strauss, V. Y., Birrell, F., Cooper, C., …VIDEO Trial Investigators. (2020). Pain trajectory defines knee osteoarthritis subgroups: a prospective observational study. PAIN, 161(12), 2841-2851. https://doi.org/10.1097/j.pain.0000000000001975
Journal Article Type | Article |
---|---|
Acceptance Date | Jun 2, 2020 |
Online Publication Date | Jun 24, 2020 |
Publication Date | Dec 1, 2020 |
Deposit Date | Jul 13, 2020 |
Publicly Available Date | Jul 14, 2020 |
Journal | Pain |
Print ISSN | 0304-3959 |
Electronic ISSN | 1872-6623 |
Publisher | Lippincott, Williams & Wilkins |
Peer Reviewed | Peer Reviewed |
Volume | 161 |
Issue | 12 |
Pages | 2841-2851 |
DOI | https://doi.org/10.1097/j.pain.0000000000001975 |
Keywords | Anesthesiology and Pain Medicine; Neurology; Clinical Neurology |
Public URL | https://nottingham-repository.worktribe.com/output/4766366 |
Publisher URL | https://journals.lww.com/pain/Fulltext/2020/12000/Pain_trajectory_defines_knee_osteoarthritis.19.aspx |
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Publisher Licence URL
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