Scientific Abstracts
Thursday, 12 June 2014
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collecting the data, particularly research nurses Boon C and Boon P. Warren R assessed MR images, and Dr Srikanth V and Dr Cooley H assessed radiographs.This study was supported by the National Health and Medical Research Council of Australia; Arthritis Foundation of Australia; Tasmanian Community Fund; Masonic Centenary Medical Research Foundation; Royal Hobart Hospital Research Foundation; and University of Tasmania Institutional Research Grants Scheme.
J Wang is supported by the China Scholarship Council. G Jones is supported by a National Health and Medical Research Council Practitioner Fellowship. C Ding is supported by an Australian Research Council Future Fellowship.
Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.6052
OP0059 THE COEXISTANCE OF OSTEOARTHRITIS AND NEUROPATHIC PAIN
D. Evcik1, S. Kibar2, S. Ay2, E. Yıldız2.1Department of Therapy and
Rehabilitation, Ankara University, Haymana Vocational School;2Department of
Physical Medicine and Rehabilitation, Ufuk University, School of Medicine, Ankara, Turkey
Background: The discordance between the structural damage and the severity
of the pain in knee osteoarthritis (OA) suggests the effect of central and peripheral sensitization mechanisms on pain perception. This comes into the question of whether the characteristics of neuropathic pain (NP) exist in OA.
Objectives: To investigate the existency of NP features in osteoarthritis patients. Methods: A total of 103 patients with knee pain lasting at least 3 months and
diagnosed as knee OA based on the criteria of American College of Rheumatology were included in this study. The patients having any disease that may cause NP and having NP medication were excluded. The patients’ knee radiographies were graded according to Kellgren Lawrence criteria. The patients were allocated in two groups; as grade I-II (Group 1) and grade III-IV (Group2). The frequency of NP were evaluated by The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Neuropathic Pain Diagnostic Questionnaire (DN4). Additionally the pain at rest and the activity were measured by Visual Analogue Scale (VAS), functional level was assessed by by Knee Outcome Survey-Activities for Daily Living Scale (KOS-ADSL) and quality of life was evaluated by Nottingham Health Profile (NHP).
Results: The mean ages of group 1 and group two were 59.74 and 67.30
respectively. The ratio of the results of LANNS and DN4 in group 1 was 10% and 79.2% in goup 2. There were statistically significant differences in group 2 in LANNS, DN-4, VAS, KOS-ADSL, NHP scores (p<0.001). A positive correlation
between NP scores (LANNS, DN-4) and the grades of disease was determined (p<0.0001, r=0,80 ve 0,81 respectively). Also there was a positive correlation
between NP (LANNS and DN-4) scores and KOS-ADSL (p<0.001, r=0,84 and
0.83). However LANNS and DN-4 were negatively correlated with NHP (p<0.001,
r=-0.88 ve -0.87).
Conclusions: The coexistence of NP increases with the progression of
os-teoarthritis. NP seems to have negative effects on functional level and quality of life. While planning a treatment program for progressive OA, NP should be kept in mind program of.
References:
[1] Finan PH, Buenaver LF, Bounds SC, et al. Discordance between pain and radiographic severity in knee osteoarthritis: findings from quantitative sensory testing of central sensitization. Arthritis Rheum. 2013;65(2):363-72. doi: 10.1002/art.34646.
[2] Allen K. Central pain contributions in osteoarthritis: next steps for im-proving recognition and treatment? Arthritis Res Ther. 2011;13(6):133. doi: 10.1186/ar3499.
[3] Ohtori S, Orita S, Yamashita M, et al. Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J. 2012 Jul 1;53(4):801-5. doi: 10.3349/ymj.2012.53.4.801.
Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.4929
OP0060 UNDERINVESTIGATED MECHANISMS OF CHRONIC PAIN IN KNEE OSTEOARTHRITIS
E. Turovskaya1,2, L. Alekseeva1, E. Filatova2.1laboratory of osteoarthritis,
Scientific-Research Institute of Rheumatology RAMS;2neurological department,
I.M.Sechenov First Moscow State Medical University, Moscow, Russian Federation
Background: In recent studies was shown that chronic pain in knee osteoarthritis
(OA) has multicomponent mechanism. Besides degenerative changes of the knee, neuroplastic changes of CNS play a leading role in sustaining pain in chronic status.
Objectives: To evaluate the role of CNS in pathogenesis of chronic pain syndrome
in knee osteoarthritis (OA).
Methods: 62 women (middle age 59±5) OA with chronic knee pain (duration more
than 3 months)passed through WOMAC, X-ray and US of the knee. Duration of knee symptoms, and pain intensity were taken into consideration. Neurological examination with detailed analysis of pain sensitivity, as well as qualitative analysis
of neuropathic transcripts with the help of neuropathic pain scales (Paindetect and DN4) were performed. We used the prevalence of anxiety and depressive disorders in population with OA, examined the interrelationships between severity of pain and emotional disturbances by Hospital Anxiety and Depression scale.
Results: According to the results of DN4 32% (n=20) pt with OA had DN4
score≥4 - neuropatic components of pain compared with 68% (n=42) who had only nociceptive mechanism of pain. Neurologic examination revealed 56%, (n=35) with referred hyperalgesia (not only knee localization (primary hyperalgesia) but also hip and shank localization) and 44%, (n=27) had primary hyperalgesia. No other somatosensory defects were found.
The presence of referred hyperalgesia correlated with higher pain intensity (VAS), poor WOMAC and significantly associated with higher level of depression, poor quality of life.No significant differences between groups were seen in age, body index, duration of knee OA and level of structural changes.
Conclusions: Chronic OA is a mixture of pain mechanisms: nociceptive and
dysfunctional pain. The presence of signs of NP and referred hyperalgesia, that spreads beyond impacted joint, may be qualified as clinical features of central sensitization.The degree of spreading sensitization is correlated with the level of clinical pain and does not correlate with structural changes.
The central sensitization of pain neurons of spinal chord take place in sustaining chronic pain and demonstrates the important role of these dysfunctional changes of CNS of chronic pain mechanisms in knee osteoarthritis (OA). So rational treatment should also target structures of central nervous system.
Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2014-eular.3801
OP0061 CROSS-SECTIONAL AND LONGITUDINAL ASSOCIATIONS BETWEEN KNEE JOINT EFFUSION AND KNEE PAIN IN OLDER ADULTS
X. Wang1, J. Xingzhong1, W. Han1,2, Y. Cao1,3, A. Halliday4, L. Blizzard1,
F. Cicuttini5, G. Jones1, C. Ding1,5,6.1University of Tasmania, Menzies Research
Institute Tasmania, Hobart, Australia;2Department of Orthopaedics, 3rd Affiliated
Hospital of Southern Medical University, Guangzhou;3Department of
Orthopaedics, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China;4Department of Radiology, Royal Hobart
Hospital, Hobart;5Department of Epidemiology and Preventive Medicine,
Monash University, Melbourne, Australia;6Arthritis Research Institute, 1st
Affiliated Hospital, Anhui Medical University, Hefei, China
Background: Knee pain is a prominent symptom of osteoarthritis (OA). Joint
synovial effusion could contribute to pain, but the relationship between them remains controversial. In addition, the effects of joint effusions at different knee compartments on knee pain are unclear.
Objectives: Aim of this study was to determine the cross-sectional and longitudinal
associations between knee joint effusions at different compartments and knee pain in older adults.
Methods: Population-based cohort study of older adults randomly selected
from local community (N=976, mean age 62.3 years, range from 50 to 80; 50.1% females). Knee joint effusions were measured at baseline using T2 weighted magnetic resonance imaging (MRI) at 4 compartments (suprapatellar pouch, central portion, posterior femoral recess, and subpopliteal recess). Other structural changes including cartilage defects, bone marrow lesions and meniscal lesions were assessed by MRI. OARSI atlas was used to assess knee osteophytes, joint space narrowing (JSN) and radiographic OA. Knee pain was assessed by self-administered Western Ontario and McMasters osteoarthritis index (WOMAC) questionnaire at baseline and 2.6 years later. The 5 WOMAC pain subscales were clinically constructed into weight-bearing pain and non-weight-bearing pain. Univariable and multivariable logistic regression analysis and generalized linear models with Poisson regression analysis were used to estimate prevalence ratios (PR) or relative risks (RR) for the association between knee effusion (0-3) and baseline or increases in knee pain.
Results: Prevalence of knee joint effusion (≥2) was 42.9% at suprapatellar pouch, 48.8% at central portion, 10.3% at posterior femoral recess and 14.4% at subpopliteal recess. Cross-sectionally, knee effusion at suprapatellar pouch was significantly associated with total (PR: 1.26, 95% CI 1.08 to 1.48) and non-weight bearing knee pain (PR: 1.24, 95% CI 1.06 to 1.46), but not with weight-bearing pain, after adjustment for age, gender, BMI, rheumatoid arthritis, radiographic OA and other knee structures. Joint effusions at other compartments were not significantly associated with knee pain.
Longitudinally, effusion at suprapatellar pouch was associated with increases in total (RR: 1.20, 95% CI 1.00 to 1.44), non-weight-bearing (RR: 1.38, 95% CI 1.09 to 1.75) and weight-bearing knee pain (RR: 1.26, 95% CI 1.04 to 1.53) after adjustment for above covariates. Effusions at posterior femoral recess and central portion were associated with increases in non-weight-bearing knee pain (RR: 1.55, 95% CI 1.25 to 1.91 and RR: 1.29, 95% CI 1.01 to 1.65; respectively) but not with weight-bearing knee pain. Effusion at subpopliteal recess was significantly associated with an increase in total knee pain (RR: 1.16, 95% CI 1.01 to 1.32) after adjustment for age, sex and BMI, but became non-significant after further adjustments.
Conclusions: Knee joint effusions have independent compartment-specific
associations with knee pain in older adults. Suprapatellar pouch effusion is associated with both non-weight-bearing and weight-bearing knee pain, while
