Depression may worsen symptoms in older patients with knee OA

Clinical depression can exacerbate the symptoms of knee osteoarthritis beyond what is evident on X-rays, according to a study recently published in the Journal of Bone and Joint Surgery.

The study also noted that patients with mild or moderate knee osteoarthritis (OA) were most likely to experience a connection between OA symptoms and depression, according to an American Academy of Orthopaedic Surgeons (AAOS) press release.

“Despite the reported satisfactory outcomes of knee replacement surgery, a percentage of patients still experience knee pain and impaired movement,” lead author Tae Kyun Kim, MD, stated in the release. “Sometimes pain and disability after surgery is medically unexplained, so in these patients screening for depression might be a very good option.”

Radiographic, symptom severity

Kim and colleagues investigated 660 elderly Korean patients. The investigators evaluated the patients’ radiographic severity of knee OA using the Kellgren-Lawrence grading system and symptom severity using the WOMAC scale. The investigators also used patient interviews and a questionnaire that made use of a geriatric depression scale to assess depressive disorders.

They performed regression analyses to assess relative contributions by radiographic severity and depression severity to WOMAC scores to explore potential associations between radiographic severity and the presence of a depressive disorder with regards to the risk of symptomatic knee OA.

The investigators found that the presence of a depressive disorder was associated with an increased risk of symptomatic knee OA. They noted, however, that the influence of the presence of a depressive disorder was limited to subjects with “minimal to moderate” radiographic OA. In patients with severe OA, the presence of a depressive disorder was not associated with any risk of symptoms.

Integrated management

The findings indicate that assessment and management of co-existing depression should be integrated with assessment and management of knee OA, the authors wrote, adding that patients who are not experiencing severe OA are particularly at risk.

“The results of this study indicate that depression can play a major role in the way patients experience the symptoms of knee arthritis, and that even when X-rays show the arthritis is not severe, patients with depression may report significant pain,” Kim stated in the release. “The relationship between pain and depression suggests that both should be considered by physicians when treating patients with knee osteoarthritis, particularly in those with X-rays not indicating severe damage to the joint.”

References:
Kim KW, et al. Association between comorbid depression and osteoarthritis symptom severity in patients with knee osteoarthritis. JBJS (Am). 2011;93:556-563. doi:10.2106/JBJS.I.01344.
www.aaos.org
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Pfizer Global Pharmaceuticals (Grant No. 06-05-039) and Seongnam City Government in Korea (Grant No. 800-20050211). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

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