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Pain phenotypes in knee osteoarthritis

Is it time to sub categorise osteoarthritis based upon pain presentation?

Osteoarthritis of the knee (OA) is the most common form of arthritis and effects large numbers of elders, limiting their function and causing significant levels of pain. Historically seen as a disease of ‘wear and tear’, the modern diagnostic criteria for OA is a combination of clinical features, examination and radiological findings.

However, these broad criteria encompass a heterogeneous range of presentations and may overlook several clinically relevant variables which can affect patient management and outcome. Examples of this include poor correlation between radiological findings and symptom severity, as well as the reported inconsistent efficacy of several interventions within the literature. It has previously been hypothesized that several sub categories exist within OA, each with their own unique pain presentations, or pain phenotypes.

The results of this analysis support the emerging narrative that OA is a multifactorial disease with a complex interplay of physical, environmental and psychological factors contributing to symptomatic manifestation. Further to this, should the concept of pain phenotypes be validated by ongoing research, it may have a profound effect on the future physiotherapy research/ practice in OA, as interventions and clinical trials could be tailored to specific phenotypes.  

> From: Kittelson et al., Arthritis Care Res 68 (2017-03-27 20:22:31) 612-620 . All rights reserved to American College of Rheumatology. Click here for the online summary.

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