Comorbidities and use of analgesics in people with knee pain: a study in the Nottingham Knee Pain and Health in the Community (KPIC) cohort

Subhashisa Swain, Gwen Sascha Fernandes, Aliya Sarmanova, Ana M Valdes, David A Walsh, Carol Coupland, Michael Doherty, Weiya Zhang, Subhashisa Swain, Gwen Sascha Fernandes, Aliya Sarmanova, Ana M Valdes, David A Walsh, Carol Coupland, Michael Doherty, Weiya Zhang

Abstract

Objectives: The aims were to examine the prevalence of comorbidities and role of oral analgesic use in people with knee pain (KP) compared with those without.

Methods: The Knee Pain and related health In the Community (KPIC) cohort comprises community-derived adults aged ≥40 years, irrespective of knee pain. Thirty-six comorbidities across 10 systems were compared between people with KP and controls without KP or knee OA. Multivariable logistic regression analysis was used to determine the adjusted odds ratio (aOR) and 95% CI for multimorbidity (at least two chronic conditions) and each specific comorbidity. Both prescribed and over-the-counter analgesics were included in the model, and their interactions with KP for comorbidity outcomes were examined.

Results: Two thousand eight hundred and thirty-two cases with KP and 2518 controls were selected from 9506 baseline participants. The mean age of KP cases was 62.2 years, and 57% were women. Overall, 29% of the total study population had multimorbidity (KP cases 34.4%; controls 23.8%). After adjustment for age, sex, BMI and analgesic use, KP was significantly associated with multimorbidity (aOR 1.35; 95% CI 1.17, 1.56) and with cardiovascular (aOR 1.25; 95% CI 1.08, 1.44), gastrointestinal (aOR 1.34; 95% CI 1.04, 1.92), chronic widespread pain (aOR 1.54; 95% CI 1.29, 1.86) and neurological (aOR 1.32; 95% CI 1.01, 1.76) comorbidities. For multimorbidity, the use of paracetamol and opioids interacted positively with KP, whereas the use of NSAIDs interacted negatively for seven comorbidities.

Conclusion: People with KP are more likely to have other chronic conditions. The long-term benefits and harms of this change remain to be investigated.

Trial registration: ClinicalTrials.gov, https://ichgcp.net/clinical-trials-registry/NCT02098070" title="See in ClinicalTrials.gov">NCT02098070.

Keywords: NSAIDs; OA; community survey; comorbidity; interaction; opioids; paracetamol.

© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.

Figures

Fig . 1
Fig. 1
Distribution of the number of chronic conditions in both knee pain and non-knee pain groups (χ2 test P-value <0.05)
Fig . 2
Fig. 2
Comorbidity network in both the groups (A) Knee pain. (B) Non-knee pain. The different comorbidities are represented by nodes (circles); if there is a pairwise comorbid association in the cohort, the two disease nodes are connected with a line. The size of each node is proportional to the prevalence of the illustrated comorbidity, and the thickness of the line is proportional to the number of the pairwise associations. The nodes are placed such that those with more connections are closer to each other.

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Source: PubMed

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