Neuropathic pain in the IMI-APPROACH knee osteoarthritis cohort: prevalence and phenotyping

Eefje Martine van Helvoort, Paco M J Welsing, Mylène P Jansen, Willem Paul Gielis, Marieke Loef, Margreet Kloppenburg, Francisco Blanco, Ida K Haugen, Francis Berenbaum, Anne-C Bay-Jensen, Christoph Ladel, Agnes Lalande, Jonathan Larkin, John Loughlin, Ali Mobasheri, Harrie Weinans, Floris Lafeber, Niels Eijkelkamp, Simon Mastbergen, Eefje Martine van Helvoort, Paco M J Welsing, Mylène P Jansen, Willem Paul Gielis, Marieke Loef, Margreet Kloppenburg, Francisco Blanco, Ida K Haugen, Francis Berenbaum, Anne-C Bay-Jensen, Christoph Ladel, Agnes Lalande, Jonathan Larkin, John Loughlin, Ali Mobasheri, Harrie Weinans, Floris Lafeber, Niels Eijkelkamp, Simon Mastbergen

Abstract

Objectives: Osteoarthritis (OA) patients with a neuropathic pain (NP) component may represent a specific phenotype. This study compares joint damage, pain and functional disability between knee OA patients with a likely NP component, and those without a likely NP component.

Methods: Baseline data from the Innovative Medicines Initiative Applied Public-Private Research enabling OsteoArthritis Clinical Headway knee OA cohort study were used. Patients with a painDETECT score ≥19 (with likely NP component, n=24) were matched on a 1:2 ratio to patients with a painDETECT score ≤12 (without likely NP component), and similar knee and general pain (Knee Injury and Osteoarthritis Outcome Score pain and Short Form 36 pain). Pain, physical function and radiographic joint damage of multiple joints were determined and compared between OA patients with and without a likely NP component.

Results: OA patients with painDETECT scores ≥19 had statistically significant less radiographic joint damage (p≤0.04 for Knee Images Digital Analysis parameters and Kellgren and Lawrence grade), but an impaired physical function (p<0.003 for all tests) compared with patients with a painDETECT score ≤12. In addition, more severe pain was found in joints other than the index knee (p≤0.001 for hips and hands), while joint damage throughout the body was not different.

Conclusions: OA patients with a likely NP component, as determined with the painDETECT questionnaire, may represent a specific OA phenotype, where local and overall joint damage is not the main cause of pain and disability. Patients with this NP component will likely not benefit from general pain medication and/or disease-modifying OA drug (DMOAD) therapy. Reserved inclusion of these patients in DMOAD trials is advised in the quest for successful OA treatments.Trial registration numberThe study is registered under clinicaltrials.gov nr: NCT03883568.

Keywords: knee osteoarthritis; patient reported outcome measures; therapeutics.

Conflict of interest statement

Competing interests: The IMI-APPROACH project received a grant from Innovative Medicines Institute, grant agreement 115770. Outside the submitted work: EMvH has nothing to disclose; PMJW has nothing to disclose; MPJ has nothing to disclose; WPG has nothing to disclose; ML has nothing to disclose; MK reports grants from IMI-APPROACH, grants from Dutch Arthritis Association, during the conduct of the study; other from GlaxoSmithKline, Pfizer, Merck-Serono, Kiniksa, Abbvie, outside the submitted work; FBl reports grants from Gebro Pharma, grants from BIOIBERICA, grants from AB Science, grants from Abbvie, grants from Ablynx N.V., grants from Amgen, grants from Archigen Biotech, grants from Boehringer, grants from Bristol-Myers, grants from Celgene, grants from Eli Lilly and Company, grants from F. Hoffmann- La Roche., grants from Galapagos, grants from Gedeon, grants from Genentech, grants from Gideal Sciences, NC, grants from Glaxosmithkline, grants from Hospira, grants from INC Research UK, grants from Inventiv Health Clinical, grants from Janssen, grants from Lilly, grants from Nichi-IKO Pharmaceutical, grants from Novartis, grants from ONO Pharma, grants from Pfizer, grants from Pharmaceutical Research, grants from Regeneron, grants from Roche, grants from SA UCB Pharma, grants from Sanofi, grants from TRB Chemedica, grants from UCB Biosciences, outside the submitted work; In addition, FB has a patent Molecular block-matching method for gel image analysis issued, a patent Targeting A Specific Receptor On Cells With A Specific Compound For Use In The Treatment And/Or The Prevention Of Osteoarthritis And Rheumatoid Arthritis pending, a patent Genetic markers for osteoarthritis issued, a patent Method for the diagnosis of osteoarthritis issued, a patent Genetic markers for osteoarthritis pending, a patent Method for the diagnosing Arthrosis pending, a patent Method for diagnosing Arthrosis pending, a patent Method for the diagnosis of osteoarthritis pending, and a patent Anti-connexin compounds for use in the prevention and/or treatment of degenerative joint diseases. pending; IKH reports personal fees from AbbVie, grants from Pfizer, outside the submitted work; FBe reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Nordic, Novartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, 4P Pharma; A-CB-J reports non-financial support from Nordic Bioscience, personal fees from Nordic Bioscience, during the conduct of the study; CHL reports other from Merck KGaA, during the conduct of the study; AL is employee of Institut de Recherches Internationales Servier; JLa reports personal fees and other from GlaxoSmithKline, outside the submitted work; JLo has nothing to disclose; AM has nothing to disclose; HHW has nothing to disclose; FL has nothing to disclose; NE has nothing to disclose; SM has nothing to disclose.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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