Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanismsReport as inadecuate

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Arthritis Research and Therapy

, 13:R135

First Online: 24 August 2011Received: 26 April 2011Revised: 08 July 2011Accepted: 24 August 2011


IntroductionAlthough people with knee and hip osteoarthritis OA seek treatment because of pain, many of these individuals have commonly co-occurring symptoms for example, fatigue, sleep problems, mood disorders. The purpose of this study was to characterize adults with OA by identifying subgroups with the above comorbid symptoms along with illness burden a composite measure of somatic symptoms to begin to examine whether subsets may have differing underlying pain mechanisms.

MethodsCommunity-living older adults with symptomatic knee and hip OA n = 129 participated 68% with knee OA, 38% with hip OA. Hierarchical agglomerative cluster analysis was used. To determine the relative contribution of each variable in a cluster, multivariate analysis of variance was used.

ResultsWe found three clusters. Cluster 1 n = 45 had high levels of pain, fatigue, sleep problems, and mood disturbances. Cluster 2 n = 38 had intermediate degrees of depression and fatigue, but low pain and good sleep. Cluster 3 n = 42 had the lowest levels of pain, fatigue, and depression, but worse sleep quality than Cluster 2.

ConclusionsIn adults with symptomatic OA, three distinct subgroups were identified. Although replication is needed, many individuals with OA had symptoms other than joint pain and some such as those in Cluster 1 may have relatively stronger central nervous system CNS contributions to their symptoms. For such individuals, therapies may need to include centrally-acting components in addition to traditional peripheral approaches.

AbbreviationsANOVAanalysis of variance

BFIbrief fatigue inventory

CES-DCenter for Epidemiological Studies Depression Scale

CNScentral nervous system

MANOVAmultivariate analysis of variance


PSQIPittsburgh Sleep Quality Index

WOMACWestern Ontario and McMaster Universities Osteoarthritis Index

Electronic supplementary materialThe online version of this article doi:10.1186-ar3449 contains supplementary material, which is available to authorized users.

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Author: Susan L Murphy - Angela K Lyden - Kristine Phillips - Daniel J Clauw - David A Williams



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