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- DOI: 10.1016/j.joca.2014.06.030
- PMID: 24999111
- UKPMCID: 24999111
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Examining Sex Differences in Knee Pain: The Multicenter Osteoarthritis Study.
Glass, N; Segal, N A; Sluka, K A; Torner, J C; Nevitt, M C; Felson, D T; Bradley, L A; Neogi, T; Lewis, C E; Frey-Law, L A
Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society. 2014;22(8):1100-1116.
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Full-text held externally
- DOI: 10.1016/j.joca.2014.06.030
- PMID: 24999111
- UKPMCID: 24999111
Abstract
OBJECTIVE: To determine whether women experience greater knee pain severity than men at equivalent levels of radiographic knee osteoarthritis (OA). DESIGN AND METHODS: A cross-sectional analysis of 2712 individuals (60% women) without knee replacement or a recent steroid injection. Sex differences in pain severity at each KL grade were assessed by knee using VAS scale and WOMAC with and without adjustment for age, analgesic use, BMI, clinic site, comorbid conditions, depression score, education, race, and widespread pain (WSP) using generalized estimating equations. Effect sizes (Cohen's d) were also calculated. Analyses were repeated in those with and without patellofemoral OA (PFOA). RESULTS: Women reported higher VAS pain at all KL grades in unadjusted analyses (d=0.21-0.31, p<0.0001-0.0038) and in analyses adjusted for all covariates except WSP (d=0.16-0.22, p<0.0001-0.0472). Pain severity differences further decreased with adjustment for WSP (d=0.10-0.18) and were significant for KL grade ≤2 (p=0.0015) and 2 (p=0.0200). Presence compared with absence of WSP was associated with significantly greater knee pain at all KL grades (d=0.32-0.52, p<0.0001-0.0008). In knees with PFOA, VAS pain severity sex differences were greater at each KL grade (d=0.45-0.62, p=0.0006-0.0030) and remained significant for all KL grades in adjusted analyses (d=0.31-0.57, p=0.0013-0.0361). Results using WOMAC were similar. CONCLUSIONS: Women reported greater knee pain than men regardless of KL grade, though effect sizes were generally small. These differences increased in the presence of PFOA. The strong contribution of WSP to sex differences in knee pain suggests that central sensitivity plays a role in these differences.