Pain and Symptoms
Six-year course and prognosis of nontraumatic knee symptoms in adults in general practice: A prospective cohort study
Article first published online: 29 AUG 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 9, pages 1287–1294, September 2011
How to Cite
Kastelein, M., Luijsterburg, P. A. J., Belo, J. N., Verhaar, J. A. N., Koes, B. W. and Bierma-Zeinstra, S. M. A. (2011), Six-year course and prognosis of nontraumatic knee symptoms in adults in general practice: A prospective cohort study. Arthritis Care Res, 63: 1287–1294. doi: 10.1002/acr.20522
- Issue published online: 29 AUG 2011
- Article first published online: 29 AUG 2011
- Accepted manuscript online: 13 JUN 2011 01:17PM EST
- Manuscript Accepted: 2 JUN 2011
- Manuscript Received: 15 MAR 2011
- Department of General Practice of the Erasmus MC University Medical Centre
- Anna Fonds
- Insurance companies TRIAS, Zilveren Kruis, Achmea, and OZ
To examine the 6-year course of nontraumatic knee symptoms in adults in general practice, to identify prognostic factors for unfavorable outcome, and to develop a clinical prediction rule.
Adults (ages >35 years) with incident nontraumatic knee symptoms (n = 549) were followed for 6 years. Multivariable logistic regression analysis was used to identify prognostic factors associated with an unfavorable outcome, the area under the receiver operating curve (AUC) was calculated to determine discriminative ability, and a clinical prediction rule was developed. Unfavorable outcome is defined as persistent knee symptoms at 6-year followup or having undergone knee replacement surgery during followup.
At 6-year followup, 42.1% of patients had an unfavorable outcome. Having persistent knee symptoms (odds ratio [OR] 5.31, 95% confidence interval [95% CI] 3.27–8.61) and fulfilling the clinical American College of Rheumatology (ACR) criteria for osteoarthritis (OA; OR 2.65, 95% CI 1.48–4.73) at 1-year followup were significantly associated with unfavorable outcome, while fulfilling the clinical ACR criteria for OA at baseline was not. Baseline factors independently associated with an unfavorable outcome were low/middle education level, comorbidity of the skeletal system, duration of knee symptoms of >3 months, bilateral knee symptoms, self-reported warm knee, history of nontraumatic knee symptoms, valgus alignment, pain at passive knee flexion/extension, and bony enlargement of the knee joint (AUC 0.80).
Nontraumatic knee symptoms in adults in general practice appear to become a chronic disorder in nearly half of the patients. The developed clinical prediction rule with 10 baseline prognostic factors can be used to select high-risk patients for an unfavorable outcome at long-term followup.