Accepted Articles
ORIGINAL ARTICLE

Knee osteoarthritis, potential mediators, and risk of all‐cause mortality: data from the Osteoarthritis Initiative

Yilun Wang

Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

Search for more papers by this author
Uyen‐Sa D.T. Nguyen

Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, School of Public Health, Texas, USA

Department of Medicine, Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, USA

Search for more papers by this author
Nancy E. Lane

Center for Musculoskeletal Health, Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of California, Davis, USA

Search for more papers by this author
Na Lu

Arthritis Research Canada, Richmond, Canada

Search for more papers by this author
Jie Wei

Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA

The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA

Health Management Center, Xiangya Hospital, Central South University, Changsha, China

Search for more papers by this author
Guanghua Lei

Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China

National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China

Search for more papers by this author
Chao Zeng

Corresponding Author

E-mail address: zengchao@csu.edu.cn

Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA

The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA

Corresponding Authors:

Chao Zeng, MD, PhD, Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, Hunan 410008, China

E-mail address: zengchao@csu.edu.cn

Yuqing Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114

E-mail address: yzhang108@mgh.harvard.edu

Search for more papers by this author
Yuqing Zhang

Corresponding Author

E-mail address: yzhang108@mgh.harvard.edu

Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA

The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA

Corresponding Authors:

Chao Zeng, MD, PhD, Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Rd, Changsha, Hunan 410008, China

E-mail address: zengchao@csu.edu.cn

Yuqing Zhang, DSc, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114

E-mail address: yzhang108@mgh.harvard.edu

Search for more papers by this author
First published: 21 January 2020
Citations: 1

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1002/acr.24151

Abstract

Objective

To assess the relation of symptomatic knee osteoarthritis (OA), knee pain, and radiographic knee OA to all‐cause mortality and identify mediators in the causal pathway.

Methods

Participants from the Osteoarthritis Initiative were divided into four groups: (1) symptomatic knee OA (i.e., both radiographic knee OA [Kellgren and Lawrence grade ≥2] and knee pain); (2) knee pain only; (3) radiographic knee OA only; and (4) neither radiographic knee OA nor knee pain. We examined the relation of knee OA status to all‐cause mortality using a multivariable Cox‐proportional model and assessed the extent to which the association was mediated by disability, physical (PCS) and mental component summary scores (MCS) of quality of life (QoL), and oral pain‐relief medications (i.e. nonsteroidal anti‐inflammatory drugs and opioids) use.

Results

Among 4,796 participants, 282 died over the 96‐month follow‐up period. Compared with those with neither radiographic knee OA nor knee pain, multivariable‐adjusted hazard ratios (HRs) of mortality were 2.2 (95% confidence interval [CI]: 1.6‐3.1) for symptomatic knee OA, 0.9 (95%CI: 0.6‐1.4) for knee pain only, and 2.0 (95%CI: 1.4‐2.9) for radiographic knee OA only, respectively. Indirect effects (HRs) of symptomatic knee OA on mortality via disability and PCS of QoL were 1.1 (95%CI: 1.0‐1.4) and 1.2 (95%CI: 1.0‐1.4), respectively. No apparent mediation effect was observed through either MCS of QoL or oral pain‐relief medications use.

Conclusion

Participants with either symptomatic or radiographic knee OA were at an increased risk of all‐cause mortality. Increased risk of mortality from symptomatic knee OA was partially mediated through its effect on disability and PCS of QoL.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.