First Step Toward Knee OA Progression: Pain on Stairs


Data from a large sample of patients with knee osteoarthritis shows a common pattern in the onset of knee pain.

Hensor EMA, Kingsbury SR, Tennant A. Conaghan PG. Toward a Clinical Definition of Early Osteoarthritis: Onset of Patient-Reported Knee Pain Begins on Stairs. Data From the Osteoarthritis Initiative.Arthritis Care & Research.  2015;67:40–47. [Online first 27 Dec2014] doi: 10.1002/acr.22418

All patients with ostearthritis (OA) are different, but for the most common form, knee OA, one factor stands out in this study: The first hints of pain begin with bending the joint and load-bearing, using stairs. [[{"type":"media","view_mode":"media_crop","fid":"31430","attributes":{"alt":"knee osteoarthritis","class":"media-image media-image-right","id":"media_crop_366721415608","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3314","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 175px; height: 157px; float: right; margin: 1px;","title":"","typeof":"foaf:Image"}}]]

British researchers looked at data for almost 5,000 patients in the prospective multicenter Osteoarthritis Initiative (OAI) who either had confirmed knee OA or who were at high risk for the condition.

Patients completed the pain subscale of the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) at baseline and annually for up to 72 months.

The 5-point WOMAC pain scale asks patients to rate their pain their pain while walking, using stairs, in bed, sitting or lying down, and standing up, according a 0-to-4 scale (from absent to extreme).

Among study subjects with complete WOMAC responses, the question that most often was first to cross the threshold from 0 (no pain) to 1 (some pain) was the one about using stairs. Eventually 81% of them eventually crossed this threshold.

In general, load-bearing activities (walking and standing) were more likely to elicit pain responses than sitting or lying down. The responses didn't differ between the 1,390 patients with radiographically confirmed knee OA and the 3,284 considered at high risk.

The authors hope that pain during activities like stair climbing can be validated as a way to screen patients for knee OA and intervene well before damage appears on X-rays.

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