The contribution of selected non-articular conditions to knee pain severity and associated disability in older adults

Objective: To estimate the contribution of selected non-articular conditions (NACs) to pain severity and functional limitation in community-dwelling older adults with knee pain. Design: Population-based, cross-sectional study of 745 adults aged 50 years and over with knee pain. Self-complete questionnaires, clinical history and physical examination were used to identify the presence of selected NACs that could cause pain around the knee. Regression analyses were used to compare levels of knee pain severity (0-20) and functional limitation (0-68) (Western Ontario and McMaster Universities osteoarthritis index physical function subscale [WOMAC-PF]), between those with one or more NACs and those with none (NACs-absent). Results: Two hundred and seventy-three (36.6%) participants had at least one NAC: widespread pain, n = 159; low back pain with index leg referral, n = 102; full-leg pain, n = 88; hip arthritis, n = 65; prepatellar, infrapatellar or pes anserine bursitis, n = 35. The NACs group had significantly higher levels of pain severity and functional limitation than the NACs-absent group: 8.2(+/- 4.6) vs 5.4(+/- 3.8) and 27.9(+/- 15.8) vs 16.8(+/- 13.2), respectively. The groups did not differ with respect to severity of radiographic osteoarthritis (ROA). Having one or more NACs accounted for a significant proportion of the variance in WOMAC scores, above that which could be explained by age, gender, body mass index and severity of ROA. Conclusion: NACs appear to be common in older adults with knee pain. They make a significant contribution to knee pain severity and functional limitation and are likely to represent additional, rather than alternative, causes of knee pain/functional limitation to osteoarthritis (OA). These factors should be taken into account in epidemiological studies of knee pain and OA. (C) 2007 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.