Depression may boost arthritis pain
Clinical depression can exacerbate the symptoms of knee arthritis beyond what is evident on X-rays.
Knee osteoarthritis (age-related degeneration) is a common cause of pain and impairment in older adults. Often, the level of arthritic symptoms reported by patients is much more severe than what is represented by x-rays, which can make it difficult for the doctor to treat. The condition typically affects men and women over 50 years of age, and occurs most frequently in people who are overweight. Common symptoms include pain or stiffness in or around the knee; swelling of the knee; limited range of motion when walking or moving the knee; or knee weakness or a feeling of instability. In more severe cases, the knee joint may appear deformed, such as bowlegged or knock-kneed appearance, either bulging outward or toward the side of the leg. Knee replacement surgery is often performed in patients with severe symptoms.
Researchers from South Korea used x-rays to assess the severity of knee osteoarthritis in 660 men and women, aged 65 years and older. The patients were also evaluated for the severity of their symptoms and for depression. As expected, levels of pain were higher in patients whose x-rays showed greater joint damage. However, the researchers also found that depression was associated with an increase in pain in patients with mild to moderate knee osteoarthritis, even when significant joint damage was not evident in the x-ray image.
The results of the study indicate that depression can play a major role in the way patients experience the symptoms of knee arthritis, and that even when x-rays show the arthritis is not severe, patients with depression may report significant pain. The relationship between pain and depression suggests that both should be considered by physicians when treating patients with knee osteoarthritis, particularly in those with x-rays not indicating severe damage to the joint.
The researchers noted that some patients with knee osteoarthritis still experience pain and impaired movement after undergoing knee replacement surgery. Sometimes pain and disability after surgery is medically unexplained, so in these patients screening for depression might be a very good option, they suggested.
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