Patient Risk Factors associated with Osteoarthritis Symptom Severity

Hello everyone. My name is Harold Schwartzberg. I'm representing a project titled Patient Characteristics Associated with Knee Osteoarthritis Symptoms severity at initial orthopedic consultation.

So here's a picture of the entire poster and the following slides will take you through a summary of each section one at a time.

So Osteoarthritis is the most common of joint disorders in the United States, with over 13 million patients suffering from some degree of symptomatic Osteoarthritis. Up to this point, few studies have quantified differences in Pain observed between separate patient populations at the time of initial orthopedic consultation for Knee Osteoarthritis.

This study's purpose was to identify the characteristics which are independently associated with the severity of NOA at the time of initial orthopedic consultation.

So this was a Retrospective chart review which included patients seen by a single tertiary care facility provider between 2016 and 2017.

The information that was gathered for this study included demographic information, disease characteristics information, and CUS score results gauging patients' Knee Pain and function at the time of their initial visit with an orthopedist.

The scene here is the Kellerren-Lawrence scale or KL score, and it's used for gauging radiographic Osteoarthritis severity. This is the scoring system that we used to classify the patient's radiographic Osteoarthritis in the study, and you can see that the score spans from 1 to 4, with 4 representing severe radiographic evidence of Osteoarthritis. Something to note about the KL score is that while it is indicative of radiographic Osteoarthritis severity, it does not necessarily define a patient's symptomatic Osteoarthritis severity.

So here includes some information on the Knee Osteoarthritis outcome score questionnaire, otherwise known as the CUS score.

The patients completed these questionnaires at the time of their initial orthopedist visit, and they showed uh basically a measure of the patient's Knee Pain. So you'll notice that the COU score is made up of four subscales Pain, symptoms, activities of daily living, function in sports and recreation, and knee-related quality of life.

For our study, the subscale of function in sports and recreation was not used because few patients included in the study participated in any recreational activities.

So here you can see the patient demographic information for the study. So 559 patients overall were included in the study. The notable traits of this patient population that I wanted to point out are the majority of the patients, over 60%, featured a KL grade of 4, indicating severe radiographic Osteoarthritis. Another unique feature of our patient population is a large proportion of black patients. Most studies quantifying Osteoarthritis and Knee Pain struggle to include non-white patients. Our study population was able to include a majority of black patients, however.

Our unique pace of population puts LSU's orthopedic department in a position to engage our community. It's a big reason why our department has devoted so much time and energy into researching racial disparities in Orthopedic Surgery.

So our results showed that female sex, black race, Medicaid insurance, younger age, and more severe radiographic Knee Osteoarthritis were all significantly associated with worse Pain and function measured by the CooS subscales. The variables of BMI and the Charleston comorbidity index were not statistically significant predictors of differences in Osteoarthritis Knee Pain in any of the CooS subscales which were measured.

And here's a statistical analysis showing the results that I mentioned in the previous slide.

So our explanation for these findings all revolve around the biopsychosocial model of Pain, which states that biological, psychological, social, and behavioral factors dynamically interact with one another to impact the patient's Pain.

Literature describing the relationship between age and Knee Osteoarthritis symptoms severity is mixed, but patients with end-stage Osteoarthritis who are younger have consistently been shown to have worse self-reported Knee Pain and disability, which agrees with the results of our study.

And this makes sense in regards to RCV because as I stated before, our city population was made up of almost 70% of patients with severe radiographic Osteoarthritis represented by a KL score of 4.

So here you see that almost every KOS subscale of female patients experience in every COS subscale, female patients experience worse Osteoarthritis Knee Pain when compared to males. Much of the literature focuses on biological causes for these differences in Knee Pain observed between males and females. Examples of the literature.

Examples from the literature include higher rates of low bone mineral density in female patients, as well as the loss of estrogen's counterprotective role in postmenopausal women.

The the disparities that we observed regarding the patient's race are likely highly complex in their origin and most likely lead to multiple factors such as societal inequities and access to care, patient education, and nutrition, among Other things.

Some studies have shown that the differences in Osteoarthritis and Knee Pain between races can be attenuated when accounting for psychological factors like emotion-focused coping mechanism, but these are likely only a small contributor to the overall cause of the disparities observed in our study.

So our studies showed that disparities in Knee Osteoarthritis Pain do exist at the time of initial orthopedic consultation and that women, black patients, and patients with lower socioeconomic status represented by the Medicaid group are those with worse Knee Pain despite having the same severity radiographic Knee Osteoarthritis when compared to patients who are male, white, and of a higher socioeconomic status.

All the factors that we identified have also been associated with Osteoarthritis progression, which makes these risks, these at-risk patient populations, women, black patients, and Medicaid patients, those who are more likely to progress to debilitating disease with a greater degree of functional impairment.

For these patients who are the most vulnerable within our current healthcare system, it is imperative that more Research be dedicated to defining the underlying causes of the disparities described in this study in order to provide a more equitable healthcare for all patients.

Uh, here are my references. Uh, thank you very much for your time.