In Knee Osteoarthritis, Your Patient May Suffer From One of Four Depression Types

May 7, 2019
Whitney J. Palmer

Identifying the type of depression present in an individual with or at-risk for symptomatic knee osteoarthritis can help clinicians best target therapies to reduce pain and disability over time, according to a new study.

Identifying the type of depression present in an individual with or at-risk for symptomatic knee osteoarthritis can help clinicians best target therapies to reduce pain and disability over time, according to a new study.

The article, published in April in Arthritis Care & Research, shows there are four unique depression subtypes present in this patient group. But, they don’t all present the same effects on pain and disability.

“Study findings indicate that depression subtypes among individuals with or at-risk for symptomatic knee osteoarthritis are differentiated primarily by psychomotor agitation, andehonia, and other somatic complaints,” said study author Alan Rathbun, Ph.D., MPH, a University of Maryland School of Medicine epidemiology and public health research associate.

Overall, investigators said, the findings demonstrate the problems with using standard depression treatments in patients with musculoskeletal disorders. Instead, it would be preferable to use protocol targeting symptoms specifically linked to different depression subtypes in knee osteoarthritis patients.

To identify the depressive subtypes, researchers followed 4,796 individuals with symptomatic knee osteoarthritis for four years, assessing their pain and depressive symptoms, including psychomotor agitation/retardation, poor appetite, restless sleep, sadness, loneliness, social interactions, impaired concentration, and anhedonia, during four annual visits.

According to results, patients were classified into four depression categories - asymptomatic (80.6 percent), catatonic (5.3 percent), anhedonic (10.6 percent), and melancholic (3.5 percent). Depressive symptoms were highest among the melancholic group, investigators said. These individuals also had the worst outcomes for pain and disability, reporting persistently greater problems at each follow-up visit.

The anhedonic group, characterized by both somatic and cognitive symptoms, experienced the next largest increase in pain and disability. The catatonic group reported slower movement and functional impairment, but not sadness.

These results are important, researchers said, because they highlight the clinical phenotypes associated with different depressive subtypes present in knee osteoarthritis patients. Screening these patients during primary care and rheumatology appointments could provide valuable information for treatment.

Ultimately, researchers said, having a better understanding of depressive symptoms in knee osteoparthritis patients could lead to more personalized interventions that can improve clinical outcomes for both conditions.

REFERENCE

Rathbun A, Schumer M, Stuart E, Shardell M, Yau M, Gallo J, Ryan A, Hochberg M, Depression Subtypes in Persons with or at Risk for Symptomatic Knee Osteoarthritis. Arthritis Care & Research (2019), doi: 10.1002/acr.23898

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