Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four Years

Objective Quadriceps weakness increases the risk of knee osteoarthritis (OA) and functional decline. Understanding how quadriceps strength changes over time is crucial for managing knee OA. Knee pain and effusion may influence strength over time through inhibition of motor pathways, but this remains...

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Main Authors: David A. Sherman, Tuhina Neogi, Samantha Hornsby, David Felson, Michaell Lavalley, Joshua J. Stefanik, for the OAI investigators
Format: Article
Language:English
Published: Wiley 2025-07-01
Series:ACR Open Rheumatology
Online Access:https://doi.org/10.1002/acr2.70067
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author David A. Sherman
Tuhina Neogi
Samantha Hornsby
David Felson
Michaell Lavalley
Joshua J. Stefanik
for the OAI investigators
author_facet David A. Sherman
Tuhina Neogi
Samantha Hornsby
David Felson
Michaell Lavalley
Joshua J. Stefanik
for the OAI investigators
author_sort David A. Sherman
collection DOAJ
description Objective Quadriceps weakness increases the risk of knee osteoarthritis (OA) and functional decline. Understanding how quadriceps strength changes over time is crucial for managing knee OA. Knee pain and effusion may influence strength over time through inhibition of motor pathways, but this remains a critical knowledge gap. We aimed to determine quadriceps strength trajectories and the association of knee pain and effusion among individuals with or at risk of knee OA. Methods We used baseline, two‐year, and four‐year quadriceps strength data from the Osteoarthritis Initiative to identify quadriceps strength trajectory groups using discrete mixture model clustering. Pain and effusion were assessed at baseline. We determined the relation of pain and effusion to trajectory groups using multinomial logistic regression, adjusted for demographics and radiographic OA. Results From 2,527 participants, three strength trajectories were identified for both sexes (“weak,” “average,” and “strong”), all with a linear decline in strength over four years. In women, individuals with frequent knee pain had higher odds of being in the weakest trajectory group compared to the average (odds ratio [OR] 0.54 [95% confidence interval (CI) 0.43–0.68]) and strong trajectories (OR 0.46 [95% CI 0.32–0.65]). Worse pain severity increased the odds of weakest trajectory group compared to the average (OR 0.89 [95% CI 0.85–0.93]) and strong strength trajectories (OR 0.86 [95% CI 0.80–0.92]). Effusion showed no association. Similar effects were present in men. Conclusion Frequent knee pain and knee pain severity were associated with being in a lower quadriceps strength trajectory group, but the rate of strength decline over four years was similar across all groups, suggesting that pain may not influence the rate of decline.
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spelling doaj-art-bbe68ff5fcec40e18acf767c97ec81262025-08-20T02:46:13ZengWileyACR Open Rheumatology2578-57452025-07-0177n/an/a10.1002/acr2.70067Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four YearsDavid A. Sherman0Tuhina Neogi1Samantha Hornsby2David Felson3Michaell Lavalley4Joshua J. Stefanik5for the OAI investigatorsBouvé College of Health Sciences, Northeastern University Boston MassachusettsChobanian & Avedisian School of Medicine, Boston University Boston MassachusettsBouvé College of Health Sciences, Northeastern University Boston MassachusettsChobanian & Avedisian School of Medicine, Boston University Boston MassachusettsChobanian & Avedisian School of Medicine, Boston University Boston MassachusettsBouvé College of Health Sciences, Northeastern University Boston MassachusettsObjective Quadriceps weakness increases the risk of knee osteoarthritis (OA) and functional decline. Understanding how quadriceps strength changes over time is crucial for managing knee OA. Knee pain and effusion may influence strength over time through inhibition of motor pathways, but this remains a critical knowledge gap. We aimed to determine quadriceps strength trajectories and the association of knee pain and effusion among individuals with or at risk of knee OA. Methods We used baseline, two‐year, and four‐year quadriceps strength data from the Osteoarthritis Initiative to identify quadriceps strength trajectory groups using discrete mixture model clustering. Pain and effusion were assessed at baseline. We determined the relation of pain and effusion to trajectory groups using multinomial logistic regression, adjusted for demographics and radiographic OA. Results From 2,527 participants, three strength trajectories were identified for both sexes (“weak,” “average,” and “strong”), all with a linear decline in strength over four years. In women, individuals with frequent knee pain had higher odds of being in the weakest trajectory group compared to the average (odds ratio [OR] 0.54 [95% confidence interval (CI) 0.43–0.68]) and strong trajectories (OR 0.46 [95% CI 0.32–0.65]). Worse pain severity increased the odds of weakest trajectory group compared to the average (OR 0.89 [95% CI 0.85–0.93]) and strong strength trajectories (OR 0.86 [95% CI 0.80–0.92]). Effusion showed no association. Similar effects were present in men. Conclusion Frequent knee pain and knee pain severity were associated with being in a lower quadriceps strength trajectory group, but the rate of strength decline over four years was similar across all groups, suggesting that pain may not influence the rate of decline.https://doi.org/10.1002/acr2.70067
spellingShingle David A. Sherman
Tuhina Neogi
Samantha Hornsby
David Felson
Michaell Lavalley
Joshua J. Stefanik
for the OAI investigators
Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four Years
ACR Open Rheumatology
title Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four Years
title_full Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four Years
title_fullStr Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four Years
title_full_unstemmed Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four Years
title_short Association of Knee Pain Frequency and Severity with Quadriceps Strength but Not Rate of Decline Over Four Years
title_sort association of knee pain frequency and severity with quadriceps strength but not rate of decline over four years
url https://doi.org/10.1002/acr2.70067
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