Knee joint osteoarthritis and myofascial pain syndrome: diagnosis, pathogenesis, and therapeutic approaches

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Abstract

Knee joint osteoarthritis (KJ OA) is one of the most common musculoskeletal system degenerative diseases, characterized by pain, progressive joint deformity, and decreased quality of life. Myofascial pain syndrome (MFPS) often accompanies KJ OA and exacerbates its clinical manifestations; however, data on MFPS incidence and its role in KJ OA pathogenesis are limited.

The aim: to determine the incidence of MFPS in KJ OA patients, analyze MFPS association with comorbid conditions, and evaluate the efficacy of combination therapy with a medicinal product based on a bioactive marine fish concentrate and a complex based on unsaponifiable fractions of avocado and soy as a part of a complex therapy plan.

Material and methods. Open-label, prospective study included 72 patients (56 female and 16 male individuals) with Kellgren – Lawrence stage I–II KJ OA. MFPS was diagnosed according to the IASP clinical criteria (2017) and confirmed by tensoalgometry of trigger points (TP). All patients were divided into two groups basing on the presence of MFPS: Group 1 – OA + MFPS (n = 47), Group 2 – OA without MFPS (n = 25). During 12-week follow-up, pain was assessed using VAS during exercise and at rest, also WOMAC index, TP pain threshold, sleep quality (10-point scale), frequency of nonsteroidal anti-inflammatory drugs (NSAID) use, and the spectrum of comorbidities were estimated.

Results. MFPS was detected in 65.3% of patients. In participants with a combination of OA and MFPS, TP pain threshold increased from 2.1 [1.9; 2.3] to 2.8 [2.5; 3.1] kg/cm² (p <0.05). Pain intensity according to VAS during exercise decreased from 68 [62; 75] to 39 [33; 47] mm in Group 1 and from 57 [51; 63] to 36 [30; 42] mm in the Group 2. WOMAC index decreased by 30.9 and 35.4%, respectively. Sleep quality improved from 5 [4; 5] to 6 [6; 7] points in Group 1 and from 6 [5; 7] to 8 [7; 9] points in Group 2. Frequency of NSAIDs use decreased from 3.2 [2; 4] to 1.9 [1; 3] and from 2.8 [2; 3] to 1.3 [1; 2] days per week, respectively. The number of comorbid conditions was higher in the MFBS group – 2 [1; 3] versus 1 [1; 2] (p=0.018).

Conclusion. The combination of KJ OA and MFPS is found in more than a half of patients and significantly worsens the course of the disease. The inclusion of combination therapy using a medicinal product based on a bioactive concentrate of marine fish and a complex based on unsaponifiable fractions of avocado and soy in complex treatment provides a significant reduction in pain, improved function, and a reduced need for NSAIDs. Targeted correction of myofascial component is necessary in the complex treatment of knee joint OA.

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About the authors

Andrey A. Shokhin

Northern State Medical University; Medical Center “DEMA-Sever” LLC

Author for correspondence.
Email: andra.11@yandex.ru
ORCID iD: 0009-0000-5440-237X
SPIN-code: 8922-1101

MD, assistant at the Department of family medicine, rheumatologist

Russian Federation, Arkhangelsk; Severodvinsk

Anna S. Trofimova

I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia

Email: Anna.Trofimova@szgmu.ru
ORCID iD: 0000-0001-5926-7912
SPIN-code: 6827-3934

MD, PhD (Medicine), assistant professor of the Department of therapy, rheumatology, temporary disability assessment, and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald

Russian Federation, Saint Petersburg

Evgeny A. Trofimov

I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia

Email: Evgeniy.trofimov@szgmu.ru
ORCID iD: 0000-0003-3236-4485
SPIN-code: 4358-1663

MD, Dr. Sci. (Medicine), professor, professor of the Department of therapy, rheumatology, temporary disability assessment, and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald

Russian Federation, Saint Petersburg

Inna Z. Gaydukova

I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia

Email: ubp1976@list.ru
ORCID iD: 0000-0003-3500-7256

deputy director of the Research institute of rheumatology, professor of the Department of therapy, rheumatology, temporary disability assessment, and quality of medical care with a course in hematology and transfusiology named after E.E. Eichwald

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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2. 1. A variant of the vicious circle in the formation of osteoarthritis of the knee joint

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3. Fig. 2. Pain radiance zone from the hip trigger point

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4. Fig. 3. Examination of trigger points in the rectus femoris

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5. 4. Dynamics of pain level in patients on a visual analog scale (mm): A - during exercise; B - at rest

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6. 5 The need for nonsteroidal anti-inflammatory drugs (number of doses per week) in the study groups

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7. 6. The structure of comorbid conditions in the patients included in the study (n = 140)

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