Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

The Association of Arm and Back Pain with Incidence of Slow Walking in Persons with Knee Osteoarthritis: The MOST Study.

White1,  Daniel, Zhang2,  Yuqing, Niu2,  Jingbo, Nevitt3,  Michael, Lewis4,  C. Elizabeth, Torner5,  James, Neogi2,  Tuhina

Boston University, Boston, MA
Boston University
University California San Francisco
University of Alabama
University of Iowa

Slow walking is a marker for adverse outcomes such as persistent limitation and mortality. Due to factors such as knee pain, persons with knee osteoarthritis (OA) are already at increased risk for slow walking. However, it is not known if upper body pain, such as shoulder pain affecting arm swing during gait, or back pain that may limit activity, is associated with the development of slow walking speed. Thus, we examined the independent effects of pain in the arm and back with the incidence of slow walking speed among persons with or at risk for knee osteoarthritis (OA).

The Multicenter Osteoarthritis Study (MOST) is a NIH funded longitudinal study of persons who have or are at high risk for knee OA. Pain assessments were taken at baseline, and walking speed at baseline and 30 months. We defined incidence of slow walking as < 1.0 meter per second (m/s) at 30 months, a speed shown to be a risk factor for persistent functional limitation and death in older adults, among participants whose walking speed was >=1m/s at baseline. We quantified pain as the number of areas subjects marked on a homunculus, counted as 0, 1, or > 2. For the arm, this included both hands, wrists, elbows and shoulders, and for the back, the lumbar, thoracic, and cervical areas. We examined the association of the number of painful areas within arm and back areas with the incidence of slow walking using risk ratios adjusted for age, sex, BMI, race, radiographic knee OA (ROA), knee pain, and pain in the hip, ankle, or foot. We additionally adjusted for the presence of widespread pain in separate analyses.

Of the 2204 persons walking at least 1.0 m/s at baseline (mean age 62 ± 8 yrs, BMI 30 ± 6 kg/m2, female 57%) 8% had incidence of slow walking at 30 months. Arm pain was present in 0, 1, and >2 areas in 39%, 15%, and 46% of persons, and back pain in 32%, 48%, and 20%, respectively. Adjusting for potential confounders, persons with arm pain in 1 and 2 or more areas were 1.6 and 1.5 times more likely to have incidence of slow walking, respectively, compared with persons without any arm pain. No association between back pain and incident slow walking was found. (see table) We found similar results in analyses adjusted for the presence of widespread pain.

The presence of arm but not back pain was associated with the incidence of slow walking. Providers should consider that pain not only in the lower body, but also in the arms is important for future walking function.

  % (Number with incident slow walking/total number of subjects)Adjusted Risk Ratio*95% CI
Number of arm areas with pain04 (39/882)1.0Ref
 110 (31/324)1.6[1.1, 2.5]
 >=210 (102/983)1.5[1.0, 2.2]
Number of back areas with pain07 (50/741)1.0Ref
 17 (77/1031)0.8[0.6, 1.1]
 >=211 (45/422)0.9[0.6, 1.4]
*Mutually adjusted for age, sex, BMI, depressive symptoms, ROA, knee pain, and pain in the lower body apart from the knee (the hip, ankle, or foot)

To cite this abstract, please use the following information:
White, Daniel, Zhang, Yuqing, Niu, Jingbo, Nevitt, Michael, Lewis, C. Elizabeth, Torner, James, et al; The Association of Arm and Back Pain with Incidence of Slow Walking in Persons with Knee Osteoarthritis: The MOST Study. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2058
DOI: 10.1002/art.29823

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