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Semin Arthritis Rheum. 2018 Jun;47(6):805-813. doi: 10.1016/j.semarthrit.2017.10.016. Epub 2017 Oct 31.

Presence of comorbidities and prognosis of clinical symptoms in knee and/or hip osteoarthritis: A systematic review and meta-analysis.

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Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University Hospital Campus, Building 3B3, Room 007, De Pintelaan 185, BE-9000, Ghent, Belgium; FWO (Pegasus)(2) EU Marie-Sklodowska Curie Fellow, EU Horizon 2020 Program, Brussels, Belgium. Electronic address:



(i) To determine the association between the presence of comorbidities and severity of pain and physical dysfunction in people with knee and/or hip osteoarthritis; (ii) to explore associations between specific comorbidities (cardiac disease and/or hypertension, diabetes, depression, and back pain) and symptom severity.


Studies were identified through systematic searches in four electronic databases and grey literature, and, subsequently, methodologically appraised. Eligible citations entailed cross-sectional or longitudinal studies as well as randomised controlled trials providing data of a direct association between comorbidity presence and the severity of self-reported and/or performance-based symptoms of pain and/or physical functioning, in people with knee and/or hip osteoarthritis. We performed random-effects meta-analysis if at least two citations of low-to-moderate risk of bias were available. The quality of the body of evidence was determined using Cochrane-recommended methods.


Of all eligible citations (n = 26), 17 studies were entered in meta-analysis. Moderate quality evidence revealed an association between having ≥1 general comorbidity and worsening of pain (regression coefficient (95% confidence interval (CI)): 0.18 (95% CI: 0.14,0.22)) and/or performance-based physical functioning (0.20 (95% CI: 0.10,0.29)). The presence of cardiac disease and/or hypertension (self-reported: 0.08 (95% CI: 0.01,0.16); performance-based: 0.11 (95% CI: 0.02,0.20)), or back pain (self-reported: 0.12 (95% CI: 0.04,0.20)) predicted deteriorated physical functioning. Co-existing diabetes was associated with worse pain (0.10 (95% CI: 0.02,0.17)). Other findings were non-significant and/or the evidence of poor quality.


Greater comorbidity burden contributes to worse pain and performance-based physical function in people with knee and/or hip osteoarthritis. Suffering comorbid cardiac disease including hypertension, back pain or diabetes may have differential effects on symptom severity.


Comorbidity; Pain; Physical function; Prognosis

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