Sleep Quality Is Related to Worsening Knee Pain in Those with Widespread Pain: The Multicenter Osteoarthritis Study


We examined the association between sleep and odds of developing knee pain, and whether this relationship varied by status of widespread pain (WSP).


At the 60-month visit of the Multicenter Osteoarthritis Study, sleep quality and restless sleep were each assessed by using a single item from two validated questionnaires; each sleep measure was categorized into three levels with poor/most restless sleep as the reference. WSP was defined as pain above and below the waist on both sides of the body and axially using a standard homunculus, based on the American College of Rheumatology criteria. Outcomes from 60-84 months included 1) knee pain worsening (KPW, defined as minimal clinically important difference in WOMAC pain], 2) prevalent and 3) incident consistent frequent knee pain. We applied Generalized Estimating Equations in multivariable logistic regression models.


We studied 2329 participants (4658 knees) [67.9y, BMI: 30.9]. We found that WSP modified the relationship between sleep quality and KPW (p<0.01 for interaction). Among persons with WSP, odds ratio (95% confidence interval) for KPW was 0.54 (0.35, 0.78) for those with very good sleep quality (p-trend<0.001); additionally, we found the strongest association of sleep quality in persons with >8 painful joint sites (p- trend<0.01), but not in those with ≤ 2 painful joint sites. Similar results were observed using restless sleep, in the presence of WSP. Cross-sectional relationship was suggested significant between sleep and prevalence of consistent frequent knee pain.


Better sleep was related to less knee pain worsening with coexisting widespread pain.

 2019 Nov 15. pii: jrheum.181365. doi: 10.3899/jrheum.181365. [Epub ahead of print]