title: Association between comorbid depression and osteoarthritis symptom severity in patients with knee osteoarthritis.
abstract: BACKGROUND
  We sought to investigate the reported association between depression and severity of knee osteoarthritis symptoms stratified by radiographic severity of osteoarthritis and to quantify the contribution made by depression to symptom severity.
  
  
  METHODS
  Six hundred and sixty elderly Koreans (sixty-five years or older) were evaluated for radiographic severity of knee osteoarthritis on the basis of the Kellgren-Lawrence grading system and also for symptom severity on the basis of the Western Ontario and McMaster Universities Osteoarthritis Index scales. Patient interviews and a questionnaire that made use of a geriatric depression scale were conducted for the purpose of assessing depressive disorders. Regression analyses were performed to assess the relative contributions by radiographic severity and depression severity to Western Ontario and McMaster Universities Osteoarthritis Index scores and to explore any associations between radiographic severity and the presence of a depressive disorder with regard to the risk of symptomatic knee osteoarthritis. Symptomatic knee osteoarthritis was defined as a Western Ontario and McMaster Universities Osteoarthritis Index score of ≥39.
  
  
  RESULTS
  The presence of a depressive disorder was found to be associated with an increased risk of symptomatic knee osteoarthritis (odds ratio = 5.87 [95% confidence interval, 3.01 to 11.44]). However, the influence of the presence of a depressive disorder was limited to subjects with a radiographic severity of minimal to moderate (Kellgren-Lawrence grade 0 to 3). The presence of a depressive disorder was not associated with the risk of symptomatic knee osteoarthritis in subjects with severe osteoarthritis (Kellgren-Lawrence grade 4).
  
  
  CONCLUSIONS
  This study indicates that the assessment and management of coexisting depression should be integrated with the assessment and management of knee osteoarthritis, particularly when radiographic changes of osteoarthritis in the knee joint are not severe.
authors.affiliation: Department of Neuropsychiatry, Seoul National University Bundang Hospital, South Korea.
authors.forename: Ki Woong
authors.initials: KW
authors.lastname: Kim
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Han
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Cho
authors.forename: Chong Bum
authors.initials: CB
authors.lastname: Chang
authors.forename: Joon Hyuk
authors.initials: JH
authors.lastname: Park
authors.forename: Jung Jae
authors.initials: JJ
authors.lastname: Lee
authors.forename: Seok Bum
authors.initials: SB
authors.lastname: Lee
authors.forename: Sang Cheol
authors.initials: SC
authors.lastname: Seong
authors.forename: Tae Kyun
authors.initials: TK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D008297:Male; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000523:psychology*; D011859:Radiography