Impact of pain sensitisation on the quality of life of patients with knee osteoarthritis.

OBJECTIVES: We aim to evaluate the effect on different ways of classifying pain sensitisation on impact and quality of life (QoL) in knee osteoarthritis (KOA). METHODS: We used baseline data from a cohort of consecutive patients with KOA listed for arthroplasty. We collected demographics and number of painful body sites. We measured pressure pain thresholds at the right forearm (PPTarm). Pain sensitisation was classified using: (1) widespread pain, (2) lowest 10th percentile of PPTarm and (3) PainDETECT questionnaire ≥13/38. Impact and QoL were assessed using Western Ontario and McMaster Universities Osteoarthritis Index and Short Form-36. Impact and QoL scores in patients with or without pain sensitisation were compared. We evaluated the association of pain sensitisation measures with QoL scores using multivariable regression. RESULTS: 233 patients (80% female, mean age 66 years) included in the analysis; 7.3%, 11.6% and 4.7% were classified as having pain sensitisation by widespread pain, low PPTarm and PainDETECT criteria, respectively. There was minimal overlap of patients as classified as pain sensitisation phenotype by different measures. Patients with pain sensitisation had poorer QoL compared with those without. Low PPTarm identified patients with poorer general health, while widespread pain and PainDETECT identified poorer QoL in more psychological domains. There was weak correlation between number of painful body sites and PainDETECT (rho=0.23, p<0.01), but no significant correlation with PPTarm. CONCLUSION: Patients with KOA with pain sensitisation have poorer QoL compared with those without, regardless of classification method. Different criteria defined patients with different pattern of QoL impact.

Measurement properties of Pain Catastrophizing Scale in patients with knee osteoarthritis.

OBJECTIVES: Pain catastrophizing impacts symptoms and outcomes for knee osteoarthritis (OA). We evaluated the internal consistency, content, construct and structure validity of the Pain Catastrophizing Scale (PCS) in patients with knee OA. METHODS: We evaluated content validity of PCS via cognitive interviews. We then recruited patients with knee OA enlisted for knee replacement (KR) surgery in a Singapore tertiary referral hospital for cross-sectional validation evaluation of PCS. Data was collected 2 weeks prior to KR. Analyses was guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework for internal consistency, construct validity and structure validity. RESULTS: Adequate content validity was confirmed from 10 patients in cognitive interviews. 675 (70.4% female, mean (standard deviation, SD) age = 65.52 (6.84) years) were included (91.7% total KR, 8.3% unicompartmental KR) in the cross-sectional study. The mean (SD) PCS score was 12.65 (10.55), with 0.14% and 8.63% ceiling and floor effects, respectively. PCS demonstrates high internal consistency (Cronbach's alpha = 0.94). Construct validity was demonstrated by fulfilment of seven out of seven (100%) a priori hypotheses. PCS was strongly correlated with anxiety and depression, and moderately correlated with physical functioning and mental health domains of the short form 36 health survey (SF-36). Sensitivity analyses between Chinese and non-Chinese subgroups are generally consistent. From confirmatory factor analysis, the PCS model showed good fit for a second-order, three-factor structure (CFI = 0.965, TLI = 0.950, SRMR = 0.031). CONCLUSIONS: This study supports internal consistency, construct validity and structural validity of PCS as a measure of pain catastrophizing in knee OA patients. Key points • The PCS is validated for measuring pain catastrophizing in knee OA patients, for evaluation of possible link to post-KR surgery satisfaction outcomes and other purposes.

Radiology Preparedness in the Ongoing Battle against COVID-19: Experiences from Large to Small Public Hospitals in Singapore.

The coronavirus disease 2019 (COVID-19) pandemic presents an unprecedented challenge to the health care systems of the world. In Singapore, early experiences of the radiology community on managing this pandemic was shaped by lessons learned from the severe acute respiratory syndrome outbreak in 2003. This article surveys the operational responses of radiology departments from six public hospitals in Singapore. © RSNA, 2020.

The role of magnetic resonance imaging in the evaluation of scaphoid fractures.

Radiographs are currently accepted as the first-line modality for the investigation of scaphoid fractures. Early use of magnetic resonance imaging (MRI) in patients with radio-occult scaphoid fractures has been shown to be beneficial in the management of such patients. Incorporation of early MRI into the management protocol for scaphoid fracture is recommended.

Validation of screening questionnaires for evaluation of knee osteoarthritis prevalence in the general population of Singapore.

BACKGROUND: The prevalence of symptomatic knee osteoarthritis (KOA) in Singapore is unknown. We aimed to: (i) validate questionnaires to screen for symptomatic KOA; and (ii) estimate the prevalence of symptomatic KOA in Singapore using the validated algorithms. METHODS: Subjects aged ≥50 years were evaluated for symptomatic KOA based on American College of Rheumatology clinical and radiographic criteria in a rheumatology clinic, and completed three sets of adapted screening questionnaires. The better performing screening questionnaire with adequate sensitivity and specificity was adminitered to a nationally representative sample of survey subjects (n = 3364) to estimate the weighted prevalence of symptomatic KOA in Singapore. RESULTS: Out of 146 subjects evaluated in the clinic, 45 had symptomatic KOA. A screening algorithm which consisted of three KOA symptoms or one symptom plus physician-diagnosed KOA produced high specificity (0.95, 95% confidence intervals [CI]: 0.88-0.98) but low sensivity (0.44, 95% CI: 0.30-0.60). Replacing the term 'KOA' with 'physician-diagnosed ageing-related knee problem' improved the sensivity (0.62, 95% CI: 0.47-0.76) without significantly compromising the specificity (0.87, 95% CI: 0.79-0.93). The prevalence of symptomatic KOA weighted to the Singapore population distribution were 4.7% and 11%, using the most conservative and more liberal algorithms, respectively. There was a sharp rise in prevalence after age of 40. The weighted prevalence of KOA was higher in women and among Indian and Malay than Chinese. CONCLUSION: Our study adapted and validated questionnaires to the local context to screen for symptomatic KOA. We estimated the prevalence of symptomatic KOA in Singapore utilizing the better-performing algorithms.

Clinics in diagnostic imaging (144). Lateral meniscal ossicle.

A 35-year-old female patient with previous left knee anterior cruciate ligament repair for a skiing injury presented six years later with a traumatic lateral patellar subluxation. Radiographs and magnetic resonance imaging of her left knee joint showed an ossific structure in the region of the lateral meniscus. This was diagnosed as a meniscal ossicle and confirmed during successful arthroscopic excision. The imaging features of meniscal ossicles are reported.

Clinics in diagnostic imaging (150).

Spontaneous spinal epidural haematoma is a rarely encountered cause of back pain. It often leads to cauda equina syndrome, necessitating emergency spinal surgery. We report the case of a 19-year-old Chinese man who presented with pain in the lower back, which started after he had carried some heavy boxes. He denied a history of fall or trauma. Magnetic resonance (MR) imaging showed a hyperintense biconvex-shaped lesion in the posterior epidural space on both T1- and T2-weighted sequences, diagnostic of a spinal epidural haematoma. The patient, who was admitted and managed conservatively, had gradual resolution of his pain. No neurological deficit was detected on discharge or on follow-up. Repeat MR imaging showed total resolution of the lumbar spinal epidural haematoma. The clinical characteristics, MR imaging features, diagnosis and management of spontaneous spinal epidural haematoma are discussed.