Abstract
BACKGROUND: To assess the compound effects of BMI and sustained depressive symptoms on changes in knee structure, cartilage composition, and knee pain over 4 years using statistical interaction analyses. METHODS: One thousand eight hundred forty-four individuals from the Osteoarthritis Initiative Database were analyzed at baseline and 4-year follow-up. Individuals were categorized according to their BMI and presence of depressive symptoms (based on the Center for Epidemiological Studies Depression Scale (threshold≥16)) at baseline and 4-year follow-up. 3 T MRI was used to quantify knee cartilage T(2) over 4 years, while radiographs were used to assess joint space narrowing (JSN). Mixed effects models examined the effect of BMI-depressive symptoms interactions on outcomes of cartilage T(2), JSN, and knee pain over 4-years. RESULTS: The BMI-depressive symptoms interaction was significantly associated with knee pain (p < 0.001) changes over 4 years, but not with changes in cartilage T(2) (p = 0.27). In women, the BMI-depressive symptoms interaction was significantly associated with JSN (p = 0.01). In a group-based analysis, participants with obesity and depression had significantly greater 4-year changes in knee pain (coeff.((obesity + depression vs. no_obesity + no_depression)) = 4.09, 95%CI = 3.60-4.58, p < 0.001), JSN (coeff. = 0.60, 95%CI = 0.44-0.77, p < 0.001), and cartilage T(2) (coeff. = 1.09, 95%CI = 0.68-1.49, p < 0.001) than participants without depression and normal BMI. CONCLUSIONS: The compound effects of obesity and depression have greater impact on knee pain and JSN progression compared to what would be expected based on their individual effects.