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Roemer FW, Jarraya M, Hayashi D, Crema MD, Haugen IK, Hunter DJ, Guermazi A. A perspective on the evolution of semi-quantitative MRI assessment of osteoarthritis: Past, present and future. Osteoarthritis Cartilage 2024; 32:460-472. [PMID: 38211810 DOI: 10.1016/j.joca.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE This perspective describes the evolution of semi-quantitative (SQ) magnetic resonance imaging (MRI) in characterizing structural tissue pathologies in osteoarthritis (OA) imaging research over the last 30 years. METHODS Authors selected representative articles from a PubMed search to illustrate key steps in SQ MRI development, validation, and application. Topics include main scoring systems, reading techniques, responsiveness, reliability, technical considerations, and potential impact of artificial intelligence (AI). RESULTS Based on original research published between 1993 and 2023, this article introduces available scoring systems, including but not limited to Whole-Organ Magnetic Resonance Imaging Score (WORMS) as the first system for whole-organ assessment of the knee and the now commonly used MRI Osteoarthritis Knee Score (MOAKS) instrument. Specific systems for distinct OA subtypes or applications have been developed as well as MRI scoring instruments for other joints such as the hip, the fingers or thumb base. SQ assessment has proven to be valid, reliable, and responsive, aiding OA investigators in understanding the natural history of the disease and helping to detect response to treatment. AI may aid phenotypic characterization in the future. SQ MRI assessment's role is increasing in eligibility and safety evaluation in knee OA clinical trials. CONCLUSIONS Evidence supports the validity, reliability, and responsiveness of SQ MRI assessment in understanding structural aspects of disease onset and progression. SQ scoring has helped explain associations between structural tissue damage and clinical manifestations, as well as disease progression. While AI may support human readers to more efficiently perform SQ assessment in the future, its current application in clinical trials still requires validation and regulatory approval.
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Affiliation(s)
- Frank W Roemer
- Universitätsklinikum Erlangen & Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany; Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA.
| | - Mohamed Jarraya
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daichi Hayashi
- Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Michel D Crema
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA; Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, St. Leonards, NSW, Australia
| | - Ali Guermazi
- Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA; Boston VA Healthcare System, West Roxbury, MA, USA
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Roemer FW, Wirth W, Demehri S, Kijowski R, Jarraya M, Hayashi D, Eckstein F, Guermazi A. Imaging Biomarkers of Osteoarthritis. Semin Musculoskelet Radiol 2024; 28:14-25. [PMID: 38330967 DOI: 10.1055/s-0043-1776432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Currently no disease-modifying osteoarthritis drug has been approved for the treatment of osteoarthritis (OA) that can reverse, hold, or slow the progression of structural damage of OA-affected joints. The reasons for failure are manifold and include the heterogeneity of structural disease of the OA joint at trial inclusion, and the sensitivity of biomarkers used to measure a potential treatment effect.This article discusses the role and potential of different imaging biomarkers in OA research. We review the current role of radiography, as well as advances in quantitative three-dimensional morphological cartilage assessment and semiquantitative whole-organ assessment of OA. Although magnetic resonance imaging has evolved as the leading imaging method in OA research, recent developments in computed tomography are also discussed briefly. Finally, we address the experience from the Foundation for the National Institutes of Health Biomarker Consortium biomarker qualification study and the future role of artificial intelligence.
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Affiliation(s)
- Frank W Roemer
- Department of Radiology, Chobanian & Avedisian Boston University School of Medicine, Boston, Massachusetts
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Wirth
- Center of Anatomy, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
- Chondrometrics, GmbH, Freilassing, Germany
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard Kijowski
- Department of Radiology, New York University Grossmann School of Medicine, New York, New York
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daichi Hayashi
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Felix Eckstein
- Center of Anatomy, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria
- Chondrometrics, GmbH, Freilassing, Germany
| | - Ali Guermazi
- Department of Radiology, Chobanian & Avedisian Boston University School of Medicine, Boston, Massachusetts
- Department of Radiology, Boston VA Healthcare System, West Roxbury, Massachusetts
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Clausen SH, Skou ST, Boesen MP, Radev DI, Kurt EY, Damsted C, Hölmich P, Lind M, Tørring S, Isaksen C, Varnum C, Englund M, Thorlund JB. Two-year MRI-defined structural damage and patient-reported outcomes following surgery or exercise for meniscal tears in young adults. Br J Sports Med 2023; 57:1566-1572. [PMID: 37879858 DOI: 10.1136/bjsports-2023-107352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To investigate potential differences in structural knee joint damage assessed by MRI and patient-reported outcomes (PROMs) at 2-year follow-up between young adults randomised to early surgery or exercise and education with optional delayed surgery for a meniscal tear. METHODS A secondary analysis of a multicentre randomised controlled trial including 121 patients (18-40 years) with an MRI-verified meniscal tear. For this study, only patients with 2-year follow-up were included. The main outcomes were the difference in worsening of structural knee damage, assessed by MRI using the Anterior Cruciate Ligament OsteoArthrits Score, and the difference in change in the mean score of four Knee Injury and Osteoarthritis Outcome Score (KOOS4) subscales covering pain, symptoms, function in sport and recreation, and quality of life, from baseline to 2 years. RESULTS In total, 82/121 (68%) patients completed the 2-year follow-up (39 from the surgical group and 43 from the exercise group). MRI-defined cartilage damage had developed or progressed in seven (9.1%) patients and osteophytes developed in two (2.6%) patients. The worsening of structural damage from baseline to 2-year follow-up was similar between groups. The mean (95% CI) adjusted differences in change in KOOS4 between intervention groups from baseline to 2 years was -1.4 (-9.1, 6.2) points. The mean improvement in KOOS4 was 16.4 (10.4, 22.4) in the surgical group and 21.5 (15.0, 28.0) in the exercise group. No between group differences in improvement were found in the KOOS subscales. CONCLUSIONS The 2-year worsening of MRI-defined structural damage was limited and similar in young adult patients with a meniscal tear treated with surgery or exercise with optional delayed surgery. Both groups had similar clinically relevant improvements in KOOS4, suggesting the choice of treatment strategy does not impact 2-year structural knee damage or PROMs. TRIAL REGISTRATION NUMBER NCT02995551.
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Affiliation(s)
- Stine Haugaard Clausen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
| | - Søren T Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Mikael Ploug Boesen
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Dimitar Ivanon Radev
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Engin Yeter Kurt
- Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Camma Damsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Copenhagen University Hospital, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Martin Lind
- Department of Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Sofus Tørring
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christin Isaksen
- Department of Radiology, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Roemer F, Maschek S, Wisser A, Guermazi A, Hunter D, Eckstein F, Wirth W. Worsening of Articular Tissue Damage as Defined by Semi-Quantitative MRI Is Associated With Concurrent Quantitative Cartilage Loss Over 24 Months. Cartilage 2023; 14:39-47. [PMID: 36624993 PMCID: PMC10076901 DOI: 10.1177/19476035221147677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To assess the association of worsening of magnetic resonance imaging (MRI) semi-quantitative (SQ) tissue features with concurrent change in quantitative (Q) cartilage thickness measurements over 24 months within the Foundation for the National Institutes of Health (FNIH) Biomarker Consortium study. METHODS In all, 599 participants were included. SQ assessment included cartilage damage, meniscal extrusion and damage, osteophytes, bone marrow lesions (BMLs), and effusion- and Hoffa-synovitis. Change in medial compartment Q cartilage thickness was stratified by concurrent ipsicompartmental SQ changes. Between-group comparisons were performed using analysis of covariance (ANCOVA) with adjustment for age, sex, and body mass index (BMI). Results were presented as adjusted mean difference. RESULTS Knees with any increase in SQ cartilage scores in the medial compartment (n = 268) showed more Q cartilage loss compared to knees that remained stable (mean adjusted difference [MAD] = -0.16 mm, 95% confidence interval [CI]: [-0.19, -0.13] mm). Knees with any increase in meniscal extrusion in the medial compartment (n = 98) showed more Q cartilage loss than knees without (MAD = -0.18 mm, 95% CI: [-0.22, -0.14] mm. Comparable findings were seen for meniscal damage worsening. Regarding BMLs, an increase by one subregion resulted in a MAD of Q cartilage loss of -0.10 mm, 95% CI: [-0.14, -0.06] mm, while this effect almost tripled for change in two or more subregions. Increase in either effusion- and/or Hoffa-synovitis by one grade resulted in a MAD of -0.07 mm, 95% CI: [-0.10, -0.03] mm. CONCLUSION Worsening of SQ cartilage damage, meniscal extrusion and damage, number of subregions affected by BML, maximum size of BMLs and worsening of effusion- and/or Hoffa synovitis is associated with increased Q cartilage loss.
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Affiliation(s)
- Frank Roemer
- Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | - Susanne Maschek
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Anna Wisser
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | | | - David Hunter
- The University of Sydney, Sydney, NSW, Australia
| | - Felix Eckstein
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
| | - Wolfgang Wirth
- Paracelsus Medizinische Privatuniversität, Salzburg, Austria
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Guermazi A, Roemer FW, Crema MD, Jarraya M, Mobasheri A, Hayashi D. Strategic application of imaging in DMOAD clinical trials: focus on eligibility, drug delivery, and semiquantitative assessment of structural progression. Ther Adv Musculoskelet Dis 2023; 15:1759720X231165558. [PMID: 37063459 PMCID: PMC10103249 DOI: 10.1177/1759720x231165558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
Despite decades of research efforts and multiple clinical trials aimed at discovering efficacious disease-modifying osteoarthritis (OA) drugs (DMOAD), we still do not have a drug that shows convincing scientific evidence to be approved as an effective DMOAD. It has been suggested these DMOAD clinical trials were in part unsuccessful since eligibility criteria and imaging-based outcome evaluation were solely based on conventional radiography. The OA research community has been aware of the limitations of conventional radiography being used as a primary imaging modality for eligibility and efficacy assessment in DMOAD trials. An imaging modality for DMOAD trials should be able to depict soft tissue and osseous pathologies that are relevant to OA disease progression and clinical manifestations of OA. Magnetic resonance imaging (MRI) fulfills these criteria and advances in technology and increasing knowledge regarding imaging outcomes likely should play a more prominent role in DMOAD clinical trials. In this perspective article, we will describe MRI-based tools and analytic methods that can be applied to DMOAD clinical trials with a particular emphasis on knee OA. MRI should be the modality of choice for eligibility screening and outcome assessment. Optimal MRI pulse sequences must be chosen to visualize specific features of OA.
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Affiliation(s)
| | - Frank W. Roemer
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Department of Radiology, School of Medicine, Boston University, Boston, MA, USA
| | - Michel D. Crema
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
- Department of Radiology, School of Medicine, Boston University, Boston, MA, USA
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Mobasheri
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - Daichi Hayashi
- Department of Radiology, Tufts Medical Center, Tufts Medicine, Boston, MA, USA
- Department of Radiology, School of Medicine, Boston University, Boston, MA, USA
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Chang AH, Almagor O, Muhammad LN, Guermazi A, Prasad PV, Chmiel JS, Moisio KC, Lee JJ, Sharma L. Ambulatory support moment contribution patterns and MRI-detected tibiofemoral and patellofemoral disease worsening in adults with knee osteoarthritis: A preliminary study. J Orthop Res 2022; 41:1206-1216. [PMID: 36268875 PMCID: PMC10119326 DOI: 10.1002/jor.25475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
We investigated whether baseline sagittal-plane ankle, knee, and hip contribution to the total support moment (TSM) are each associated with baseline-to-2-year tibiofemoral and patellofemoral tissue damage worsening in adults with knee osteoarthritis. Ambulatory lower-limb kinetics were captured and computed. TSM is the sum of ankle, knee, and hip extensor moments at each instant during gait. Ankle, knee, and hip contributions to TSM were computed as joint moments divided by TSM, expressed as percentages. Participants underwent MRI of both knees at baseline and 2 years later. Logistic regression models assessed associations of baseline ankle contribution to TSM with baseline-to-2-year cartilage damage and bone marrow lesion worsening, adjusted for age, sex, BMI, gait speed, disease severity, and pain. We used similar analytic approaches for knee and hip contributions to TSM. Sample included 391 knees from 204 persons (age[SD]: 64[10] years; 76.5% women). Greater ankle contribution may be associated with increased odds of tibiofemoral cartilage damage worsening (OR = 2.38; 95% CI: 1.02-5.57) and decreased odds of patellofemoral bone marrow lesion worsening (OR = 0.14; 95% CI: 0.03-0.73). The ORs for greater knee contribution were in the protective range for tibiofemoral compartment and in the deleterious range for patellofemoral. Greater hip contribution may be associated with increased odds of tibiofemoral worsening (OR = 2.71; 95% CI: 1.17-6.30). Greater ankle contribution to TSM may be associated with baseline-to-2-year tibiofemoral worsening, but patellofemoral tissue preservation. Conversely, greater knee contribution may be associated with patellofemoral worsening, but tibiofemoral preservation. Preliminary findings illustrate potential challenges in developing biomechanical interventions beneficial to both tibiofemoral and patellofemoral compartments.
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Affiliation(s)
- Alison H Chang
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
| | - Orit Almagor
- Department of Medicine, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
| | - Lutfiyya N Muhammad
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Quantitative Imaging Center, Massachusetts, Boston, USA
| | - Pottumarthi V Prasad
- Department of Radiology, NorthShore University HealthSystem, Illinois, Evanston, USA
| | - Joan S Chmiel
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
| | - Kirsten C Moisio
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
| | - Jungwha Julia Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
| | - Leena Sharma
- Department of Medicine, Northwestern University Feinberg School of Medicine, Illinois, Chicago, USA
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Roemer FW, Guermazi A, Demehri S, Wirth W, Kijowski R. Imaging in Osteoarthritis. Osteoarthritis Cartilage 2022; 30:913-934. [PMID: 34560261 DOI: 10.1016/j.joca.2021.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis with major implications on both individual and public health care levels. The field of joint imaging, and particularly magnetic resonance imaging (MRI), has evolved rapidly due to the application of technical advances to the field of clinical research. This narrative review will provide an introduction to the different aspects of OA imaging aimed at an audience of scientists, clinicians, students, industry employees, and others who are interested in OA but who do not necessarily focus on OA. The current role of radiography and recent advances in measuring joint space width will be discussed. The status of cartilage morphology assessment and evaluation of cartilage biochemical composition will be presented. Advances in quantitative three-dimensional morphologic cartilage assessment and semi-quantitative whole-organ assessment of OA will be reviewed. Although MRI has evolved as the most important imaging method used in OA research, other modalities such as ultrasound, computed tomography, and metabolic imaging play a complementary role and will also be discussed.
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Affiliation(s)
- F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, Erlangen, 91054, Germany.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, VA Boston Healthcare System, 1400 VFW Pkwy, Suite 1B105, West Roxbury, MA, 02132, USA
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolf Street, Park 311, Baltimore, MD, 21287, USA
| | - W Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg, Salzburg, Austria, Nüremberg, Germany; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria; Chondrometrics, GmbH, Freilassing, Germany
| | - R Kijowski
- Department of Radiology, New York University Grossmann School of Medicine, 550 1st Avenue, 3nd Floor, New York, NY, 10016, USA
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Crema MD, Roemer FW, Nevitt MC, Felson DT, Marra MD, Lynch JA, Tolstykh I, Lewis CE, Torner J, Guermazi A. Cross-sectional and longitudinal reliability of semiquantitative osteoarthritis assessment at 1.0T extremity MRI: Multi-reader data from the MOST study. Osteoarthr Cartil Open 2021; 3:100214. [PMID: 36474762 PMCID: PMC9718190 DOI: 10.1016/j.ocarto.2021.100214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022] Open
Abstract
Objective To determine reliability among four experienced and calibrated readers in cross-sectional and longitudinal semi-quantitative MRI assessments of knee osteoarthritis (OA) in the Multicenter Osteoarthritis (MOST) study. Design From all MOST participants with at least one knee with readable 60-month and 84-month paired knee MRIs (1.0 T extremity systems), we selected 10 subjects having a spectrum of baseline disease severity of cartilage, bone marrow lesions, and meniscal damage and a spectrum of longitudinal changes in severity at 24 months follow-up. MRIs were independently assessed using the WORMS grading system by four musculoskeletal radiologists with the chronological sequence known to the readers. Kappa statistics were used to determine agreement between each pair of readers and Kendall's coefficient of concordance to determine average agreement across readers. Results For most features, cross-sectional reliability was substantial to almost perfect. Regarding longitudinal reliability (detection of longitudinal change), inter-reader reliability as weighted kappa values ranged from 0.62 to 0.78 for cartilage damage, 0.75-0.88 for bone marrow lesions, 0.75-0.92 for meniscal tears, 0.67-0.95 for meniscal extrusion, 0.51-0.77 for bone attrition, 0.43-0.76 for osteophytes, 0.31-0.70 for Hoffa-synovitis, and 0.47-0.85 for effusion-synovitis. Kendall's coefficient ranged from 0.65 to 0.98. Conclusion High levels of cross-sectional reliability and moderate to high longitudinal reliability was achieved using four experienced readers in semiquantitative MRI-assessment of most knee OA features.
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Affiliation(s)
- Michel D. Crema
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Institute of Sports Imaging; Department of Sports Medicine, French National Institute of Sports (INSEP), Paris, France
| | - Frank W. Roemer
- Institute of Sports Imaging; Department of Sports Medicine, French National Institute of Sports (INSEP), Paris, France
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - David T. Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Monica D. Marra
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Rothschild Hospital, Sorbonne University, Paris, France
| | - John A. Lynch
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Irina Tolstykh
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Cora E. Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Torner
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, VA Boston Healthcare System, Boston, MA, USA
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Harkey MS, Blackburn JT, Hackney AC, Lewek MD, Schmitz RJ, Pietrosimone B. Sex-Specific Associations between Cartilage Structure and Metabolism at Rest and Acutely Following Walking and Drop-Landing. Cartilage 2021; 13:1772S-1781S. [PMID: 32954820 PMCID: PMC8808927 DOI: 10.1177/1947603520959386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Cartilage health is thought to be dependent on the relationship between mechanics, structure, and metabolism, rather than these individual components in isolation. Due to sex differences in cartilage health, there is need to determine if the relationships between these cartilage components separately for males and females. Therefore, we sought to determine the sex-specific associations between cartilage structure and metabolism at rest and their acute response following walking and drop-landing in healthy individuals. DESIGN A cartilage ultrasound assessment and an ante-cubital blood draw were performed before and after walking and drop-landing conditions in 20 males and 20 females. Cartilage structure was assessed via medial and lateral femoral cartilage cross-sectional area. Cartilage metabolism was quantified with serum cartilage oligomeric matrix protein (COMP) concentration. Percent change scores from pre- to postloading were used to calculate acute alterations in cross-sectional area and COMP. Correlational analyses were used to assess the association between cartilage structure and metabolism measures separately for males and females. RESULTS In females, greater resting COMP concentration was associated with less cartilage cross-sectional area in the medial(ρ = -0.50, P = 0.03) and lateral (ρ = -0.69, P = 0.001) femur. Resting cartilage measures were not associated among males. Following walking and drop-landing, percent change scores in cartilage structure and metabolism were not associated. CONCLUSIONS This study highlights that, in females, thinner anterior femoral cartilage is associated with greater resting serum COMP concentrations, a biomarker often linked to cartilage breakdown. Future studies into the relationships between various cartilage components should consider sex-specific analyses as these relationships are sex dependent.
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Affiliation(s)
- Matthew S. Harkey
- Department of Kinesiology, Michigan
State University, East Lansing, MI, USA,Matthew S. Harkey, Department of
Kinesiology, Michigan State University, 308 W. Circle Drive #112, East Lansing,
MI 48824, USA.
| | - J. Troy Blackburn
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anthony C. Hackney
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Nutrition, School of
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA
| | - Michael D. Lewek
- Division of Physical Therapy, University
of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Randy J. Schmitz
- Department of Kinesiology, University of
North Carolina at Greensboro, Greensboro, NC, USA
| | - Brian Pietrosimone
- Department of Exercise and Sports
Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Hayashi D, Roemer FW, Guermazi A. How to effectively utilize imaging in disease-modifying treatments for osteoarthritis clinical trials: the radiologist's perspective. Expert Rev Mol Diagn 2021; 21:673-684. [PMID: 34015975 DOI: 10.1080/14737159.2021.1933444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: One of the reasons for failures of disease-modifying osteoarthritis drug clinical trials has been the radiography-based definition of structural eligibility criteria. Imaging, particularly MRI, has a critical role in planning and conducting clinical trials of osteoarthritis.Areas covered: A literature search was performed using keywords including 'osteoarthritis,' 'knee,' 'MRI,' 'intra-articular injection,' 'semiquantitative scoring,' 'clinical trial,' and other specific terms where relevant. The core concepts of using MRI in osteoarthritis clinical trials are explained focusing on knee osteoarthritis, including its role in determining patient eligibility and inclusion/exclusion criteria as well as outcome measures from the expert musculoskeletal radiologist's perspective. A brief overview of statistical analyses that should be deployed in clinical trials utilizing semiquantitative MRI analyses is discussed.Expert opinion: In order to increase chances to detect measurable efficacy effects, investigators should consider utilizing MRI from screening to outcome assessment. Recognition of several phenotypes of osteoarthritis helps in participant stratification and will lead to more targeted clinical trials. Inclusion and exclusion criteria need to be defined using not only radiography but also MRI. Correct intra-articular injection of investigational compounds is critically important if intra-articular drug delivery is required, and such procedure should be performed and documented using appropriate imaging guidance.
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Affiliation(s)
- Daichi Hayashi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, Stony Brook University, Renaissance School of Medicine, State University of New York, Stony Brook, NY, USA
| | - Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, Friedrich-Alexander University Erlangen-Nuremberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, Veterans Affairs Boston Healthcare System, Boston, MA, USA
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11
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Roemer FW, Lohmander LS, Englund M, Guermazi A, Åkesson A, Frobell R. Development of MRI-defined Structural Tissue Damage after Anterior Cruciate Ligament Injury over 5 Years: The KANON Study. Radiology 2021; 299:383-393. [PMID: 33687286 DOI: 10.1148/radiol.2021202954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background MRI is used to evaluate structural joint changes after anterior cruciate ligament (ACL) injury, but no long-term data are available for comparing different treatment approaches. Purpose To describe structural joint damage with MRI over a 5-year period in the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) study and to compare frequencies of such tissue damage for a nonsurgical versus a surgical treatment strategy. Materials and Methods In this secondary analysis of a prospective trial (ISRCTN 84752559), 119 participants with an acute ACL injury were evaluated. Participants were enrolled from 2002 through 2006, the 2-year follow-up started in 2008, and the 5-year follow-up started in 2011. A 1.5-T MRI examination was performed at baseline and at 2- and 5-year follow-up. MRI scans were read according to a validated scoring instrument. Kruskal-Wallis tests were used to assess whether the frequencies of structural damage differed between the three as-treated groups. Results Of 119 participants (mean age, 26 years ± 5 [standard deviation]), 91 men were evaluated. At 2- and 5-year follow-up, respectively, 13% (15 of 117) and 13% (15 of 115) of knees showed incident cartilage damage in the medial tibiofemoral joint, 11% (13 of 117) and 17% (20 of 115) of knees showed incident cartilage damage in the lateral tibiofemoral joint, and 4% (five of 117) and 8% (nine of 115) of knees showed incident cartilage damage in the patellofemoral joint. Osteophyte development was seen in 23% (27 of 117) and 29% (33 of 115) of knees in the medial tibiofemoral joint, in 36% (42 of 117) and 43% (49 of 115) of knees in the lateral tibiofemoral joint, and in 35% (41 of 117) and 37% (42 of 115) of knees in the patellofemoral joint. No major differences between the groups were found for incident or worsening cartilage damage, bone marrow lesions, and osteophytes at 2 or 5 years. The rehabilitation-alone group showed less Hoffa-synovitis at 2 (P = .02) and 5 (P = .008) years. Conclusion Young adults with anterior cruciate ligament injury showed no major difference in frequency of structural tissue damage on MRI scans at 2 and 5 years regardless of treatment. However, the rehabilitation-alone group had less inflammation at 2 and 5 years. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Andreisek in this issue.
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Affiliation(s)
- Frank W Roemer
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - L Stefan Lohmander
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Martin Englund
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Ali Guermazi
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Anna Åkesson
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Richard Frobell
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
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12
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Macri EM, Runhaar J, Damen J, Oei EH, Bierma-Zeinstra SM. Kellgren & Lawrence grading in cohort studies: methodological update and implications illustrated using data from the CHECK cohort. Arthritis Care Res (Hoboken) 2021; 74:1179-1187. [PMID: 33450140 PMCID: PMC9541941 DOI: 10.1002/acr.24563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
Objective The Cohort Hip and Cohort Knee (CHECK) is a cohort of middle‐aged individuals with hip or knee pain. Radiographs were assigned Kellgren/Lawrence (K/L) scores under different conditions at each follow‐up visit for 10 years. We aimed to describe and consolidate each scoring approach, then illustrate implications of their use by comparing baseline K/L scores assigned using 2 of these approaches, and evaluating their respective associations with joint replacement and incident radiographic osteoarthritis (ROA). Methods We compared baseline K/L scores assigned to hips and knees using 2 scoring approaches: 1) assigned by senior researchers to baseline images alone and 2) assigned by trained readers, with images read paired and in known sequence with up to 10 years of follow‐up radiographs (Poisson regression). We evaluated the associations of baseline ROA (any: K/L grade ≥1; established: K/L ≥2) with joint replacement, and of K/L 1 joints with incident established ROA (survival analysis). Results Of 1,002 participants (79% women, mean ± SD age 55.9 ± 5.2 years, body mass index 26.2 ± 4.0 kg/m2), the second scoring approach had 2.4 times (95% confidence interval [95% CI] 1.8–3.1 for knees) and 2.9 times (95% CI 2.3–3.7 for hips) higher prevalence of established ROA than the first approach. Established hip ROA had a higher risk of joint replacement using the first approach (hazard ratio [HR] 24.2 [95% CI 15.0–39.8] versus second approach HR 7.7 [95% CI 4.9–12.1]), as did knees (HR 19.3 [95% CI 10.3–36.1] versus second approach HR 4.8 [95% CI 2.4–9.6]). The risk of incident ROA did not differ by approach. Conclusion This study demonstrates that evaluating ROA prevalence and predicting outcomes depends on the scoring approach.
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Affiliation(s)
- Erin M Macri
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands
| | - Jurgen Damen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands
| | - Edwin Hg Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Netherlands
| | - Sita Ma Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Netherlands
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13
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Neuprez A, Kaux JF, Locquet M, Beaudart C, Reginster JY. The presence of erosive joints is a strong predictor of radiological progression in hand osteoarthritis: results of a 2-year prospective follow-up of the Liège Hand Osteoarthritis Cohort (LIHOC). Arthritis Res Ther 2021; 23:12. [PMID: 33407767 PMCID: PMC7788934 DOI: 10.1186/s13075-020-02390-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study measured the magnitude and determinants of clinical and radiological progression in patients with hand osteoarthritis (HOA) over a 2-year prospective follow-up to gain a greater understanding of the disease time course. Methods Two hundred three consecutive outpatients diagnosed with HOA were followed for 2 years (183 women, median age 69 years). Pain and function were evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and clinical examination recorded the number of painful/swollen joints and nodes. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Clinical progression was defined as deterioration in AUSCAN ≥ the minimal clinically important difference. Radiographic progression was defined as (a) one new erosive/remodeled joint, (b) progression of ≥ one anatomical stage in one joint, or (c) change in KL total score above the smallest detectable difference. Logistic regression was performed to determine whether patient characteristics influenced clinical and radiological progression. Results After 2 years, all radiographic scores deteriorated significantly in the study population (p < 0.05), and the number of proximal and distal interphalangeal nodes was significantly higher (p < 0.01). The AUSCAN, number of painful joints at rest or at pressure, number of swollen joints, and pain measure on a visual analog scale remained unchanged. At the individual level, the number of patients with clinically meaningful progression ranged from 25 to 42% (clinical progression) and from 22 to 76% (radiological progression). The only significant predictor of worsening of total AUSCAN was AUSCAN pain subscale < 74.5 (odds ratio [OR] 1.02 [1.01, 1.03]; p < 0.01). The presence of ≥ four swollen joints (OR 2.78 [1.21, 6.39]; p = 0.02) and erosive osteoarthritis (OR 13.23 [5.07, 34.56]; p < 0.01) at baseline predicted a new erosive joint. A meaningful change in KL was more frequent with painful joints at baseline (OR 3.43 [1.68, 7.01]; p < 0.01). Conclusions Evidence of radiological progression over 2 years was observed in patients with HOA in the LIHOC population even without clinical worsening of disease. For individual patients, baseline pain level is predictive for clinical progression and the presence of erosive or swollen joints are significant predictors of radiological progression. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-020-02390-x.
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Affiliation(s)
- Audrey Neuprez
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium. .,Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium.
| | - Jean-François Kaux
- Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium
| | - Médéa Locquet
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium
| | - Charlotte Beaudart
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium.,Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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14
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Dório M, Hunter DJ, Collins JE, Asher R, Eckstein F, Guermazi A, Roemer FW, Deveza LA. Association of baseline and change in tibial and femoral cartilage thickness and development of widespread full-thickness cartilage loss in knee osteoarthritis - data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2020; 28:811-818. [PMID: 32240744 DOI: 10.1016/j.joca.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/23/2020] [Accepted: 03/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether baseline cartilage thickness and its longitudinal change are associated with incident widespread full-thickness cartilage loss (wsFTCL) in knee osteoarthritis, and whether there are optimal cut-off values for predicting wsFTCL. METHODS Central medial tibial (cMT) and femoral (cMF) cartilage were assessed using quantitative magnetic resonance imaging data from the Osteoarthritis Initiative cohort (N = 600 knees). Cartilage thickness was measured at baseline and 12 months. wsFTCL was defined semi-quantitatively (scores 2 and 3 from the MRI Osteoarthritis Knee Score) and its incidence at 24 months recorded. Logistic regression was used to determine the odds of developing wsFTCL for baseline and for each 0.1 mm decrease in cartilage thickness. Cut-off values were investigated using the minimal-p method and area under the Receiver Operating Characteristic curves (AUC). RESULTS Incident wsFTCL was observed in 66 (12%) and 73 (14%) knees in cMT and cMF, respectively. Lower baseline cMT and cMF cartilage thickness values were associated with wsFTCL (OR = 1.20; 95% CI: 1.11, 1.28 and OR = 1.15; 95% CI: 1.06 to 1.24, respectively). Optimal cut-off AUCs for the tibia and femur were 0.64 (0.57-0.70) and 0.63 (0.57-0.69), respectively. Longitudinal decrease in femoral, but not tibial, cartilage thickness was associated with incident wsFTCL (OR = 1.77; 95% CI: 1.30 to 2.40); optimal cut-off AUC 0.65 (95% CI: 0.58-0.72). CONCLUSION Lower baseline cMT and baseline/change (decrease) over 12 months in cMF cartilage thickness were associated with incident, location-specific, wsFTCL at 24 months. Optimal cut-off values were relatively low and of uncertain utility for predicting incident wsFTCL.
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Affiliation(s)
- M Dório
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - D J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
| | - J E Collins
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - R Asher
- NHMRC Clinical Trials Centre, The University of Sydney, Australia.
| | - F Eckstein
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology, Paracelsus Medical University, Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany.
| | - A Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - F W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - L A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.
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15
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Pfeiffer SJ, Davis-Wilson HC, Pexa B, Szymczak J, Wistreich C, Sorensen R, Wikstrom EA, Blackburn JT, Pietrosimone B. Assessing Step Count-Dependent Changes in Femoral Articular Cartilage Using Ultrasound. J Ultrasound Med 2020; 39:957-965. [PMID: 31763713 DOI: 10.1002/jum.15180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate changes in the femoral cartilage cross-sectional area (CSA) measured with ultrasound (US) between baseline and 1000, 2000, 3000, 4000, and 5000 steps of walking on a treadmill. METHODS Forty-one healthy individuals completed a single testing session. Participants rested with their knees extended on a plinth for 45 minutes to unload the femoral cartilage. Ultrasound was used to acquire images of the femoral cartilage before the treadmill-walking protocol. After the baseline US acquisition, participants walked on a treadmill at their preferred overground walking speed for 1000 steps, after which additional US images of the femoral cartilage were acquired. This process was repeated after 2000, 3000, 4000, and 5000 steps. A 1-way repeated-measures analysis of variance compared the CSA across the 6 step counts. An analysis of variance with repeated measures on time and Bonferroni corrected planned comparisons (.05/5) were used to evaluate differences in the femoral cartilage at each step count compared to baseline. RESULTS The study included 20 male and 21 female participants (mean age ± SD, 21.5 ± 2.8 years; mean body mass index, 24.3 ± 3.4 kg/m 2 ). The CSAs were significantly greater at the 2000-step (1.27 ± 1.75 mm 2 ; P < .001), 4000-step (0.89 ± 1.17 mm2; P < .001), and 5000-step (2.10 ± 1.73 mm 2 ; P < .001) points compared to baseline. The CSA was significantly less at the 3000-step point (1.05 ± 1.29 mm 2 ; P < .001) compared to baseline. CONCLUSIONS Changes in the CSA after walking may be dependent on the number of steps. The participants had a significant decrease in the CSA after 3000 steps of normal walking and a significant increase in the CSA after 2000, 4000, and 5000 steps of normal walking.
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Affiliation(s)
- Steven J Pfeiffer
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hope C Davis-Wilson
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brett Pexa
- Department of Athletic Training, High Point University, High Point, NC, USA
| | - Jessica Szymczak
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Catherine Wistreich
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Rachel Sorensen
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
| | - J Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina, USA
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16
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Snyder EA, Alvarez C, Golightly YM, Renner JB, Jordan JM, Nelson AE. Incidence and progression of hand osteoarthritis in a large community-based cohort: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2020; 28:446-452. [PMID: 32084589 PMCID: PMC7108963 DOI: 10.1016/j.joca.2020.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/23/2019] [Accepted: 02/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the incidence and progression of radiographic and symptomatic hand osteoarthritis (rHOA and sxHOA) in a large community-based cohort. DESIGN Data were from the Johnston County OA Project (1999-2015, 12 ± 1.2 years follow-up, age 45+). Participants had bilateral hand radiographs each visit, read for Kellgren-Lawrence grade (KLG) at 30 joints. We defined rHOA as KLG ≥2 in ≥1 joint. SxHOA was defined in a hand/joint with rHOA and self-reported symptoms or tenderness on exam. Incidence was assessed in those without, while progression was assessed in those with, baseline rHOA. Proportions or medians are reported; differences by sex and race were assessed using models appropriate for dichotomous or continuous definitions, additionally adjusted for age, education, body mass index (BMI), and weight change. RESULTS Of 800 participants (68% women, 32% African American, mean age 60 years), 327 had baseline rHOA and were older, more often white and female, than those without rHOA (n = 473). The incidence of HOA was high, for rHOA (60%) and for sxHOA (13%). Women were more likely than men to have incident HOA, particularly for distal interphalangeal joint radiographic osteoarthritis (DIP rOA) (adjusted odds ratios (aOR) 1.60 95% confidence intervals (95% CI) [1.03, 2.49]) and sxHOA (aOR 2.98 [1.50, 5.91]). Progressive HOA was more similar by sex, although thumb base rOA progressed more frequently in women than in men (aOR 2.56 [1.44, 4.55]). Particularly HOA incidence, but also progression, was more frequent among whites compared with African Americans. CONCLUSION This study provides much needed information about the natural history of HOA, a common and frequently debilitating condition, in the general population.
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Affiliation(s)
- E A Snyder
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Medicine, University of North Carolina at Chapel Hill, USA.
| | - C Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA.
| | - Y M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | - J B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Radiology, University of North Carolina at Chapel Hill, USA.
| | - J M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Medicine, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | - A E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Medicine, University of North Carolina at Chapel Hill, USA.
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Roemer FW, Eckstein F, Duda G, Guermazi A, Maschek S, Sharma L, Wirth W. Frequencies of MRI-detected structural pathology in knees without radiographic OA and worsening over three years: How relevant is contralateral radiographic osteoarthritis? Osteoarthritis and Cartilage Open 2020; 1:100014. [DOI: 10.1016/j.ocarto.2019.100014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023] Open
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Harkey MS, Price LL, McAlindon TE, Davis JE, Stout AC, Lu B, Zhang M, Eaton CB, Barbe MF, Lo GH, Driban JB. Association Between Declining Walking Speed and Increasing Bone Marrow Lesion and Effusion Volume in Individuals with Accelerated Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:259-270. [PMID: 29882630 DOI: 10.1002/acr.23613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/05/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether a decline in walking speed during the year prior to disease onset is associated with concurrent changes in cartilage, bone marrow lesions (BMLs), or effusion in adults who develop common knee osteoarthritis (OA), accelerated knee OA, or no knee OA. METHODS We identified 3 groups from the Osteoarthritis Initiative based on annual radiographs from baseline to 48 months: accelerated knee OA, common knee OA, and no knee OA. We used the cartilage damage index (CDI) to assess tibiofemoral cartilage damage and used a semiautomated program to measure BML and effusion volume. Walking speed was assessed as an individual's habitual walking speed over 20 meters. One-year change in walking speed and structural measures were calculated as index visit measurements minus measurements from the year prior visit. Logistic regression models were used to determine whether change in walking speed (exposure) was associated with change in each structural measure (outcome) for the overall group and then separately for the accelerated knee OA, common knee OA, and no knee OA groups. RESULTS Adults who slowed their walking speed were almost twice as likely to present with increased BML volume, with a significant association (odds ratio 3.04 [95% confidence interval (95% CI) 1.03-8.95]) among adults with accelerated knee OA. Adults with accelerated knee OA who slowed their walking speed were approximately 3.4 times (95% CI 1.10-10.49) more likely to present with increased effusion volume. Walking speed change was not significantly associated with CDI change. CONCLUSION A change in an easily assessable clinical examination (i.e., 20-meter walk test) was associated with concurrent worsening in BML and effusion volume in adults who developed accelerated knee OA.
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Affiliation(s)
| | - Lori Lyn Price
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | | | | | | | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ming Zhang
- Tufts Medical Center, Boston, Massachusetts
| | - Charles B Eaton
- Alpert Medical School of Brown University, Pawtucket, Rhode Island
| | - Mary F Barbe
- Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Grace H Lo
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston Texas
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Pfeiffer SJ, Valentine JA, Goodwin JS, Nissman DB, Blackburn T, Pietrosimone B. Effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following walking in varus-aligned individuals. Knee 2019; 26:1067-1072. [PMID: 31340891 DOI: 10.1016/j.knee.2019.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee varus alignment may increase loading in the medial tibiofemoral compartment, which can increase strain on the articular cartilage. Knee valgus unloader braces seek to reduce loading through the medial femoral compartment, but their effects on cartilage characteristics during dynamic tasks have not been evaluated. OBJECTIVE To determine the effects of a knee valgus unloader brace on medial femoral articular cartilage deformation following a single 5000-step walking protocol in individuals with varus-knee alignment. METHODS Twenty-four healthy individuals (63% female, BMI = 22 ± 3 kg/m2, age = 21 ± 3 years) completed two testing sessions (braced and unbraced) separated by one week. During both sessions, femoral cartilage ultrasound images were acquired prior to and following a 5000-step treadmill walking protocol at self-selected speed. Percent change scores in medial cartilage cross-sectional area (MCCA) were calculated and used as the primary outcome, and compared between the braced and unbraced conditions. RESULTS There was no difference in percent change of MCCA between conditions (braced = -2.77%, unbraced = -3.15%, p = 0.699). Individuals whose cartilage deformed more than a previously established minimal detectable change (MDC ≥ 1.58 mm2) deformed less during the braced condition (braced = -2.94%, unbraced = -6.34%, p = 0.028), compared to individuals who did not deform greater than the MDC (n = 15, braced = -2.67%, unbraced = -1.23%, p = 0.210). CONCLUSIONS There was no significant difference in MCCA percent change between the braced and unbraced conditions across the entire cohort; yet a valgus unloader braces may serve as a potential intervention strategy for reducing articular cartilage deformation in certain varus-aligned individuals who normally undergo measurable deformation during walking.
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Affiliation(s)
- Steven J Pfeiffer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Joshua A Valentine
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Johnathan S Goodwin
- Department of Physical Therapy Education, Elon University, Elon, NC, United States of America
| | - Daniel B Nissman
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Troy Blackburn
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Brian Pietrosimone
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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20
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Chang AH, Chmiel JS, Almagor O, Hayes KW, Guermazi A, Prasad PV, Moisio KC, Zhang Y, Szymaszek J, Sharma L. Hip muscle strength and protection against structural worsening and poor function and disability outcomes in knee osteoarthritis. Osteoarthritis Cartilage 2019; 27:885-894. [PMID: 30825608 PMCID: PMC6536333 DOI: 10.1016/j.joca.2019.02.795] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Examine associations of hip abductor strength with (1) cartilage damage worsening in the tibiofemoral and patellofemoral compartments 2 years later, and (2) poor function and disability outcomes 5 years later. METHODS Participants had knee osteoarthritis (K/L ≥ 2) in at least one knee. Hip abductor strength was measured using Biodex Dynamometry. Participants underwent 3.0T MRI of both knees at baseline and 2 years later. Baseline-to-2-year cartilage damage progression, defined as any worsening of WORMS cartilage damage score, was assessed at each tibiofemoral and patellofemoral surface. LLFDI (Late-Life Function and Disability Instrument) and Chair-Stand-Rate were recorded at baseline and 5-year follow-up; outcomes analyzed using quintiles. Poor outcomes were defined as remaining in the same low-function quintiles or being in a worse quintile at 5-year follow-up. We analyzed associations of baseline hip abductor strength with cartilage damage worsening and function and disability outcomes using multivariable log-binomial models. RESULTS 275 knees from 164 persons [age = 63.7 (SD = 9.8) years, 79.3% women] comprised the structural outcome sample, and 187 persons [age = 64.2 (9.7), 78.6% women] the function and disability outcomes sample. Greater baseline hip abductor strength was associated with reduced risks of baseline-to-2-year medial patellofemoral and lateral tibiofemoral cartilage damage worsening [adjusted relative risks (RRs) range: 0.80-0.83) and with reduced risks of baseline-to-5-year poor outcomes for Chair-Stand-Rate and LLFDI Basic Lower-Extremity Function and Disability Limitation (adjusted RRs range: 0.91-0.94). CONCLUSION Findings support a beneficial role of hip abductor strength for disease modification and for function and disability outcomes, and as a potential therapeutic target in managing knee osteoarthritis.
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Affiliation(s)
- Alison H. Chang
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joan S. Chmiel
- Department of Preventive Medicine, Feinberg School of
Medicine, Northwestern University, Chicago, IL, USA
| | - Orit Almagor
- Department of Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
| | - Karen W. Hayes
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology,
Boston University School of Medicine, Boston, MA, USA
| | | | - Kirsten C. Moisio
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yunhui Zhang
- Department of Physical Therapy and Human Movement Sciences,
Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julie Szymaszek
- Department of Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
| | - Leena Sharma
- Department of Medicine, Feinberg School of Medicine,
Northwestern University, Chicago, IL, USA
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21
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Eymard F, Parsons C, Edwards MH, Petit-Dop F, Reginster JY, Bruyère O, Chevalier X, Cooper C, Richette P. Statin use and knee osteoarthritis progression: Results from a post-hoc analysis of the SEKOIA trial. Joint Bone Spine 2017; 85:609-614. [PMID: 29037516 DOI: 10.1016/j.jbspin.2017.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/27/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Epidemiological and experimental studies have suggested that lipid disorders might be involved in the pathophysiology of knee osteoarthritis (OA). Studies assessing the effect of statins on knee OA progression have shown conflicting results. We investigated the impact of statin use on radiological progression in patients with radiological and symptomatic knee OA. METHODS In total, 336 patients from the placebo arm of SEKOIA trial completed the 3-year follow-up and were included in this post-hoc analysis. Statin use was recorded at baseline interview. Minimal medial tibiofemoral joint space was measured on plain radiographs by an automated method at baseline and then annually. Radiologic progression was defined as joint space narrowing≥0.5mm over 3 years. RESULTS Overall, 71 patients were statin users (21.1%). They had a higher BMI (31.1±5.3 vs. 29.3±5.2kg/m2, P=0.008), a higher sum of metabolic factors (≥3 factors: 43.7% vs 7.2%; P for trend<0.001) and a higher rate of radiological progression (49.3% vs. 32.1%, P=0.007) as compared to statin non-users. The significant association between radiological progression and statin use was independent of age, gender, WOMAC global score, disease duration, baseline joint space width, hypertension, type 2 diabetes, obesity (BMI>30kg/m2) and cardiovascular diseases [relative risk 1.49 (95% CI: 1.10-2.02), P=0.010]. CONCLUSION Among patients with knee OA, statin use was associated with radiological worsening over 3 years, regardless of other potential confounding factors (obesity, type 2 diabetes, hypertension, disease duration, symptom intensity and radiological severity).
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Affiliation(s)
- Florent Eymard
- Department of rheumatology, Henri-Mondor hospital, AP-HP, 94010 Créteil cedex, France
| | - Camille Parsons
- MRC lifecourse epidemiology unit, Southampton general hospital, Southampton SO16 6YD, UK
| | - Mark H Edwards
- MRC lifecourse epidemiology unit, Southampton general hospital, Southampton SO16 6YD, UK
| | | | - Jean-Yves Reginster
- Department of public health and health economics, university of Liege, 4020 Liege, Belgium
| | - Olivier Bruyère
- Department of public health and health economics, university of Liege, 4020 Liege, Belgium
| | - Xavier Chevalier
- Department of rheumatology, Henri-Mondor hospital, AP-HP, 94010 Créteil cedex, France
| | - Cyrus Cooper
- MRC lifecourse epidemiology unit, Southampton general hospital, Southampton SO16 6YD, UK
| | - Pascal Richette
- Department of rheumatology, Lariboisière hospital, AP-HP, 75475 Paris cedex 10, France; Inserm U1132, university Paris 7, Lariboisière hospital, AP-HP, 75475 Paris cedex 10, France.
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22
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Sharma L, Hochberg M, Nevitt M, Guermazi A, Roemer F, Crema MD, Eaton C, Jackson R, Kwoh K, Cauley J, Almagor O, Chmiel JS. Knee tissue lesions and prediction of incident knee osteoarthritis over 7 years in a cohort of persons at higher risk. Osteoarthritis Cartilage 2017; 25:1068-1075. [PMID: 28232012 PMCID: PMC5466844 DOI: 10.1016/j.joca.2017.02.788] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Among high risk individuals, whether knee lesions in tissues involved in osteoarthritis (OA) can improve prediction of knee OA is unclear. We hypothesized that models predicting (1) incident osteophytes and (2) incident osteophytes and joint space narrowing can be improved by including symptoms or function, and further improved by lesion status. DESIGN In Osteoarthritis Initiative (OAI) participants with normal knee X-rays, we assessed cartilage damage, bone marrow lesions (BMLs), and menisci. Cox proportional hazards models were used to develop risk prediction models for risk of each outcome. Nested models (increasingly larger baseline covariable sets) were compared using likelihood ratio tests and Schwarz Bayesian Information Criterion (SBC). Model discrimination used receiver operating characteristic (ROC) curves and area under the curve (AUC). RESULTS In 841 participants [age 59.6, body mass index (BMI) 26.7, 55.9% women] over up to 7 years follow-up, each larger set improved prediction (+hand OA, injury, surgery, activities; +symptoms/function). Prediction was further improved by including cartilage damage both compartments, BMLs both compartments, meniscal tear, meniscal extrusion, sum of lesion types, number of subregions with cartilage damage, number of subregions with BMLs, and (concurrently) subregion number with cartilage damage, subregion number with BMLs, and meniscal tear. AUCs were ≥0.80 for both outcomes for number of subregions with cartilage damage and the combined model. CONCLUSIONS Among persons at higher risk for knee OA with normal X-rays, MRI tissue lesions improved prediction of mild as well as moderate disease. These findings support that disease onset is likely occurring during the "high-risk" period and encourage a reorientation of approach.
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Affiliation(s)
| | | | - Michael Nevitt
- University of California at San Francisco, San Francisco, CA
| | | | - Frank Roemer
- Boston University, Boston, MA,University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michel D. Crema
- Boston University, Boston, MA,Saint-Antoine Hospital, Paris VI University, Paris, France
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23
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Chang AH, Chmiel JS, Almagor O, Guermazi A, Prasad PV, Moisio KC, Belisle L, Zhang Y, Hayes K, Sharma L. Association of baseline knee sagittal dynamic joint stiffness during gait and 2-year patellofemoral cartilage damage worsening in knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:242-248. [PMID: 27729289 PMCID: PMC5258842 DOI: 10.1016/j.joca.2016.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/11/2016] [Accepted: 10/05/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee sagittal dynamic joint stiffness (DJS) describes the biomechanical interaction between change in external knee flexion moment and flexion angular excursion during gait. In theory, greater DJS may particularly stress the patellofemoral (PF) compartment and thereby contribute to PF osteoarthritis (OA) worsening. We hypothesized that greater baseline knee sagittal DJS is associated with PF cartilage damage worsening 2 years later. METHODS Participants all had OA in at least one knee. Knee kinematics and kinetics during gait were recorded using motion capture systems and force plates. Knee sagittal DJS was computed as the slope of the linear regression line for knee flexion moments vs angles during the loading response phase. Knee magnetic resonance imaging (MRI) scans were obtained at baseline and 2 years later. We assessed the association between baseline DJS and baseline-to-2-year PF cartilage damage worsening using logistic regression with generalized estimating equations (GEE). RESULTS Our sample had 391 knees (204 persons): mean age 64.2 years (SD 10.0); body mass index (BMI) 28.4 kg/m2 (5.7); 76.5% women. Baseline knee sagittal DJS was associated with baseline-to-2-year cartilage damage worsening in the lateral (OR = 5.35, 95% CI: 2.37-12.05) and any PF (OR = 2.99, 95% CI: 1.27-7.04) compartment. Individual components of baseline DJS (i.e., change in knee moment or angle) were not associated with subsequent PF disease worsening. CONCLUSION Capturing the concomitant effect of knee kinetics and kinematics during gait, knee sagittal DJS is a potentially modifiable risk factor for PF disease worsening.
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Affiliation(s)
- A H Chang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - J S Chmiel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - O Almagor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - P V Prasad
- Department of Radiology, NorthShore University HealthSystem, Evanston, IL, USA.
| | - K C Moisio
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - L Belisle
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Y Zhang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - K Hayes
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - L Sharma
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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24
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Roemer FW, Hunter DJ, Crema MD, Kwoh CK, Ochoa-Albiztegui E, Guermazi A. An illustrative overview of semi-quantitative MRI scoring of knee osteoarthritis: lessons learned from longitudinal observational studies. Osteoarthritis Cartilage 2016; 24:274-89. [PMID: 26318656 PMCID: PMC4724524 DOI: 10.1016/j.joca.2015.08.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/06/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To introduce the most popular magnetic resonance imaging (MRI) osteoarthritis (OA) semi-quantitative (SQ) scoring systems to a broader audience with a focus on the most commonly applied scores, i.e., the MOAKS and WORMS system and illustrate similarities and differences. DESIGN While the main structure and methodology of each scoring system are publicly available, the core of this overview will be an illustrative imaging atlas section including image examples from multiple OA studies applying MRI in regard to different features assessed, show specific examples of different grades and point out pitfalls and specifics of SQ assessment including artifacts, blinding to time point of acquisition and within-grade evaluation. RESULTS Similarities and differences between different scoring systems are presented. Technical considerations are followed by a brief description of the most commonly utilized SQ scoring systems including their responsiveness and reliability. The second part is comprised of the atlas section presenting illustrative image examples. CONCLUSIONS Evidence suggests that SQ assessment of OA by expert MRI readers is valid, reliable and responsive, which helps investigators to understand the natural history of this complex disease and to evaluate potential new drugs in OA clinical trials. Researchers have to be aware of the differences and specifics of the different systems to be able to engage in imaging assessment and interpretation of imaging-based data. SQ scoring has enabled us to explain associations of structural tissue damage with clinical manifestations of the disease and with morphological alterations thought to represent disease progression.
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Affiliation(s)
- Frank W. Roemer
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA,Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany,Corresponding author and reprint requests: Frank W. Roemer, M.D., Associate Professor of Radiology, Boston University School of Medicine, Boston, MA & University of Erlangen-Nuremberg, Erlangen, Germany, Co-Director Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, FGH Building, 3rd floor, 820 Harrison Ave, Boston, MA 02118, Tel +1 617 414-4954 Fax +1 617 638-6616,
| | - David J. Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia and Rheumatology Department, Royal North Shore Hospital
| | - Michel D. Crema
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA,Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo-SP, Brazil
| | - C. Kent Kwoh
- University of Arizona Arthritis Center & University of Arizona College of Medicine, Tucson, AZ, USA
| | - Elena Ochoa-Albiztegui
- Department of Radiology and Molecular Medicine, The American British Cowdray Medical Center, I.A.P., Mexico City, Mexico
| | - Ali Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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25
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Edwards MH, Parsons C, Bruyère O, Petit Dop F, Chapurlat R, Roemer FW, Guermazi A, Zaim S, Genant H, Reginster JY, Dennison EM, Cooper C. High Kellgren-Lawrence Grade and Bone Marrow Lesions Predict Worsening Rates of Radiographic Joint Space Narrowing; The SEKOIA Study. J Rheumatol 2016; 43:657-65. [PMID: 26773120 DOI: 10.3899/jrheum.150053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Determinants of radiographic progression in osteoarthritis (OA) are poorly understood. We investigated which features on baseline magnetic resonance imaging (MRI) acted as predictors of change in joint space width (JSW). METHODS A total of 559 men and women over the age of 50 years with clinical knee OA [Kellgren-Lawrence (KL) grade 2-3] were recruited to the placebo arm of the SEKOIA study (98 centers; 18 countries). Minimal tibiofemoral joint space and KL grade on plain radiograph of the knee were assessed at baseline and at yearly followup up to 3 years. In a subset, serial knee MRI examinations were performed. Individuals with a bone marrow lesion (BML) ≥ grade 2 at the tibiofemoral joint at baseline were classified as BML-positive. Relationships between change in JSW and risk factors were assessed using linear regression. RESULTS The mean age of study participants was 62.8 (SD 7.5) years and 73% were female; 38.6% had BML. Mean baseline JSW was 3.65 mm. This reduced by 0.18 (0.30) mm/year in men and 0.13 (0.23) mm/year in women. Those with BML had a significantly higher rate of annualized change in JSW; this relationship remained robust after adjustment for age, sex, and baseline KL grade [β = -0.10 (95% CI -0.18, -0.02) mm/yr]. Age, sex, baseline KL grade, and other MRI findings did not influence the rate of change in JSW. CONCLUSION The rate of change in JSW was similar in men and women. BML on knee MRI predicted the rate of radiographic change in JSW. This relationship was independent of age, sex, and baseline KL grade.
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Affiliation(s)
- Mark H Edwards
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Camille Parsons
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Olivier Bruyère
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Forence Petit Dop
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Roland Chapurlat
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Frank W Roemer
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Ali Guermazi
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Souhil Zaim
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Harry Genant
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Jean-Yves Reginster
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Elaine M Dennison
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
| | - Cyrus Cooper
- From the MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Public Health and Health Economics, University of Liege, Liege, Belgium; Innovative Therapeutic Pole of Rheumatology, Servier, Surenes, France; INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon, Lyon, France; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Radiology, University of Erlangen-Nuremburg, Erlangen, Germany; Synarc, San Francisco, California, USA; Department of Public Health and Health Economics, University of Liege; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital; and NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.M.H. Edwards, MD, PhD; C. Parsons, MSc, MRC Lifecourse Epidemiology Unit, University of Southampton; O. Bruyère, PhD, Department of Public Health and Health Economics, University of Liege; F. Petit Dop, PhD, Innovative Therapeutic Pole of Rheumatology; R. Chapurlat, MD, PhD, INSERM UMR 1033, Service de Rhumatolgie et Pathologie Osseuse, Hôpital Edouard Herriot, Université de Lyon; F.W. Roemer, MD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; Department of Radiology, University of Erlangen-Nuremburg; A. Guermazi, MD, PhD, Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine; S. Zaim, MD, Synarc; H. Genant, MD, Synarc; J-Y. Reginster, MD, PhD, Department of Public Health and Health Economics, University of Liege; E.M. Dennison, MD, PhD, MRC Lifecourse Epidemiology Unit, University of Southampton; Victoria University; C. Cooper, FMedSci, MRC Lifecourse Epidemiology Unit, University of Southampton; NIHR Biomedical
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Guermazi A, Eckstein F, Hayashi D, Roemer FW, Wirth W, Yang T, Niu J, Sharma L, Nevitt MC, Lewis CE, Torner J, Felson DT. Baseline radiographic osteoarthritis and semi-quantitatively assessed meniscal damage and extrusion and cartilage damage on MRI is related to quantitatively defined cartilage thickness loss in knee osteoarthritis: the Multicenter Osteoarthritis Study. Osteoarthritis Cartilage 2015; 23:2191-2198. [PMID: 26162806 PMCID: PMC4957527 DOI: 10.1016/j.joca.2015.06.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 05/19/2015] [Accepted: 06/29/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To provide a comprehensive simultaneous relation of various semiquantitative knee OA MRI features as well as the presence of baseline radiographic osteoarthritis (OA) to quantitative longitudinal cartilage loss. METHODS We studied Multicenter OA Study (MOST) participants from a longitudinal observational study that included quantitative MRI measurement of cartilage thickness. These subjects also had Whole Organ MRI Score (WORMS) scoring of cartilage damage, bone marrow lesions (BMLs), meniscal pathology, and synovitis, as well as baseline radiographic evaluation for Kellgren and Lawrence (KL) grading. Knee compartments were classified as progressors when exceeding thresholds of measurement variability in normal knees. All potential risk factors of cartilage loss were dichotomized into "present" (score ≥2 for cartilage, ≥1 for others) or "absent". Differences in baseline scores of ipsi-compartmental risk factors were compared between progressor and non-progressor knees by multivariable logistic regression, adjusting for age, sex, body mass index, alignment axis (degrees) and baseline KL grade. Odds ratios (OR) and 95% CIs were calculated for medial femorotibial compartment (MFTC) and lateral femorotibial compartment (LFTC) cartilage loss. Cartilage loss across both compartments was studied using Generalized Estimating Equations. RESULTS 196 knees of 196 participants were included (age 59.8 ± 6.3 years [mean ± SD], BMI 29.5 ± 4.6, 62% women). For combined analyses of MFTC and LFTC, baseline factors related to cartilage loss were radiographic OA (KL grade ≥2: aOR 4.8 [2.4-9.5], cartilage damage (aOR 2.3 [1.2-4.4])), meniscal damage (aOR 3.9 [2.1-7.4]) and extrusion (aOR 2.9 [1.6-5.3]), all in the ipsilateral compartment, but not BMLs or synovitis. CONCLUSION Baseline radiographic OA and semiquantitatively (SQ) assessed MRI-detected cartilage damage, meniscal damage and extrusion, but not BMLs or synovitis is related to quantitatively measured ipsi-compartmental cartilage thinning over 30 months.
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Affiliation(s)
- A Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - F Eckstein
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - D Hayashi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Bridgeport Hospital, Yale School of Medicine, Bridgeport, CT, USA
| | - F W Roemer
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - W Wirth
- Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - T Yang
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - J Niu
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - L Sharma
- Multidisciplinary Clinical Research Center in Rheumatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - C E Lewis
- Division of Preventive Medicine, University of Alabama, Birmingham, AL, USA
| | - J Torner
- Department of Radiology at the University of Iowa, Iowa City, IA, USA
| | - D T Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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Sharma L, Nevitt M, Hochberg M, Guermazi A, Roemer FW, Crema M, Eaton C, Jackson R, Kwoh K, Cauley J, Almagor O, Chmiel JS. Clinical significance of worsening versus stable preradiographic MRI lesions in a cohort study of persons at higher risk for knee osteoarthritis. Ann Rheum Dis 2015; 75:1630-6. [PMID: 26467570 DOI: 10.1136/annrheumdis-2015-208129] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/20/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Whether preradiographic lesions in knees at risk for osteoarthritis are incidental versus disease is unclear. We hypothesised, in persons without but at higher risk for knee osteoarthritis, that: 12-48 month MRI lesion status worsening is associated with 12-48 month incident radiographic osteoarthritis (objective component of clinical definition of knee osteoarthritis) and 48-84 month persistent symptoms. METHODS In 849 Osteoarthritis Initiative participants Kellgren/Lawrence (KL) 0 in both knees, we assessed cartilage damage, bone marrow lesions (BMLs), and menisci on 12 month (baseline) and 48 month MRIs. Multivariable logistic regression was used to evaluate associations between 12-48 month worsening versus stable status and outcome (12-48 month incident KL ≥1 and KL ≥2, and 48-84 month persistent symptoms defined as frequent symptoms or medication use most days of ≥1 month in past 12 month, at consecutive visits 48-84 months), adjusting for age, gender, body mass index (BMI), injury and surgery. RESULTS Mean age was 59.6 (8.8), BMI 26.7 (4.2) and 55.9% were women. 12-48 month status worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs was associated with 12-48 month incident radiographic outcomes, and worsening of cartilage damage and BMLs with 48-84 month persistent symptoms. There was a dose-response association for magnitude of worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs and radiographic outcomes, and cartilage damage and BMLs and persistent symptoms. CONCLUSIONS In persons at higher risk, worsening MRI lesion status was associated with concurrent incident radiographic osteoarthritis and subsequent persistent symptoms. These findings suggest that such lesions represent early osteoarthritis, and add support for a paradigm shift towards investigation of intervention effectiveness at this stage.
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Affiliation(s)
- Leena Sharma
- Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Nevitt
- Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - Marc Hochberg
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ali Guermazi
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Frank W Roemer
- Department of Radiology, Boston University, Boston, Massachusetts, USA University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michel Crema
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | | | | | - Kent Kwoh
- Division of Rheumatology, University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona, USA
| | - Jane Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Orit Almagor
- Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joan S Chmiel
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Guermazi A, Hayashi D, Roemer F, Felson DT, Wang K, Lynch J, Amin S, Torner J, Lewis CE, Nevitt MC. Severe radiographic knee osteoarthritis--does Kellgren and Lawrence grade 4 represent end stage disease?--the MOST study. Osteoarthritis Cartilage 2015; 23:1499-505. [PMID: 25929973 DOI: 10.1016/j.joca.2015.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 04/13/2015] [Accepted: 04/19/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine what MRI-detectable osteoarthritis features that are not visualized on radiography demonstrate progression longitudinally in Kellgren and Lawrence (KL) grade 4 knees. METHODS We studied subjects from the Multicenter Osteoarthritis Study who had KL grade 4 knees at baseline and had baseline and 30-month MRI. Cartilage damage, bone marrow lesions (BMLs), meniscal damage, synovitis (signal changes in Hoffa fat pad), and effusion (fluid equivalent signal in the joint cavity) were semiquantitatively scored using the Whole Organ MRI Score (WORMS) system in five subregions of the medial and lateral tibiofemoral (TF) compartments. Analysis was performed for the compartment showing bone-on-bone appearance ("index") on radiograph and also for the other TF compartment of the same knee. Synovitis and effusion were assessed for the whole knee. Changes in scores at follow-up were noted for each feature. For cartilage and BML, within-grade changes were also recorded. RESULTS 140 subjects (164 knees) were included (50% women, mean age 66.0 ± 8.6 years, mean BMI 30.4 ± 5.1 kg/m(2)). Longitudinally, 51 index compartments (34%) showed an increase in the sum of cartilage scores from all subregions. In the other compartment, 25% showed an increase in the sum score for cartilage damage. For BMLs in the index compartment, 50 knees (33%) showed an increase in maximum score and 32 (21%) showed a decrease. Meniscal status mostly remained stable. Effusion worsened in 36 knees (25%) and improved in 13 knees (9%). Synovitis worsened in 14 knees (10%) and improved in six knees (4%). CONCLUSION In KL grade 4 knees, MRI-detected cartilage loss and fluctuation of BMLs, effusion, and synovitis occurred frequently over a 30-month period.
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Kumm J, Roemer FW, Guermazi A, Turkiewicz A, Englund M. Natural History of Intrameniscal Signal Intensity on Knee MR Images: Six Years of Data from the Osteoarthritis Initiative. Radiology 2015; 278:164-71. [PMID: 26172533 DOI: 10.1148/radiol.2015142905] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the natural history of intrameniscal signal intensity on magnetic resonance (MR) images of the medial compartment. MATERIALS AND METHODS Both knees of 269 participants (55% women, aged 45-55 years) in the Osteoarthritis Initiative without radiographic knee osteoarthritis (OA) and without medial meniscal tear at baseline were studied. One radiologist assessed 3-T MR images from baseline and 24-, 48-, and 72-month follow-up for intrameniscal signal intensity and tears. A complementary log-log model with random effect was used to evaluate the risk of medial meniscal tear, adjusting for age, sex, body mass index, and knee side. RESULTS At baseline, linear intrameniscal signal intensity in the medial compartment was present in 140 knees (26%). Once present, regression only in a single knee was observed. In 31 knees (19%) with linear intrameniscal signal intensity at any of the first three time points, the signal intensity progressed to a tear in the same segment, and in a single knee, the tear occurred in an adjacent segment. The corresponding number of tears without prior finding of intrameniscal signal intensities was 11 (3%). In the adjusted model, the hazard ratio for developing medial meniscal tear was 18.2 (95% confidence interval: 8.3, 39.8) if linear intrameniscal signal intensity was present, compared when there was no linear signal intensity. There was only one of 43 knees with injury reported in conjunction with the incident tear. CONCLUSION In middle-aged persons without OA, linear intrameniscal signal intensity on MR images is highly unlikely to resolve and should be considered a risk factor for medial degenerative meniscal tear.
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Affiliation(s)
- Jaanika Kumm
- From the Department of Radiology, University of Tartu, L.Puusepa 8-G.1.R, 51014 Tartu, Estonia (J.K.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Department of Radiology (F.W.R., A.G.) and Clinical Epidemiology Research and Training Unit (M.E.), Boston University School of Medicine, Boston, Mass; Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Sweden (A.T., M.E.)
| | - Frank W Roemer
- From the Department of Radiology, University of Tartu, L.Puusepa 8-G.1.R, 51014 Tartu, Estonia (J.K.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Department of Radiology (F.W.R., A.G.) and Clinical Epidemiology Research and Training Unit (M.E.), Boston University School of Medicine, Boston, Mass; Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Sweden (A.T., M.E.)
| | - Ali Guermazi
- From the Department of Radiology, University of Tartu, L.Puusepa 8-G.1.R, 51014 Tartu, Estonia (J.K.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Department of Radiology (F.W.R., A.G.) and Clinical Epidemiology Research and Training Unit (M.E.), Boston University School of Medicine, Boston, Mass; Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Sweden (A.T., M.E.)
| | - Aleksandra Turkiewicz
- From the Department of Radiology, University of Tartu, L.Puusepa 8-G.1.R, 51014 Tartu, Estonia (J.K.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Department of Radiology (F.W.R., A.G.) and Clinical Epidemiology Research and Training Unit (M.E.), Boston University School of Medicine, Boston, Mass; Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Sweden (A.T., M.E.)
| | - Martin Englund
- From the Department of Radiology, University of Tartu, L.Puusepa 8-G.1.R, 51014 Tartu, Estonia (J.K.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.); Department of Radiology (F.W.R., A.G.) and Clinical Epidemiology Research and Training Unit (M.E.), Boston University School of Medicine, Boston, Mass; Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Sweden (A.T., M.E.)
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Chang AH, Moisio KC, Chmiel JS, Eckstein F, Guermazi A, Prasad PV, Zhang Y, Almagor O, Belisle L, Hayes K, Sharma L. External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis. Osteoarthritis Cartilage 2015; 23:1099-106. [PMID: 25677110 PMCID: PMC4470726 DOI: 10.1016/j.joca.2015.02.005] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/31/2014] [Accepted: 02/01/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Test the hypothesis that greater baseline peak external knee adduction moment (KAM), KAM impulse, and peak external knee flexion moment (KFM) during the stance phase of gait are associated with baseline-to-2-year medial tibiofemoral cartilage damage and bone marrow lesion progression, and cartilage thickness loss. METHODS Participants all had knee OA in at least one knee. Baseline peak KAM, KAM impulse, and peak KFM (normalized to body weight and height) were captured and computed using a motion analysis system and six force plates. Participants underwent MRI of both knees at baseline and 2 years later. To assess the association between baseline moments and baseline-to-2-year semiquantitative cartilage damage and bone marrow lesion progression and quantitative cartilage thickness loss, we used logistic and linear regressions with generalized estimating equations (GEE), adjusting for gait speed, age, gender, disease severity, knee pain severity, and medication use. RESULTS The sample consisted of 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m(2) (5.7); 156 (76.5%) women. Greater baseline peak KAM and KAM impulse were each associated with worsening of medial bone marrow lesions, but not cartilage damage. Higher baseline KAM impulse was associated with 2-year medial cartilage thickness loss assessed both as % loss and as a threshold of loss, whereas peak KAM was related only to % loss. There was no relationship between baseline peak KFM and any medial disease progression outcome measures. CONCLUSION Findings support targeting KAM parameters in an effort to delay medial OA disease progression.
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Affiliation(s)
- Alison H. Chang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kirsten C. Moisio
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joan S. Chmiel
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Yunhui Zhang
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Orit Almagor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura Belisle
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Hayes
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Leena Sharma
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Eymard F, Parsons C, Edwards MH, Petit-Dop F, Reginster JY, Bruyère O, Richette P, Cooper C, Chevalier X. Diabetes is a risk factor for knee osteoarthritis progression. Osteoarthritis Cartilage 2015; 23:851-9. [PMID: 25655678 DOI: 10.1016/j.joca.2015.01.013] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/19/2015] [Accepted: 01/23/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Recent studies have suggested that metabolic factors (obesity, diabetes, hypertension and dyslipidemia) and their clustering in metabolic syndrome (MetS) might be involved in the pathophysiology of knee osteoarthritis (OA). We investigated their impact on radiographic progression by an annualised measure of the joint space narrowing (JSN) of the medial tibiofemoral compartment. METHODS 559 patients older than 50 years with symptomatic knee OA were recruited for the placebo arm of the SEKOIA trial. The presence of diabetes, hypertension and dyslipidemia was determined at baseline interview. Body mass index (BMI) was calculated, obesity was considered >30 kg/m(2). MetS was defined by the sum of metabolic factors ≥ 3. Minimal medial tibiofemoral joint space on plain radiographs was measured by an automated method at baseline and then annually for up to 3 years. RESULTS The mean age of patients was 62.8 [62.2-63.4] years; 392 were women. A total of 43.8% was obese, 6.6% had type 2 diabetes, 45.1% hypertension, 27.6% dyslipidemia and 13.6% MetS. Mean annualised JSN was greater for patients with type 2 diabetes than without diabetes (0.26 [-0.35 to -0.17] vs 0.14 [-0.16 to -0.12] mm; P = 0.001). This association remained significant after adjustment for sex, age, BMI, hypertension and dyslipidemia (P = 0.018). In subgroup analysis, type 2 diabetes was a significant predictor of JSN in males but not females. The other metabolic factors and MetS were not associated with annualised JSN. CONCLUSION Type 2 diabetes was a predictor of joint space reduction in men with established knee OA. No relationships were found between MetS or other metabolic factors and radiographic progression.
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Affiliation(s)
- F Eymard
- Department of Rheumatology, AP-HP Henri Mondor Hospital, F-94010 Créteil Cedex, France
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, SO16 6YD Southampton, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, SO16 6YD Southampton, UK
| | - F Petit-Dop
- Clinical Department, Servier Laboratory, 92150 Suresnes, France
| | - J-Y Reginster
- Department of Public Health and Health Economics, University of Liege, 4020 Liege, Belgium
| | - O Bruyère
- Department of Public Health and Health Economics, University of Liege, 4020 Liege, Belgium
| | - P Richette
- Department of Rheumatology, AP-HP Lariboisière Hospital, F-75475 Paris Cedex 10, France
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, SO16 6YD Southampton, UK
| | - X Chevalier
- Department of Rheumatology, AP-HP Henri Mondor Hospital, F-94010 Créteil Cedex, France.
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Hunter DJ, Arden N, Cicuttini F, Crema MD, Dardzinski B, Duryea J, Guermazi A, Haugen IK, Kloppenburg M, Maheu E, Miller CG, Martel-Pelletier J, Ochoa-Albíztegui RE, Pelletier JP, Peterfy C, Roemer F, Gold GE. OARSI Clinical Trials Recommendations: Hand imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage 2015; 23:732-46. [PMID: 25952345 DOI: 10.1016/j.joca.2015.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
Tremendous advances have occurred in our understanding of the pathogenesis of hand osteoarthritis (OA) and these are beginning to be applied to trials targeted at modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply hand imaging assessments in disease modifying clinical trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for MRI); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
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Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 years. Ann Rheum Dis 2015; 75:825-30. [PMID: 25834142 DOI: 10.1136/annrheumdis-2015-207241] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/15/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine whether ultrasound predicts radiographic hand osteoarthritis (OA) progression after 5 years. METHODS We included 78 participants (71 women, mean (SD) age 67.8 (5.2) years) from the Oslo Hand OA cohort with ultrasound examination (gray-scale (GS) synovitis and power Doppler (PD) signals) at baseline and conventional radiographs and clinical examination at baseline and 5-year follow-up. Radiographic progression was defined as an increase in global OA according to the Kellgren-Lawrence (KL) scale or progression of individual radiographic OA features. We examined whether baseline ultrasound features and clinical examination predicted radiographic progression using generalised estimating equations, adjusted for age, sex, body mass index and follow-up time. RESULTS Radiographic progression occurred in 17.9% joints for KL, 12.1% for joint space narrowing, 11.7% for osteophytes and 4.5% for erosions. Ultrasound-detected inflammation predicted KL progression, and dose-response associations were observed for GS synovitis grade 1 (OR=2.8, 95% CI 1.8 to 4.2), grade 2 (OR=3.6, 95% CI 2.2 to 5.8) and grade 3 (OR=15.2, 95% CI 6.9 to 33.6), and for PD signal grade 1 (OR=2.9, 95% CI 1.2 to 6.8) and grades 2-3 (OR=12.0, 95% CI 3.5 to 41.0). Significant associations were also observed between ultrasound inflammation and progression of all individual radiographic features, and between clinical soft tissue swelling at baseline and radiographic progression. CONCLUSIONS Ultrasound-detected GS synovitis and PD signals were significantly associated with radiographic progression after 5 years. This study supports the use of ultrasound as a tool to detect patients with hand OA who are likely to progress.
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Affiliation(s)
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Sharma L, Chmiel JS, Almagor O, Dunlop D, Guermazi A, Bathon JM, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Mysiw WJ, Crema MD, Roemer FW, Nevitt MC. Significance of preradiographic magnetic resonance imaging lesions in persons at increased risk of knee osteoarthritis. Arthritis Rheumatol 2014; 66:1811-9. [PMID: 24974824 DOI: 10.1002/art.38611] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/25/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Little is known about early knee osteoarthritis (OA). The significance of lesions on magnetic resonance imaging (MRI) in older persons without radiographic OA is unclear. Our objectives were to determine the extent of tissue pathology by MRI and evaluate its significance by testing the following hypotheses: cartilage damage, bone marrow lesions, and meniscal damage are associated with prevalent frequent knee symptoms and incident persistent symptoms; bone marrow lesions and meniscal damage are associated with incident tibiofemoral (TF) cartilage damage; and bone marrow lesions are associated with incident patellofemoral (PF) cartilage damage. METHODS In a cohort study of 849 Osteoarthritis Initiative (OAI) participants who had a bilateral Kellgren/Lawrence (K/L) score of 0, we assessed cartilage damage, bone marrow lesions, and meniscal damage using the MRI OA Knee Score, as well as prevalent frequent knee symptoms, incident persistent symptoms, and incident cartilage damage. Multiple logistic regression (one knee per person) was used to evaluate associations between MRI lesions and each of these outcomes. RESULTS Of the participants evaluated, 76% had cartilage damage, 61% had bone marrow lesions, 21% had meniscal tears, and 14% had meniscal extrusion. Cartilage damage (any; TF and PF), bone marrow lesions (any; TF and PF), meniscal extrusion, and body mass index (BMI) were associated with prevalent frequent symptoms. Cartilage damage (isolated PF; TF and PF), bone marrow lesions (any; isolated PF; TF and PF), meniscal tears, and BMI were associated with incident persistent symptoms. Hand OA, but no individual lesion type, was associated with incident TF cartilage damage, and bone marrow lesions (any; any PF) with incident PF damage. Having more lesion types was associated with a greater risk of outcomes. CONCLUSION MRI-detected lesions are not incidental and may represent early disease in persons at increased risk of knee OA.
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Bruns K, Svensson F, Turkiewicz A, Wirth W, Guermazi A, Eckstein F, Englund M. Meniscus body position and its change over four years in asymptomatic adults: a cohort study using data from the Osteoarthritis Initiative (OAI). BMC Musculoskelet Disord 2014; 15:32. [PMID: 24499033 PMCID: PMC3924236 DOI: 10.1186/1471-2474-15-32] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 02/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high degree of meniscal body extrusion on knee magnetic resonance imaging has been shown to be strongly associated with development of knee osteoarthritis. However, very little is known about meniscal position in the asymptomatic knee and its natural history. Hence our objective was to study meniscal body position and its change over 4 years in asymptomatic adults. METHODS Cohort study using data from the Osteoarthritis Initiative (OAI) involving four clinical sites in the United States (Baltimore, Maryland, Pawtucket, Rhode Island, Columbus, Ohio, and Pittsburgh, Pennsylvania). We studied both knees from 118 subjects (mean age 55 years, 61% women, mean body mass index 24.4) from the OAI "non-exposed" reference cohort free of knee pain, radiographic knee osteoarthritis and risk factors for knee osteoarthritis at baseline. We assessed mid-coronal intermediate-weighted 3-Tesla magnetic resonance images from baseline and the 2- and 4-year follow-up visit. One observer measured tibia plateau, meniscal body width and meniscal body extrusion in both compartments. We calculated meniscal overlap distance on the tibial plateau, % coverage, and extrusion index compared to tibia width. Potential trends in position over the 4-year period were evaluated using a linear mixed-effects regression model. RESULTS The mean (SD) values at baseline for medial meniscal body extrusion and overlap distance were 1.64 mm (0.92) and 10.1 mm (3.5), and coverage was 34.4% (11.9). The corresponding values for the lateral compartment were 0.63 mm (0.73), 9.8 mm (2.4), and 31.0% (7.7). Medial meniscus body extrusion index was greater in female knees (p = 0.03). There was slight increase in medial meniscal body extrusion over 4 years (0.040 mm/year [95% CI: 0.019-0.062]). The other variables were relatively stable. CONCLUSIONS In asymptomatic adults, the relative degree of meniscus body extrusion is more pronounced in female knees. Although a slight increase in extrusion over time was noted for the medial body, positions were relatively stable within subjects over time.
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Affiliation(s)
| | | | | | | | | | | | - Martin Englund
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
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Reginster JY, Badurski J, Bellamy N, Bensen W, Chapurlat R, Chevalier X, Christiansen C, Genant H, Navarro F, Nasonov E, Sambrook PN, Spector TD, Cooper C. Efficacy and safety of strontium ranelate in the treatment of knee osteoarthritis: results of a double-blind, randomised placebo-controlled trial. Ann Rheum Dis 2012; 72:179-86. [PMID: 23117245 PMCID: PMC3599139 DOI: 10.1136/annrheumdis-2012-202231] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Strontium ranelate is currently used for osteoporosis. The international, double-blind, randomised, placebo-controlled Strontium ranelate Efficacy in Knee OsteoarthrItis triAl evaluated its effect on radiological progression of knee osteoarthritis. Methods Patients with knee osteoarthritis (Kellgren and Lawrence grade 2 or 3, and joint space width (JSW) 2.5–5 mm) were randomly allocated to strontium ranelate 1 g/day (n=558), 2 g/day (n=566) or placebo (n=559). The primary endpoint was radiographical change in JSW (medial tibiofemoral compartment) over 3 years versus placebo. Secondary endpoints included radiological progression, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee pain. The trial is registered (ISRCTN41323372). Results The intention-to-treat population included 1371 patients. Treatment with strontium ranelate was associated with smaller degradations in JSW than placebo (1 g/day: −0.23 (SD 0.56) mm; 2 g/day: −0.27 (SD 0.63) mm; placebo: −0.37 (SD 0.59) mm); treatment-placebo differences were 0.14 (SE 0.04), 95% CI 0.05 to 0.23, p<0.001 for 1 g/day and 0.10 (SE 0.04), 95% CI 0.02 to 0.19, p=0.018 for 2 g/day. Fewer radiological progressors were observed with strontium ranelate (p<0.001 and p=0.012 for 1 and 2 g/day). There were greater reductions in total WOMAC score (p=0.045), pain subscore (p=0.028), physical function subscore (p=0.099) and knee pain (p=0.065) with strontium ranelate 2 g/day. Strontium ranelate was well tolerated. Conclusions Treatment with strontium ranelate 1 and 2 g/day is associated with a significant effect on structure in patients with knee osteoarthritis, and a beneficial effect on symptoms for strontium ranelate 2 g/day.
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Affiliation(s)
- Jean-Yves Reginster
- Correspondence to Professor Jean-Yves Reginster, Department of Public Health and Health Economics, University of Liege, 4020 Liege, Belgium.
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Roemer FW, Nevitt MC, Felson DT, Niu J, Lynch JA, Crema MD, Lewis CE, Torner J, Guermazi A. Predictive validity of within-grade scoring of longitudinal changes of MRI-based cartilage morphology and bone marrow lesion assessment in the tibio-femoral joint--the MOST study. Osteoarthritis Cartilage 2012; 20:1391-8. [PMID: 22846715 PMCID: PMC3863692 DOI: 10.1016/j.joca.2012.07.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/04/2012] [Accepted: 07/18/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In order to increase sensitivity to detect longitudinal change, recording of within-grade changes was introduced for cartilage morphology and bone marrow lesion (BML) assessment in semiquantitative magnetic resonance imaging (MRI) scoring of knee osteoarthritis (OA). The aim of this study was to examine the validity provided by within-grade scoring. DESIGN The Multicenter Osteoarthritis (MOST) study is a longitudinal study of subjects with or at risk of knee OA. Baseline and 30 months MRIs were read according to the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) system including within-grade changes for cartilage and BMLs. We tested the validity of within-grade changes by whether the 30-month changes in cartilage and BML assessment were predicted by baseline ipsi-compartmental meniscal damage and malalignment, factors known to affect cartilage loss and BMLs, using ordinal logistic regression. RESULTS 1867 Knees (from 1411 participants) were included. Severe medial meniscal damage predicted partial grade (adjusted odds ratio (aOR) 4.4, 95% confidence interval (95% CI) 2.2, 8.7) but not ≥full grade (aOR 1.3, 95% CI 0.8, 2.2) worsening of cartilage loss and predicted both, partial grade (aOR 9.6, 95% CI 3.6, 25.1) and ≥full grade (aOR 5.1, 95% CI 3.2, 8.2) worsening of BMLs. Severe, but not moderate, malalignment predicted ipsi-compartmental within-grade (medial cartilage damage: aOR 5.5, 95% CI 2.6, 11.6; medial worsening of BMLs: aOR 4.9, 95% CI 2.0, 12.3) but not full grade worsening of BMLs and cartilage damage. CONCLUSIONS Within-grade changes in semiquantitative MRI assessment of cartilage and BMLs are valid and their use may increase the sensitivity of semiquantitative readings in detecting longitudinal changes in these structures.
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Affiliation(s)
- Frank W. Roemer
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA,Department of Radiology, Klinikum Augsburg, Augsburg, Germany,Corresponding author and reprint requests: Frank Roemer, M.D., Associate Professor of Radiology, Boston University School of Medicine and University of Erlangen, Germany, Co-Director Quantitative Imaging Center (QIC), Department of Radiology, FGH Building, 3rd floor, 820 Harrison Ave, Boston, MA 02118, Tel +1 617 414-3893, Fax +1 617 638-6616,
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - David T. Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Jingbo Niu
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - John A. Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Michel D. Crema
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Cora E. Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James Torner
- Department of Epidemiology at the University of Iowa, Iowa City, IA, USA
| | - Ali Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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Katz JN, Chaisson CE, Cole B, Guermazi A, Hunter DJ, Jones M, Levy BA, Mandl LA, Martin S, Marx RG, Safran-Norton C, Roemer FW, Skoniecki D, Solomon DH, Spindler KP, Wright J, Wright RW, Losina E. The MeTeOR trial (Meniscal Tear in Osteoarthritis Research): rationale and design features. Contemp Clin Trials 2012; 33:1189-96. [PMID: 22968127 DOI: 10.1016/j.cct.2012.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022]
Abstract
This paper presents the rationale and design features of the MeTeOR Trial (Meniscal Tear in Osteoarthritis Research; Clinical Trials.gov NCT00597012). MeTeOR is an NIH-funded seven-center prospective randomized controlled trial (RCT) designed to establish the efficacy of arthroscopic partial meniscectomy combined with a standardized physical therapy program as compared with a standardized physical therapy program alone in patients with a symptomatic meniscal tear in the setting of mild to moderate knee osteoarthritic change (OA). The design and execution of a trial that compares surgery with a nonoperative treatment strategy presents distinctive challenges. The goal of this paper is to provide the clinical rationale for MeTeOR and to highlight salient design features, with particular attention to those that present clinical and methodologic challenges.
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Roemer FW, Kwoh CK, Hannon MJ, Green SM, Jakicic JM, Boudreau R, Crema MD, Moore CE, Guermazi A. Risk factors for magnetic resonance imaging-detected patellofemoral and tibiofemoral cartilage loss during a six-month period: The Joints On Glucosamine study. ACTA ACUST UNITED AC 2012; 64:1888-98. [DOI: 10.1002/art.34353] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sharma L, Chmiel JS, Almagor O, Felson D, Guermazi A, Roemer F, Lewis CE, Segal N, Torner J, Cooke TDV, Hietpas J, Lynch J, Nevitt M. The role of varus and valgus alignment in the initial development of knee cartilage damage by MRI: the MOST study. Ann Rheum Dis 2012; 72:235-40. [PMID: 22550314 DOI: 10.1136/annrheumdis-2011-201070] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Varus and valgus alignment are associated with progression of knee osteoarthritis, but their role in incident disease is less certain. Radiographic measures of incident knee osteoarthritis may be capturing early progression rather than disease development. The authors tested the hypothesis: in knees with normal cartilage morphology by MRI, varus is associated with incident medial cartilage damage and valgus with incident lateral damage. METHODS In MOST, a prospective study of persons at risk of or with knee osteoarthritis, baseline full-limb x-rays and baseline and 30-month MRI were acquired. In knees with normal baseline cartilage morphology in all tibiofemoral subregions, logistic regression was used with generalised estimating equations to examine the association between alignment and incident cartilage damage adjusting for age, gender, body mass index, laxity, meniscal tear and extrusion. RESULTS Of 1881 knees, 293 from 256 persons met the criteria. Varus versus non-varus was associated with incident medial damage (adjusted OR 3.59, 95% CI 1.59 to 8.10), as was varus versus neutral, with evidence of a dose effect (adjusted OR 1.38/1° varus, 95% CI 1.19 to 1.59). The findings held even excluding knees with medial meniscal damage. Valgus was not associated with incident lateral damage. Varus and valgus were associated with a reduced risk of incident lateral and medial damage, respectively. CONCLUSION In knees with normal cartilage morphology, varus was associated with incident cartilage damage in the medial compartment, and varus and valgus with a reduced risk of incident damage in the less loaded compartment. These results support that varus increases the risk of the initial development of knee osteoarthritis.
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Affiliation(s)
- Leena Sharma
- Division of Rheumatology, Feinberg School of Medicine, Northwestern University, 240 East Huron, McGaw M300, Chicago, IL 60611, USA.
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Cooper C, Reginster JY, Chapurlat R, Christiansen C, Genant H, Bellamy N, Bensen W, Navarro F, Badurski J, Nasonov E, Chevalier X, Sambrook PN. Efficacy and safety of oral strontium ranelate for the treatment of knee osteoarthritis: rationale and design of randomised, double-blind, placebo-controlled trial. Curr Med Res Opin 2012; 28:231-9. [PMID: 22148897 DOI: 10.1185/03007995.2011.648758] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The osteoporosis drug strontium ranelate dissociates bone remodelling processes. It also inhibits subchondral bone resorption and stimulates cartilage matrix formation in vitro. Exploratory studies in the osteoporosis trials report that strontium ranelate reduces biomarkers of cartilage degradation, and attenuates the progression and clinical symptoms of spinal osteoarthritis, suggesting symptom- and structure-modifying activity in osteoarthritis. We describe the rationale and design of a randomised trial evaluating the efficacy and safety of strontium ranelate in knee osteoarthritis. RESEARCH DESIGN, METHODS, AND RESULTS This double-blind, placebo-controlled trial (98 centres, 18 countries) includes ambulatory Caucasian men and women aged ≥50 years with primary knee osteoarthritis of the medial tibiofemoral compartment (Kellgren and Lawrence grade 2 or 3), joint space width (JSW) 2.5 to 5 mm, and knee pain on most days in the previous month (intensity ≥40 mm on a visual analogue scale). Patients are randomly allocated to three groups (strontium ranelate 1 or 2 g/day, or placebo). Follow-up is expected to last 3 years. The primary endpoint is radiographic change in JSW from baseline in each group versus placebo. The main clinical secondary endpoint is WOMAC score at the knee. Safety is assessed at every visit. It is estimated that 1600 patients are required to establish statistical significance with power >90% (0.2 mm ± 10% between-group difference in change in JSW over 3 years). Recruitment started in April 2006. The results are expected in spring 2012. CLINICAL TRIAL REGISTRATION The trial is registered on www.controlled-trials.com (number ISRCTN41323372). CONCLUSIONS This randomised, double blind, placebo-controlled study will establish the potential of strontium ranelate in improving structure and symptoms in patients with knee osteoarthritis.
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Affiliation(s)
- Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.
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Roemer FW, Guermazi A, Felson DT, Niu J, Nevitt MC, Crema MD, Lynch JA, Lewis CE, Torner J, Zhang Y. Presence of MRI-detected joint effusion and synovitis increases the risk of cartilage loss in knees without osteoarthritis at 30-month follow-up: the MOST study. Ann Rheum Dis 2011; 70:1804-9. [PMID: 21791448 DOI: 10.1136/ard.2011.150243] [Citation(s) in RCA: 266] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate if two different measures of synovial activation, baseline Hoffa synovitis and effusion synovitis, assessed by MRI, predict cartilage loss in the tibiofemoral joint at 30 months follow-up in subjects with neither cartilage damage nor tibiofemoral radiographic osteoarthritis of the knee. METHODS Non-contrast-enhanced MRI was performed using proton density-weighted fat-suppressed sequences in the axial and sagittal planes and a short tau inversion recovery sequence in the coronal plane. Hoffa synovitis, effusion synovitis and cartilage status were assessed semiquantitatively according to the WORMS scoring system. Included were knees that had neither radiographic osteoarthritis nor MRI-detected tibiofemoral cartilage damage at the baseline visit. The presence of Hoffa synovitis was defined as any grade ≥ 2 (range 0-3) and effusion synovitis as any grade ≥ 2 (range 0-3). Logistic regression was performed to examine the relation of the presence of either measure to the risk of cartilage loss at 30 months adjusting for other potential confounders. RESULTS Of 514 knees included in the analysis, the prevalence of Hoffa synovitis and effusion synovitis at the baseline visit was 8.4% and 10.3%, respectively. In the multivariable analysis, baseline effusion synovitis was associated with an increased risk of cartilage loss. No such association was observed for baseline Hoffa synovitis. CONCLUSIONS Baseline effusion synovitis, but not Hoffa synovitis, predicted cartilage loss. The findings suggest that effusion synovitis, a reflection of inflammatory activity including joint effusion and synovitic thickening, may play a role in the future development of cartilage lesions in knees without osteoarthritis.
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Affiliation(s)
- Frank W Roemer
- Department of Radiology, Boston University Medical Center, FGH Building, 3rd floor, 820 Harrison Avenue, Boston, MA 02118, USA.
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Crema MD, Roemer FW, Guermazi A. Magnetic Resonance Imaging in Knee Osteoarthritis Research: Semiquantitative and Compositional Assessment. Magn Reson Imaging Clin N Am 2011; 19:295-321. [DOI: 10.1016/j.mric.2011.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gensburger D, Roux JP, Arlot M, Sornay-Rendu E, Ravaud P, Chapurlat R. Influence of blinding sequence of radiographs on the reproducibility and sensitivity to change of joint space width measurement in knee osteoarthritis. Arthritis Care Res (Hoboken) 2010; 62:1699-705. [DOI: 10.1002/acr.20311] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 07/19/2010] [Indexed: 12/27/2022]
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Sharma L, Song J, Dunlop D, Felson D, Lewis CE, Segal N, Torner J, Cooke TDV, Hietpas J, Lynch J, Nevitt M. Varus and valgus alignment and incident and progressive knee osteoarthritis. Ann Rheum Dis 2010; 69:1940-5. [PMID: 20511608 DOI: 10.1136/ard.2010.129742] [Citation(s) in RCA: 260] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Varus and valgus alignment increase medial and lateral tibiofemoral load. Alignment was associated with tibiofemoral osteoarthritis progression in previous studies; an effect on incident osteoarthritis risk is less certain. This study tested whether alignment influences the risk of incident and progressive radiographic tibiofemoral osteoarthritis. METHODS In an observational, longitudinal study of the Multicenter Osteoarthritis Study cohort, full-limb x-rays to measure alignment were acquired at baseline and knee x-rays were acquired at baseline and knee x-rays at baseline and 30 months. Varus alignment was defined as ≤178° and valgus ≥182°. Using logistic regression and generalised estimating equations, the associations of baseline alignment and incident osteoarthritis at 30 months (in knees without baseline osteoarthritis) and alignment and osteoarthritis progression (in knees with osteoarthritis) were examined, adjusting. For age, gender, body mass index, injury, laxity and strength, with neutral knees as referent. RESULTS 2958 knees (1752 participants) were without osteoarthritis at baseline. Varus (adjusted OR 1.49, 95% CI 1.06 to 2.10) but not valgus alignment was associated with incident osteoarthritis. 1307 knees (950 participants) had osteoarthritis at baseline. Varus alignment was associated with a greater risk of medial osteoarthritis progression (adjusted OR 3.59, 95% CI 2.62 to 4.92) and a reduced risk of lateral progression, and valgus with a greater risk of lateral progression (adjusted OR 4.85, 95% CI 3.17 to 7.42) and a reduced risk of medial progression. CONCLUSION Varus but not valgus alignment increased the risk of incident tibiofemoral osteoarthritis. In knees with osteoarthritis, varus and valgus alignment each increased the risk of progression in the biomechanically stressed compartment.
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Affiliation(s)
- Leena Sharma
- Northwestern University, Chicago, IL 60611, USA.
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Roemer FW, Eckstein F, Guermazi A. Magnetic resonance imaging-based semiquantitative and quantitative assessment in osteoarthritis. Rheum Dis Clin North Am 2010; 35:521-55. [PMID: 19931802 DOI: 10.1016/j.rdc.2009.08.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Whole organ magnetic resonance imaging (MRI)-based semiquantitative (SQ) assessment of knee osteoarthritis (OA), based on reliable scoring methods and expert reading, has become a powerful research tool in OA. SQ morphologic scoring has been applied to large observational cross-sectional and longitudinal epidemiologic studies as well as interventional clinical trials. SQ whole organ scoring analyzes all joint structures that are potentially relevant as surrogate outcome measures of OA and potential disease modification, including cartilage, subchondral bone, osteophytes, intra- and periarticular ligaments, menisci, synovial lining, cysts, and bursae. Resources needed for SQ scoring rely on the MRI protocol, image quality, experience of the expert readers, method of documentation, and the individual scoring system that will be applied. The first part of this article discusses the different available OA whole organ scoring systems, focusing on MRI of the knee, and also reviews alternative approaches. Rheumatologists are made aware of artifacts and differential diagnoses when applying any of the SQ scoring systems. The second part focuses on quantitative approaches in OA, particularly measurement of (subregional) cartilage loss. This approach allows one to determine minute changes that occur relatively homogeneously across cartilage structures and that are not apparent to the naked eye. To this end, the cartilage surfaces need to be segmented by trained users using specialized software. Measurements of knee cartilage loss based on water-excitation spoiled gradient recalled echo acquisition in the steady state, fast low-angle shot, or double-echo steady-state imaging sequences reported a 1% to 2% decrease in cartilage thickness annually, and a high degree of spatial heterogeneity of cartilage thickness changes in femorotibial subregions between subjects. Risk factors identified by quantitative measurement technology included a high body mass index, meniscal extrusion and meniscal tears, knee malalignment, advanced radiographic OA grade, bone marrow alterations, and focal cartilage lesions.
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd floor, 820 Harrison Avenue, Boston, MA 02118, USA.
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Abstract
Whole-organ semiquantitative (SQ) assessment by expert readers has become a powerful research tool in understanding the natural history of osteoarthritis (OA). SQ morphologic scoring has been applied to observational large cross-sectional and longitudinal epidemiologic studies in addition to interventional clinical trials. In comparison to quantitative and biochemical assessment of cartilage, SQ whole-organ scoring also analyzes additional joint structures that are potentially relevant as surrogate outcome measures for interventional approaches. Resources needed for SQ scoring rely on the MR imaging protocol, image quality, experience of the expert readers, method of documentation, and individual scoring system that is applied. This article discusses the different available OA whole-organ scoring systems, focusing on MR imaging of the knee, and also reviews alternative approaches.
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Affiliation(s)
- Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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