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Kon E, Robinson D, Verdonk P, Drobnic M, Patrascu JM, Dulic O, Gavrilovic G, Filardo G. A novel aragonite-based scaffold for osteochondral regeneration: early experience on human implants and technical developments. Injury 2016; 47 Suppl 6:S27-S32. [PMID: 28040083 DOI: 10.1016/s0020-1383(16)30836-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Chondral and osteochondral lesions represent a debilitating disease. Untreated lesions remain a risk factor for more extensive joint damage. The objective of this clinical study is to evaluate safety and early results of an aragonite-based scaffold used for osteochondral unit repair, by analysing both clinical outcome and MRI results, as well as the benefits of the procedure optimization through novel tapered shaped implants. METHODS A crystalline aragonite bi-phasic scaffold was implanted in patients affected by focal chondral-osteochondral knee lesions of the condyle and trochlea. Twenty-one patients (17 men, 4 women with a mean age of 31.0 ± 8.6 years) without severe OA received tapered shaped implants for the treatment of 2.5 ±1.7 cm2 sized defects. The control group consisted of 76 patients selected according to the same criteria from a database of patients who previously underwent implantation of cylindrical-shaped implants. The clinical outcome of all patients was evaluated with the IKDC subjective score, the Lysholm score, and all 5 KOOS subscales administered preoperatively and at 6 and 12 months after surgery, while MRI evaluation was performed at the 12 month follow-up. RESULTS A statistically significant improvement in all clinical scores was documented both in the tapered implants and the cylindrical group. No difference could be detected in the comparison between the improvement obtained with the two implant types, neither in the clinical nor in imaging evaluations. A difference could be detected instead in terms of revision rate, which was lower in the tapered implant group with no implant removal - 0% vs 8/76-10.5% failures in the cylindrical implants. CONCLUSIONS This study highlighted both safety and potential of a novel aragonite-based scaffold for the treatment of chondral and osteochondral lesions in humans. A tapered shape relative to the cylindrical shaped implant design, improved the scaffold's safety profile. Tapered scaffolds maintain the clinical improvement observed in cylindrical implants while reducing the postoperative risk of revision surgery. This aragonite-based implant was associated with a significant clinical improvement at the 12 month follow-up. Moreover, MRI findings revealed graft integration with good bone and cartilage formation.
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Affiliation(s)
- Elizaveta Kon
- NanoBiotecnology Lab, I Clinic - Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - Dror Robinson
- Department of Orthopedics, Hasharon Hospital affiliated with Tel Aviv University, Rabin Medical Center, Petah Tikwa, Israel
| | - Peter Verdonk
- Antwerp Orthopaedic Center, Monica Hospitals, Stevenslei, Deurne, Belgium; Department of Orthopaedic Surgery, Faculty of Medicine, Antwerp University, Wilrijkstraat, Edegem, Belgium
| | - Matej Drobnic
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Slovenia
| | - Jenel Mariano Patrascu
- Spitalul Clinic Judeţean de Urgenţă "Pius Brînzeu" Timişoara Bulevardul Liviu Rebreanu, Timişoara, Romania
| | | | | | - Giuseppe Filardo
- NanoBiotecnology Lab, I Clinic - Rizzoli Orthopaedic Institute, Bologna, Italy
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van Oudenaarde K, Jobke B, Oostveen ACM, Marijnissen ACA, Wolterbeek R, Wesseling J, Bierma-Zeinstra SMA, Bloem HL, Reijnierse M, Kloppenburg M. Predictive value of MRI features for development of radiographic osteoarthritis in a cohort of participants with pre-radiographic knee osteoarthritis—the CHECK study. Rheumatology (Oxford) 2016; 56:113-120. [DOI: 10.1093/rheumatology/kew368] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/06/2016] [Indexed: 11/13/2022] Open
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Changes in patellofemoral and tibiofemoral joint cartilage damage and bone marrow lesions over 7 years: the Multicenter Osteoarthritis Study. Osteoarthritis Cartilage 2016; 24:1160-6. [PMID: 26836287 PMCID: PMC4907825 DOI: 10.1016/j.joca.2016.01.981] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/21/2015] [Accepted: 01/24/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate changes in cartilage damage and bone marrow lesions (BMLs) on MRI in the patellofemoral and tibiofemoral joints (TFJs) over 7 years. METHODS The Multicenter Osteoarthritis (MOST) Study is a cohort study of persons aged 50-79 years at baseline with or at high risk for knee osteoarthritis (OA). Knees were eligible for the current study if they had knee MRI (1.0T) assessed for cartilage damage and BMLs at the baseline and 84-month visits. Knees were categorized as having MRI-detected structural damage (cartilage and BMLs) isolated to the patellofemoral joint (PFJ), isolated to the TFJ, mixed or no damage at baseline and 84-months. We determined the changes in PFJ and TFJ structural damage over 7 years and used logistic regression to assess the relation of baseline compartment distribution to incident isolated PFJ, isolated TFJ and mixed damage. RESULTS Among 339 knees that had full-thickness cartilage loss isolated to the PFJ or TFJ at baseline, only 68 (20.1%) developed full-thickness cartilage loss in the other compartment while 271 (79.9%) continued to only have the initial compartment affected. Compared to knees without full-thickness cartilage damage (n = 582), those with isolated TFJ and PFJ full-thickness cartilage damage had 2.7 (1.5, 4.9) and 5.8 (3.6, 9.6) times the odds of incident mixed full-thickness cartilage damage, respectively. Similar results were seen when using other definitions of MRI-defined structural damage. CONCLUSIONS Most knees with structural damage at baseline do not develop it in the other compartment. Knees that develop mixed structural damage are more likely to start with it isolated to the PFJ.
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Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med 2016; 50:839-43. [PMID: 27343241 PMCID: PMC4975817 DOI: 10.1136/bjsports-2016-096384] [Citation(s) in RCA: 335] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Joshua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
| | - James Selfe
- Faculty of Health, Psychology and Social Care, Department of Health Professions. Manchester Metropolitan University, Manchester, UK
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Spaulding National Running Centre, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Christopher M Powers
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Jenny McConnell
- McConnell Physiotherapy Group, Mosman, New South Wales, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Jean-Francois Esculier
- Faculty of Medicine, Centre for Interdisciplinary Research in Rehabilitation and Social Integration Universite Laval, Quebec, Quebec, Canada
| | - Dylan Morrissey
- Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK Physiotherapy Department, Bart's Health NHS Trust, London, UK
| | - Michael J Callaghan
- Faculty of Health, Psychology and Social Care, School of Health Professions. Manchester Metropolitan University, Manchester, UK Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
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Landsmeer MLA, Runhaar J, van der Plas P, van Middelkoop M, Vroegindeweij D, Koes B, Bindels PJE, Oei EHG, Bierma-Zeinstra SMA. Reducing progression of knee OA features assessed by MRI in overweight and obese women: secondary outcomes of a preventive RCT. Osteoarthritis Cartilage 2016; 24:982-90. [PMID: 26748391 DOI: 10.1016/j.joca.2015.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/17/2015] [Accepted: 12/23/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the preventive effects of a randomized controlled trial on progression of Magnetic Resonance Imaging (MRI) features of knee osteoarthritis (OA) in overweight and obese women. DESIGN In a 2 × 2 factorial design, 2.5 years effects of a diet and exercise program and of glucosamine sulphate (double-blind, placebo-controlled) were evaluated in 407 middle-aged women with body mass index (BMI) ≥ 27 kg/m(2) without clinical signs of knee OA at baseline (ISRCTN 42823086). MRIs were scored with the MRI Osteoarthritis Knee Score (MOAKS). Progression was defined for bone marrow lesions (BMLs), cartilage defects, osteophytes, meniscal abnormalities and meniscal extrusion. Analyses on knee level were performed over the four intervention groups using adjusted Generalized Estimating Equations (GEE). RESULTS 687 knees of 347 women with mean age 55.7 years (±3.2 SD) and mean BMI 32.3 kg/m(2) (±4.2 SD) were analyzed. Baseline prevalence was 64% for BMLs, 70% for cartilage defects, 24% for osteophytes, 66% for meniscal abnormalities and 52% for meniscal extrusions. The diet and exercise program + placebo intervention showed significantly less progression of meniscal extrusion compared to placebo only (12% vs 22%, OR 0.50, 95% CI [0.27-0.92]). The interventions did not result in significant differences on other OA MRI features. CONCLUSIONS In subjects at high risk for future knee OA development, a diet and exercise program, glucosamine sulphate and their combination showed small and mainly non-significant effects on the progression of OA MRI features. Only progression of meniscal extrusion was significantly diminished by the diet and exercise program.
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Affiliation(s)
- M L A Landsmeer
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P van der Plas
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - M van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - D Vroegindeweij
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - B Koes
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - E H G Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Culvenor AG, Collins NJ, Guermazi A, Cook JL, Vicenzino B, Whitehead TS, Morris HG, Crossley KM. Early Patellofemoral Osteoarthritis Features One Year After Anterior Cruciate Ligament Reconstruction: Symptoms and Quality of Life at Three Years. Arthritis Care Res (Hoboken) 2016; 68:784-92. [DOI: 10.1002/acr.22761] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/21/2015] [Accepted: 10/13/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Adam G. Culvenor
- University of Queensland, Brisbane, Queensland, and La Trobe University, Melbourne, Victoria, Australia, and Paracelsus Medical University–Salzburg & NuremburgSalzburg Austria
| | - Natalie J. Collins
- University of Queensland, Brisbane, Queensland, and University of MelbourneMelbourne Victoria Australia
| | - Ali Guermazi
- Boston University School of MedicineBoston Massachusetts
| | - Jill L. Cook
- La Trobe University and Monash UniversityMelbourne Victoria Australia
| | | | - Timothy S. Whitehead
- University of Queensland, Brisbane, Queensland, and La Trobe UniversityMelbourne Victoria Australia
| | - Hayden G. Morris
- The Park Clinic and St. Vincent's Private Hospital, Melbourne, Victoria, Australia
| | - Kay M. Crossley
- University of Queensland, Brisbane, Queensland, and La Trobe University, Melbourne, Victoria, Australia
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Prediction of medial tibiofemoral compartment joint space loss progression using volumetric cartilage measurements: Data from the FNIH OA biomarkers consortium. Eur Radiol 2016; 27:464-473. [PMID: 27221563 DOI: 10.1007/s00330-016-4393-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 04/28/2016] [Accepted: 05/02/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Investigating the association between baseline cartilage volume measurements (and initial 24th month volume loss) with medial compartment Joint-Space-Loss (JSL) progression (>0.7 mm) during 24-48th months of study. METHODS Case and control cohorts (Biomarkers Consortium subset from the Osteoarthritis Initiative (OAI)) were defined as participants with (n=297) and without (n=303) medial JSL progression (during 24-48th months). Cartilage volume measurements (baseline and 24th month loss) were obtained at five knee plates (medial-tibial, lateral-tibial, medial-femoral, lateral-femoral and patellar), and standardized values were analysed. Multivariate logistic regression was used with adjustment for known confounders. Artificial-Neural-Network analysis was conducted by Multi-Layer-Perceptrons (MLPs) including baseline determinants, and baseline (1) and interval changes (2) in cartilage volumes. RESULTS Larger baseline lateral-femoral cartilage volume was predictive of medial JSL (OR: 1.29 (1.01-1.64)). Greater initial 24th month lateral-femoral cartilage volume-loss (OR: 0.48 (0.27-0.84)) had protective effect on medial JSL during 24-48th months of study. Baseline and interval changes in lateral-femoral cartilage volume, were the most important estimators for medial JSL progression (importance values: 0.191(0.177-0.204), 0.218(0.207-0.228)) in the ANN analyses. CONCLUSIONS Cartilage volumes (both at baseline and their change during the initial 24 months) in the lateral femoral plate were predictive of medial JSL progression. KEY POINTS • Baseline lateral femoral cartilage volume is directly associated with medial JSL progression. • 24-month lateral femoral cartilage loss is inversely associated with medial JSL progression. • Lateral femoral cartilage volume is most important in association with medial JSL progression.
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Barr AJ, Dube B, Hensor EMA, Kingsbury SR, Peat G, Bowes MA, Sharples LD, Conaghan PG. The relationship between three-dimensional knee MRI bone shape and total knee replacement-a case control study: data from the Osteoarthritis Initiative. Rheumatology (Oxford) 2016; 55:1585-93. [PMID: 27185958 PMCID: PMC4993955 DOI: 10.1093/rheumatology/kew191] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 11/25/2022] Open
Abstract
Objective. There is growing understanding of the importance of bone in OA. Our aim was to determine the relationship between 3D MRI bone shape and total knee replacement (TKR). Methods. A nested case-control study within the Osteoarthritis Initiative cohort identified case knees with confirmed TKR for OA and controls that were matched using propensity scores. Active appearance modelling quantification of the bone shape of all knee bones identified vectors between knees having or not having OA. Vectors were scaled such that −1 and +1 represented the mean non-OA and mean OA shapes. Results. Compared to controls (n = 310), TKR cases (n = 310) had a more positive mean baseline 3D bone shape vector, indicating more advanced structural OA, for the femur [mean 0.98 vs −0.11; difference (95% CI) 1.10 (0.88, 1.31)], tibia [mean 0.86 vs −0.07; difference (95% CI) 0.94 (0.72, 1.16)] and patella [mean 0.95 vs 0.03; difference (95% CI) 0.92 (0.65, 1.20)]. Odds ratios (95% CI) for TKR per normalized unit of 3D bone shape vector for the femur, tibia and patella were: 1.85 (1.59, 2.16), 1.64 (1.42, 1.89) and 1.36 (1.22, 1.50), respectively, all P < 0.001. After including Kellgren–Lawrence grade in a multivariable analysis, only the femur 3D shape vector remained significantly associated with TKR [odds ratio 1.24 (1.02, 1.51)]. Conclusion. 3D bone shape was associated with the endpoint of this study, TKR, with femoral shape being most associated. This study contributes to the validation of quantitative MRI bone biomarkers for OA structure-modification trials.
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Affiliation(s)
- Andrew J Barr
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Bright Dube
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - George Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University
| | | | - Linda D Sharples
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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MRI findings associated with development of incident knee pain over 48 months: data from the osteoarthritis initiative. Skeletal Radiol 2016; 45:653-60. [PMID: 26919860 PMCID: PMC4815898 DOI: 10.1007/s00256-016-2343-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this nested case-control study was to identify baseline, incident, and progressive MRI findings visible on standard MRI clinical sequences that were associated with development of incident knee pain in subjects at risk for OA over a period of 48 months. METHODS We analyzed 60 case knees developing incident pain (WOMAC(pain) = 0 at baseline and WOMAC(pain) ≥ 5 at 48 months) and 60 control knees (WOMAC(pain) = 0 at baseline and WOMAC(pain) = 0 at 48 months) from the Osteoarthritis Initiative. 3 T knee MRIs were analyzed using a modified WORMS score (cartilage, meniscus, bone marrow) at baseline and after 48 months. Baseline and longitudinal findings were grouped into logistic regression models and compared using likelihood-ratio tests. For each model that was significant, a stepwise elimination was used to isolate significant MRI findings. RESULTS One baseline MRI finding and three findings that changed from baseline to 48 months were associated with the development of pain: at baseline, the severity of a cartilage lesion in the medial tibia was associated with incident pain--(odds ratio (OR) for incident pain = 3.05; P = 0.030). Longitudinally, an incident effusion (OR = 9.78; P = 0.005), a progressive cartilage lesion of the patella (OR = 4.59; P = 0.009), and an incident medial meniscus tear (OR = 4.91; P = 0.028) were associated with the development of pain. CONCLUSIONS Our results demonstrate that baseline abnormalities of the medial tibia cartilage as well as an incident joint effusion, progressive patella cartilage defects, and an incident medial meniscus tear over 48 months may be associated with incident knee pain. Clinically, this study helps identify MRI findings that are associated with the development of knee pain.
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Deveza LA, Hunter DJ. Editorial: Unraveling Osteoarthritis Pathogenesis: New Insights Into Preradiographic Disease and Patient Phenotypes. Arthritis Rheumatol 2016; 67:3097-100. [PMID: 26414537 DOI: 10.1002/art.39439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/10/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Leticia A Deveza
- Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute of Medical Research, and University of Sydney, Sydney, New South Wales, Australia
| | - David J Hunter
- Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute of Medical Research, and University of Sydney, Sydney, New South Wales, Australia
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Niu J, Felson DT, Neogi T, Nevitt MC, Guermazi A, Roemer F, Lewis CE, Torner J, Zhang Y. Patterns of Coexisting Lesions Detected on Magnetic Resonance Imaging and Relationship to Incident Knee Osteoarthritis: The Multicenter Osteoarthritis Study. Arthritis Rheumatol 2016; 67:3158-65. [PMID: 26414125 DOI: 10.1002/art.39436] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/10/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify patterns of coexisting lesions seen on magnetic resonance imaging (MRI) in knees that are free of radiographic osteoarthritis (OA) and to examine the relationship of these MRI-detected lesions to incident OA. METHODS Study subjects were individuals enrolled in the Multicenter Osteoarthritis Study, a prospective cohort study. In each subject, 1 knee in which radiographic OA was absent in both the tibiofemoral and patellofemoral joints at baseline was selected for study, with followup for 84 months. We used a novel approach, latent class analysis, to group the constellation of MRI lesions in each joint, i.e., cartilage damage, bone marrow lesion, meniscal tear, meniscal extrusion, synovitis, and effusion, into a manageable number of subgroups. The association of these subgroups with incident radiographic OA in the same joint was assessed using logistic regression. RESULTS Among 885 eligible knees (203 with incident disease in the tibiofemoral joint, 64 with incident disease in the patellofemoral joint), 4 latent subgroups in the tibiofemoral joint were identified (described briefly as minimal lesions, mild lesions, moderate lesions [but limited meniscal lesions], and severe lesions). The odds ratios of incident tibiofemoral joint OA in the latter 3 subgroups (compared to the knees with minimal lesions as the referent) were 5.6, 1.8, and 5.0, respectively. A similar set of 4 subgroups in the patellofemoral joint was identified, except that the fourth subgroup had limited meniscal lesions. The odds ratios of incident disease in the patellofemoral joint were 3.8, 5.1, and 13.7 in the subgroups with mild lesions, moderate lesions, and severe lesions, respectively. CONCLUSION Different patterns of coexisting MRI lesions, which have different implications with regard to risk of knee OA, were identified. Meniscal damage seemed to play a different role in the development of incident disease in tibiofemoral versus patellofemoral joints.
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Affiliation(s)
- Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester, Manchester, UK
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Ali Guermazi
- Boston University School of Medicine and Boston Core Imaging Lab, LLC, Boston, Massachusetts
| | - Frank Roemer
- Boston University School of Medicine and Boston Core Imaging Lab, LLC, Boston, Massachusetts, and University of Erlangen-Nuremberg, Erlangen, Germany
| | - Cora E Lewis
- University of Alabama School of Medicine, Birmingham
| | | | - Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
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Quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis--data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2016; 24:262-9. [PMID: 26318658 PMCID: PMC5476294 DOI: 10.1016/j.joca.2015.08.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/23/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test the hypothesis that quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis (KOA), prior to the advent of radiographic disease. METHODS 206 knees with incident radiographic KOA (Kellgren Lawrence Grade (KLG) 0 or 1 at baseline, developing KLG 2 or greater with a definite osteophyte and joint space narrowing (JSN) grade ≥1 by year 4) were matched to 232 control knees not developing incident KOA. Manual segmentation of the central five slices of the medial and lateral meniscus was performed on coronal 3T DESS MRI and quantitative meniscus position was determined. Cases and controls were compared using conditional logistic regression adjusting for age, sex, BMI, race and clinical site. Sensitivity analyses of early (year [Y] 1/2) and late (Y3/4) incidence was performed. RESULTS Mean medial extrusion distance was significantly greater for incident compared to non-incident knees (1.56 mean ± 1.12 mm SD vs 1.29 ± 0.99 mm; +21%, P < 0.01), so was the percent extrusion area of the medial meniscus (25.8 ± 15.8% vs 22.0 ± 13.5%; +17%, P < 0.05). This finding was consistent for knees restricted to medial incidence. No significant differences were observed for the lateral meniscus in incident medial KOA, or for the tibial plateau coverage between incident and non-incident knees. Restricting the analysis to medial incident KOA at Y1/2 differences were attenuated, but reached significance for extrusion distance, whereas no significant differences were observed at incident KOA in Y3/4. CONCLUSION Greater medial meniscus extrusion predicts incident radiographic KOA. Early onset KOA showed greater differences for meniscus position between incident and non-incident knees than late onset KOA.
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Sharma L. Osteoarthritis year in review 2015: clinical. Osteoarthritis Cartilage 2016; 24:36-48. [PMID: 26707991 PMCID: PMC4693145 DOI: 10.1016/j.joca.2015.07.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/21/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this review is to highlight clinical research in osteoarthritis (OA). A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms "osteoarthritis [All Fields] AND treatment [All Fields]" and the following limits activated: humans, English language, all adult 19+ years, published between April 1, 2014 and April 1, 2015. A second literature search was then conducted with the search terms "osteoarthritis [All Fields] AND epidemiology [All Fields]", with the same limits. Reports of surgical outcome, case series, surgical technique, tissue sample or culture studies, trial protocols, and pilot studies were excluded. Of 1523, 150 were considered relevant. Among epidemiologic and observational clinical studies, themes included physical activity, early knee OA, and confidence/instability/falls. Symptom outcomes of pharmacologic treatments were reported for methotrexate, adalimumab, anti-nerve growth factor monoclonal antibodies, strontium ranelate, bisphosphonates, glucosamine, and chondroitin sulfate, and structural outcomes of pharmacologic treatments for strontium ranelate, recombinant human fibroblast growth factor 18, and glucosamine and chondroitin sulfate. Symptom outcomes of non-pharmacologic interventions were reported for: neuromuscular exercise, quadriceps strengthening, weight reduction and maintenance, TENS, therapeutic ultrasound, stepped care strategies, cognitive behavior therapy for sleep disturbance, acupuncture, gait modification, booster physical therapy, a web-based therapeutic exercise resource center for knee OA; hip physical therapy for hip OA; and joint protection and hand exercises for hand OA. Structure outcomes of non-pharmacologic interventions were reported for patellofemoral bracing.
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Wang Y, Teichtahl AJ, Cicuttini FM. Osteoarthritis year in review 2015: imaging. Osteoarthritis Cartilage 2016; 24:49-57. [PMID: 26707992 DOI: 10.1016/j.joca.2015.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This narrative review covers original publications related to imaging in osteoarthritis (OA) published in English between 1 April 2014 and 30 April 2015. Novel lessons relating to imaging are described. METHODS An extensive PubMed database search was performed based on, but not limited to the terms "OA" in combination with "Magnetic resonance imaging (MRI)", "Imaging", "Radiography", "Ultrasound", "Computed tomography (CT)" and "Nuclear medicine" to extract relevant studies. In vitro data and animal studies were excluded. This review focuses on the new developments and observations based on the aforementioned imaging modalities, as well as a 'whole-organ' approach by presenting findings from different tissues (bone, meniscus, synovium, muscle and fat) and joints (hip, lumbar spine and hand). RESULTS AND CONCLUSIONS Over the past year, studies using imagine have made a major contribution to the understanding of the pathogenesis of OA. Significant work has continued at the knee, with MRI now being increasingly used to assess structural endpoints in clinical trials. This offers the exciting opportunity to explore potential disease modifying OA therapies. There has been a clear interest in the role of bone in the pathogenesis of OA. There is now a growing body of literature examining the pathogenesis of OA at the hip, lumbar spine and hand. The future of imaging in OA offers the exciting potential to better understand the disease process across all joints and develop more effective preventive and therapeutic interventions.
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Affiliation(s)
- Y Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - A J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia; Baker IDI Heart and Diabetes Institute, Commercial Road, Melbourne, VIC 3004, Australia
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
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Abstract
PURPOSE OF REVIEW This review focuses on recent studies of osteoarthritis epidemiology, including research on prevalence, incidence, and a broad array of potential risk factors at the person level and joint level. RECENT FINDINGS Studies continue to illustrate the high impact of osteoarthritis worldwide, with increasing incidence. Person-level risk factors with strong evidence regarding osteoarthritis incidence and/or progression include age, sex, socioeconomic status, family history, and obesity. Joint-level risk factors with strong evidence for incident osteoarthritis risk include injury and occupational joint loading; the associations of injury and joint alignment with osteoarthritis progression are compelling. Moderate levels of physical activity have not been linked to increased osteoarthritis risk. Some topics of high recent interest or emerging evidence for association with osteoarthritis include metabolic pathways, vitamins, joint shape, bone density, limb length inequality, muscle strength and mass, and early structural damage. SUMMARY Osteoarthritis is a complex, multifactorial disease, and there is still much to learn regarding mechanisms underlying incidence and progression. However, there are several known modifiable and preventable risk factors, including obesity and joint injury; efforts to mitigate these risks can help to lessen the impact of osteoarthritis.
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Individuals with incident accelerated knee osteoarthritis have greater pain than those with common knee osteoarthritis progression: data from the Osteoarthritis Initiative. Clin Rheumatol 2015; 35:1565-71. [PMID: 26614536 DOI: 10.1007/s10067-015-3128-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Abstract
We evaluated whether accelerated knee osteoarthritis (AKOA) was associated with greater pain and other outcomes and if outcomes varied over time differently among those with incident AKOA or common knee osteoarthritis (KOA), which we defined as a gradual onset of disease. We conducted longitudinal analyses among participants in the Osteoarthritis Initiative who had no radiographic KOA at baseline (Kellgren-Lawrence [KL] <2). Participants were considered AKOA if ≥1 knees progressed to KL grade ≥3 and common KOA if ≥1 knees increased in radiographic scoring within 48 months. We defined the index visit as the study visit when they met the AKOA or common KOA criteria. Our observation period included up to 3 years before and after the index visit. Our primary outcome was WOMAC pain converted to an ordinal scale: none (pain score = 0/1 out of 20), mild (pain score = 2/3), and moderate-severe pain (pain score >3). We explored 11 other secondary outcome measures. We performed an ordinal logistic regression or linear models with generalized estimating equations. The predictors were group (AKOA or common KOA), time (seven visits), and a group-by-time interaction. Overall, individuals with AKOA (n = 54) had greater pain, functional disability, and global rating scale as well as slower chair-stand and walking pace compared with those with common KOA (n = 187). There was no significant interaction between group and time for knee pain; however, there was for chair-stand pace and global rating scale. In conclusion, AKOA may be a painful and disabling phenotype that warrants more attention by clinicians and researchers.
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Lee S, Kim SJ. Prevalence of knee osteoarthritis, risk factors, and quality of life: The Fifth Korean National Health And Nutrition Examination Survey. Int J Rheum Dis 2015; 20:809-817. [PMID: 26578271 DOI: 10.1111/1756-185x.12795] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM Although there have been regional population-based studies on the prevalence of knee osteoarthritis (KOA) and its risk factors in South Koreans, those studies in common had limited external validity. This study aims to estimate the national prevalence of KOA and its risk factors using a complex sampling design. METHODS This was a cross-sectional study including 9512 participants aged ≥ 50 years of The Fifth Korean National Health and Nutrition Examination Survey, who were selected using two-step stratified clustered equal-probability systematic sampling. Radiographic KOA (RKOA) was defined as a Kellgren-Lawrence grade of ≥ 2. Symptoms of KOA were evaluated through a health interview. Obesity was defined as a body mass index ≥ 27.5 kg/m2. Quality of life was measured by the Korean version of European Quality of Life Questionnaire (EQ-5D). RESULTS The prevalence of RKOA was 21.1% (95% CI: 19.6-22.8%) in men, and 43.8% (42.0-45.6%) in women. The prevalence of symptomatic RKOA (SRKOA) was 4.4% (3.8-5.2%) and 19.2% (17.9-20.6%) in men and women, respectively. The EQ-5D index was lower in participants with KOA. When plotted against mean age and prevalence of obesity, regions with a higher mean age and prevalence of obesity had higher prevalence of KOA, which was also observed at the individual level. The prevalence of SRKOA was 36.6% (29.7-44.1%) in women in Jeju province. CONCLUSION The prevalence of SRKOA in women reached 36.6% in high-risk groups accompanied by low quality of life. The results suggest that the disease burden of KOA is high in South Korea.
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Affiliation(s)
- Sunggun Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Seon-Jeong Kim
- Department of Radiology, Myongji Hospital, Goyang, South Korea
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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] [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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Roemer FW, Kwoh CK, Hannon MJ, Hunter DJ, Eckstein F, Fujii T, Boudreau RM, Guermazi A. What comes first? Multitissue involvement leading to radiographic osteoarthritis: magnetic resonance imaging-based trajectory analysis over four years in the osteoarthritis initiative. Arthritis Rheumatol 2015; 67:2085-96. [PMID: 25940308 DOI: 10.1002/art.39176] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 04/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess whether the presence of structural osteoarthritis (OA) features over as many as 4 years prior to incident radiographic OA increases the risk of radiographic OA in a nested, case-control design. METHODS We studied 355 knees from the Osteoarthritis Initiative cohort that developed radiographic OA before the 48-month visit. They were matched one-to-one by sex, age, and contralateral knee radiographic status with a control knee. Magnetic resonance images (MRIs) were read for bone marrow lesions (BMLs), cartilage damage, meniscal damage (including tears and extrusion), Hoffa synovitis, and effusion synovitis. Conditional logistic regression was applied to assess the risk of radiographic OA with regard to the presence of BMLs (score ≥2), cartilage lesions (score ≥1.1), meniscal damage (any) and extrusion of ≥3 mm ± (score ≥2), and Hoffa and effusion synovitis (any). Time points were defined as incident radiographic OA visit (P0), 1 year prior to the detection of radiographic OA (P -1), 2 years prior to the detection of radiographic OA (P -2), etc. RESULTS The presence of Hoffa synovitis (hazard ratio [HR] 1.76 [95% confidence interval (95% CI) 1.18-2.64]), effusion synovitis (HR 1.81 [95% CI 1.18-2.78]), and medial meniscal damage (HR 1.83 [95% CI 1.17-2.89]) at P -2 predicted radiographic OA incidence. At P -1, all features but meniscal extrusion predicted radiographic OA, with highest odds for medial BMLs (HR 6.50 [95% CI 2.27-18.62]) and effusion synovitis (HR 2.50 [95% CI 1.76-3.54]). The findings at P -3 and P -4 did not reach statistical significance. CONCLUSION Our findings indicate that the presence of specific structural features of MRI-detected joint damage 2 years prior to incident radiographic OA increases the risk of incident radiographic OA. However, 1 year prior to radiographic OA, the presence of almost any abnormal morphologic feature increases the risk of radiographic OA in the subsequent year.
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Affiliation(s)
- Frank W Roemer
- Boston University School of Medicine, Boston, Massachusetts, and University of Erlangen-Nuremberg, Erlangen, Germany
| | - C Kent Kwoh
- University of Arizona College of Medicine, Tucson, and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Michael J Hannon
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - David J Hunter
- Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and University of Sydney, St. Leonards, New South Wales, Australia
| | - Felix Eckstein
- Paracelsus Medical University, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany
| | - Tomoko Fujii
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
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Barr AJ, Campbell TM, Hopkinson D, Kingsbury SR, Bowes MA, Conaghan PG. A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis. Arthritis Res Ther 2015; 17:228. [PMID: 26303219 PMCID: PMC4548899 DOI: 10.1186/s13075-015-0735-x] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 08/03/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Bone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and joint replacement in peripheral joint OA. METHODS A search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring. RESULTS In total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively. CONCLUSION Subchondral bone features have independent associations with structural progression, pain and joint replacement in peripheral OA in the hip and hand but especially in the knee. For peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target. SYSTEMATIC REVIEW PROSPERO registration number: CRD 42013005009.
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Affiliation(s)
- Andrew J Barr
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK.
| | - T Mark Campbell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK.
- Department of Medicine, University of Ottawa, Ottawa, Canada.
| | | | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK.
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapeltown Rd, Leeds, LS7 4SA, UK.
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Favero M, Ramonda R, Goldring MB, Goldring SR, Punzi L. Early knee osteoarthritis. RMD Open 2015; 1:e000062. [PMID: 26557380 PMCID: PMC4632144 DOI: 10.1136/rmdopen-2015-000062] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/30/2015] [Accepted: 06/14/2015] [Indexed: 12/13/2022] Open
Abstract
Concepts regarding osteoarthritis, the most common joint disease, have dramatically changed in the past decade thanks to the development of new imaging techniques and the widespread use of arthroscopy that permits direct visualisation of intra-articular tissues and structure. MRI and ultrasound allow the early detection of pre-radiographic structural changes not only in the peri-articular bone but also in the cartilage, menisci, synovial membrane, ligaments and fat pad. The significance of MRI findings such as cartilage defects, bone marrow lesions, synovial inflammation/effusions and meniscal tears in patients without radiographic signs of osteoarthritis is not fully understood. Nevertheless, early joint tissue changes are associated with symptoms and, in some cases, with progression of disease. In this short review, we discuss the emerging concept of early osteoarthritis localised to the knee based on recently updated knowledge. We highlight the need for a new definition of early osteoarthritis that will permit the identification of patients at high risk of osteoarthritis progression and to initiate early treatment interventions.
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Affiliation(s)
- Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED , University Hospital of Padova , Padova , Italy ; Laboratory of Immunorheumatology and Tissue Regeneration/RAMSES , Rizzoli Orthopedic Research Institute , Bologna , Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED , University Hospital of Padova , Padova , Italy
| | - Mary B Goldring
- Research Division , Hospital for Special Surgery and Weill Cornell Medical College , New York, New York , USA
| | - Steven R Goldring
- Research Division , Hospital for Special Surgery and Weill Cornell Medical College , New York, New York , USA
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine-DIMED , University Hospital of Padova , Padova , Italy
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Wang J, Antony B, Zhu Z, Han W, Pan F, Wang X, Jin X, Liu Z, Cicuttini F, Jones G, Ding C. Association of patellar bone marrow lesions with knee pain, patellar cartilage defect and patellar cartilage volume loss in older adults: a cohort study. Osteoarthritis Cartilage 2015; 23:1330-6. [PMID: 25724258 DOI: 10.1016/j.joca.2015.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 02/02/2023]
Abstract
AIM To examine the cross-sectional and longitudinal associations of patellar bone marrow lesion (BMLs) with knee pain, cartilage defects and cartilage volume in older adults. METHODS A total of 904 randomly selected subjects (mean 62.4 years, 49.9% female) were studied. Fat suppressed T1-weighted spoiled gradient recall and T2-weighted fast spin echo magnetic resonance imaging (MRI) sequences were used to assess cartilage volume, cartilage defects and/or BMLs at baseline (n = 904) and 2.6 (range: 1.4-4.8) years' follow-up (n = 414). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire at baseline (n = 904) and follow-up (n = 790). RESULTS The prevalence of any patellar BMLs was 19% and was higher in those with tibiofemoral BMLs. In multivariable analyses, patellar BMLs were positively associated with any knee pain at baseline and an increase in knee pain when going up/down stairs (odds ratio (OR): 1.67, 95% confidence interval (CI): 1.08, 2.59) but not with other knee pain subscales. Patella BMLs were also associated with patellar cartilage defects both at baseline and change over time (OR: 1.76, 95% CI: 1.00, 3.70) but not tibiofemoral defects. Patellar BMLs were negatively associated with baseline and change in patella cartilage volume (β: -2.10%, 95% CI: -3.39%, -0.80%). These associations remained significant after further adjustment for tibiofemoral BMLs. CONCLUSIONS Patellar BMLs were consistently associated with increased knee pain especially going up/down stairs, increased patellar cartilage defects, and decreased patellar cartilage volume cross-sectionally and longitudinally, suggesting a predominantly compartment specific role for patellar BMLs.
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Affiliation(s)
- J Wang
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of General Surgery, Yan'an Hospital of Kunming Medical University, Kunming Yan'an Hospital, Kunming, China
| | - B Antony
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Z Zhu
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - W Han
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - F Pan
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - X Wang
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - X Jin
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Z Liu
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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73
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Recognition of Immune Response for the Early Diagnosis and Treatment of Osteoarthritis. J Immunol Res 2015; 2015:192415. [PMID: 26064995 PMCID: PMC4433702 DOI: 10.1155/2015/192415] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 12/02/2014] [Indexed: 12/15/2022] Open
Abstract
Osteoarthritis is a common and debilitating joint disease that affects up to 30 million Americans, leading to significant disability, reduction in quality of life, and costing the United States tens of billions of dollars annually. Classically, osteoarthritis has been characterized as a degenerative, wear-and-tear disease, but recent research has identified it as an immunopathological disease on a spectrum between healthy condition and rheumatoid arthritis. A systematic literature review demonstrates that the disease pathogenesis is driven by an early innate immune response which progressively catalyzes degenerative changes that ultimately lead to an altered joint microenvironment. It is feasible to detect this infiltration of cells in the early, and presumably asymptomatic, phase of the disease through noninvasive imaging techniques. This screening can serve to aid clinicians in potentially identifying high-risk patients, hopefully leading to early effective management, vast improvements in quality of life, and significant reductions in disability, morbidity, and cost related to osteoarthritis. Although the diagnosis and treatment of osteoarthritis routinely utilize both invasive and non-invasive strategies, imaging techniques specific to inflammatory cells are not commonly employed for these purposes. This review discusses this paradigm and aims to shift the focus of future osteoarthritis-related research towards early diagnosis of the disease process.
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74
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Moyer RF, Hunter DJ. Osteoarthritis in 2014: Changing how we define and treat patients with OA. Nat Rev Rheumatol 2014; 11:65-6. [PMID: 25512014 DOI: 10.1038/nrrheum.2014.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Important advances in 2014 foster new perspectives on definitions of early and end-stage disease, and promote a shift in the clinical management of osteoarthritis (OA) through implementing treatment algorithms intended to minimize strain on current health-care models. Collectively, these changes shed new light on developing and optimizing approaches to OA treatment.
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Affiliation(s)
- Rebecca F Moyer
- Faculty of Health Sciences, The University of Western Ontario, 1151 Richmond Street, London, ON N6A 3K7, Canada
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW 2065, Australia
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75
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Felson DT, Hodgson R. Identifying and treating preclinical and early osteoarthritis. Rheum Dis Clin North Am 2014; 40:699-710. [PMID: 25437286 DOI: 10.1016/j.rdc.2014.07.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Studies suggest that many persons with painful osteoarthritis already have extensive structural disease including malalignment, which may preclude successful stabilization or reversal of disease; this provides a strong rationale for developing strategies to prevent disease or to identify and treat it early. This article reviews a variety of approaches likely to capture those at high risk of or with early disease. However, given the absence of effective treatments, it is unclear whether structural disease could be successfully slowed or prevented in those with early symptoms or at high risk of disease.
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Affiliation(s)
- David T Felson
- Medicine, Boston University School of Medicine, Suite 200, 650 Albany Street, Boston, MA 02118, USA; University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK; Clinical Epidemiology Unit, Boston University, Boston, MA, USA; NIHR Biomedical Research Unit, University of Manchester, Manchester, UK.
| | - Richard Hodgson
- Clinical Epidemiology Unit, Boston University, Boston, MA, USA; NIHR Biomedical Research Unit, University of Manchester, Manchester, UK
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Abstract
With a frustrating lack of progress in the development of treatments for osteoarthritis, EULAR has released recommendations to reorient research into this disease. These recommendations include focused attention on noncartilagenous tissues, the interaction of structures within the joint, the pathogenesis of osteoarthritic pain, new treatment strategies and early disease.
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