Risk factors can classify individuals who develop accelerated knee osteoarthritis: Data from the osteoarthritis initiative

Radiomic features of the medial meniscus predicts incident destabilizing meniscal tears: Data from the osteoarthritis initiative

The objective of this study was to determine the optimal meniscal radiomic features to classify people who will develop an incident destabilizing medial meniscal tear. We used magnetic resonance (MR) images from an existing case-control study that includes images from the first 4 years of the Osteoarthritis Initiative (OAI). For this exploratory analysis (n = 215), we limited our study sample to people with (1) intact menisci at the OAI baseline visit, (2) 4-year meniscal status data, and (3) complete meniscal data from each region of interest. Incident destabilizing meniscal tear was defined as progressing from an intact meniscus to a destabilizing tear by the 48-month visit using intermediate-weighted fat-suppressed MR images. One reader manually segmented each participant's anterior and posterior horn of the medial menisci at the OAI baseline visit. Next, 61 different radiomic features were extracted from each medial meniscus horn. We performed a classification and regression tree (CART) analysis to determine the classification rules and important variables that predict incident destabilizing meniscal tear. The CART correctly classified 24 of the 34 cases and 172 out of 181 controls with a sensitivity of 70.6% and a specificity of 95.0%. The CART identified large zone high gray level emphasis (i.e., more coarse texture) from the posterior horn as the most important variable to classify who would develop an incident destabilizing medial meniscal tear. The use of radiomic features provides sensitive and quantitative measures of meniscal alterations, allowing us to intervene and prevent destabilizing meniscal tears.

Physical Therapists' Attitudes, Beliefs, and Barriers Regarding Fall Screening and Prevention among Patients with Knee Osteoarthritis: A Cross-Sectional Study

Falls are commonly associated with knee osteoarthritis and represent a significant financial burden on the healthcare system. Therefore, the discovery of physical therapists' attitudes and practices regarding fall screening and prevention among patients with osteoarthritis should be investigated. Moreover, this study aimed to identify barriers that might limit its implementation among this population. A cross-sectional study design was used to collect the data. The electronic survey targeted licensed physical therapy professionals who currently work in clinical or academic settings in Saudi Arabia. The data were analyzed descriptively and inferentially using chi-square. Two hundred and six licensed physical therapists completed the survey, 119 females (57.8%) and 87 males (42.2%). The results of the structural equation modelling analysis showed that intention to use fall screening and management strategies was positively associated with the history of falls, identifying risk factors of falls, and documentation of risk factors of falls (p ≤ 0.0001). The most reported barriers to implement fall screening and prevention were lack of knowledge (n = 92, 45%), lack of training/skills (n = 84, 41%), and time constraints (n = 57, 45%), followed by patient compliance with 38% of the responses. The findings highlighted the importance of identifying the key opportunities for knowledge translation in clinical practices to enhance the sufficient implementation of fall screening and management in osteoarthritis care.

Triglyceride-glucose index in the prediction of new-onset arthritis in the general population aged over 45: the first longitudinal evidence from CHARLS

OBJECTIVE

Insulin resistance (IR) imposes a significant burden on inflammatory diseases, and the triglyceride-glucose (TyG) index, which is an easily accessible indicator for detecting IR, holds great application potential in predicting the risk of arthritis. The aim of this study is to analyze the association between the TyG index and the risk of new-onset arthritis in the common population aged over 45 using a prospective cohort study design.

METHOD

This population-based cohort study involved 4418 participants from the China Health and Retirement Longitudinal Study (from Wave 1 to Wave 4). Multivariate logistic regression models were employed to investigate the association between the TyG index and new-onset arthritis, and RCS analyses were used to investigate potential non-linear relationships. Moreover, decision trees were utilized to identify high-risk populations for incident arthritis.

RESULT

Throughout a 7-year follow-up interval, it was found that 396 participants (8.96%) developed arthritis. The last TyG index quartile group (Q4) presented the highest risk of arthritis (OR, 1.39; 95% CI, 1.01, 1.91). No dose-response relationship between the TyG index and new-onset arthritis was identified (Poverall=0.068, Pnon-linear=0.203). In the stratified analysis, we observed BMI ranging from 18.5 to 24 exhibited a heightened susceptibility to the adverse effects of the TyG index on the risk of developing arthritis (P for interaction = 0.035).

CONCLUSION

The TyG index can be used as an independent risk indicator for predicting the start of new-onset arthritis within individuals aged 45 and above within the general population. Improving glucose and lipid metabolism, along with insulin resistance, may play a big part in improving the primary prevention of arthritis.

Effect of knee osteoarthritis on the postoperative outcome of proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly: a retrospective analysis

BACKGROUND

The proximal femoral nail anti-rotation (PFNA) is a commonly used internal fixation system for intertrochanteric fractures (IFs) in older adults. Knee osteoarthritis (KOA) is a degenerative lower extremity disease that occurs most frequently in the elderly. Some patients have already had KOA before the IFs. However, whether KOA impacts the postoperative outcome of IFs has not been reported.

OBJECTIVE

This study aimed to investigate the effect of KOA on the fracture side on the outcome after PFNA for IFs in the elderly.

METHODS

Between January 2016 and November 2021, 297 elderly patients treated with PFNA for IFs were enrolled in this study. They were divided into two groups according to the American Rheumatism Association KOA clinical and radiographic criteria: the control group and the KOA group. Intraoperative bleeding, operative time, length of hospital stay, postoperative time out of bed, fracture healing time, postoperative complications, postoperative Harris hip function score, and Barthel ability to daily living Score were compared between the two groups. Follow-up was routinely scheduled at 1, 3, 6, and 12 months postoperatively.

RESULTS

Based on the exclusion criteria, 254 patients who met the requirements were left to be included in this study, including the control group (n = 133) and the KOA group (n = 121). Patients were followed up for a mean of 17.5 months (12-24 months). There was no significant difference between the two groups in preoperative demographic data, intraoperative blood loss, operation time, and length of stay in the hospital. The control group was statistically significant compared to the KOA group in terms of postoperative time out of bed (17.8 ± 4.0 days vs. 19.1 ± 5.8 days), fracture healing time (13.7 ± 2.2 weeks vs. 14.6 ± 3.7 weeks), and postoperative complications (12.8 vs. 23.1%). The Harris hip function score and Barthel ability to daily living score were higher in the control group than in the KOA group at 1, 3, 6, and 12 months postoperatively (the control group: 63.8 ± 10.9, 71.8 ± 10.3, 81.5 ± 8.7, and 91.6 ± 6.3 vs. The KOA group 61.0 ± 10.4, 68.6 ± 9.1, 79.0 ± 9.2, and 88.5 ± 5.9).

CONCLUSIONS

In elderly patients with IFs combined with KOA of the fracture side treated with PFNA internal fixation, KOA increases the incidence of postoperative complications of the fracture, prolongs postoperative time out of bed and fracture healing, and reduces postoperative hip function and ability to daily living. Therefore, treating KOA on the fractured side needs to be considered when treating IFs in the elderly.

Meniscal degeneration is prognostic of destabilzing meniscal tear and accelerated knee osteoarthritis: Data from the Osteoarthritis Initiative

The objective of this study was to assess the prognostic potential of magnetic resonance (MR)-detected meniscal degeneration in relation to incident destabilizing meniscal tears (radial, complex, root, or macerated) or accelerated knee osteoarthritis (AKOA). We used existing MR data from a case-control study of three groups from the Osteoarthritis Initiative without radiographic KOA at baseline: AKOA, typical KOA, and no KOA. From these groups, we included people without medial and lateral meniscal tear at baseline (n = 226) and 48-month meniscal data (n = 221). Intermediate-weighted fat-suppressed MR images annually from baseline to the 48-month visit were graded using a semiquantitative meniscal tear classification criterion. Incident destabilizing meniscal tear was defined as progressing from an intact meniscus to a destabilizing tear by the 48-month visit. We used two logistic regression models to assess whether: (1) presence of medial meniscal degeneration was associated with an incident medial destabilizing meniscal tear, and (2) presence of meniscal degeneration in either meniscus was associated with incident AKOA over the next 4 years. People with the presence of a medial meniscal degeneration had three times the odds of developing an incident destabilizing medial meniscal tear within 4 years compared with a person without medial meniscus degeneration (odds ratio [OR]: 3.03; 95% confidence interval [CI]: 1.40-6.59). People with meniscal degeneration had five times the odds of developing incident AKOA within 4 years compared with a person without meniscal degeneration in either meniscus (OR: 5.04; 95% CI: 2.57-9.89). Meniscal degeneration on MR is clinically meaningful as it relates to future poor outcomes.

Effects of ozone combined with articular injection of sodium hyaluronate on patients with knee osteoarthritis and their inflammatory factors and hemorheological indices

Objective

Knee osteoarthritis (KOA) is a common chronic progressive disease. We aimed to evaluate the effects of ozone combined with articular injection of sodium hyaluronate on KOA patients and their inflammatory factors and hemorheological indices.

Methods

A total of 292 KOA patients treated from October 2020 to October 2021 were randomly divided into observation and control groups (n=146). Observation group was treated with ozone combined with articular injection of sodium hyaluronate, while control group was routinely given glucosamine hydrochloride tablets and articular injection of sodium hyaluronate. The treatment was performed once a week for 5 consecutive weeks. Their general data, treatment outcomes, visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, inflammatory factor levels and hemorheological indices were compared.

Results

After treatment, observation group had significantly lower VAS score and higher HSS score than those of control group (P<0.05). The total response rate of observation group was higher than that of control group (P<0.05). The levels of inflammatory factors in the joint fluid were significantly lower in observation group than those in control group (P<0.05). The hemorheological indices were improved in both groups, especially in observation group (P<0.05).

Conclusion

Ozone combined with articular injection of sodium hyaluronate has obvious therapeutic effects on KOA.

After-hour elective total knee arthroplasty does not affect clinical outcomes but negatively affects alignment

INTRODUCTION

In cases of limited medical resources, elective total knee arthroplasty (TKA) sometimes needs to be performed after typical work hours. However, surgeon fatigue and logistical factors may potentially affect outcomes. This study aimed to detect whether after-hour procedures impair outcomes after TKA.

MATERIALS AND METHODS

Elective unilateral TKA from Jan 1, 2016 to Nov 31, 2018 was retrospectively selected and separated into two groups. Procedures started from 8:00 A.M. to 5:29 P.M. were identified as day-time surgeries, whereas those started from 5:30 P.M. to 11:59 P.M. were considered after-hour surgeries. Operative period, Knee Society Score (KSS), range of motion (ROM), total blood loss, length of hospital stay (LOS), and postoperative adverse events and complications were compared. Additionally, the components were evaluated radiologically.

RESULTS

A total of 321 patients were selected, including 258 (80.37%) patients in the day-time group and 63 (19.63%) patients in the after-hour group. Operative period, LOS, total blood loss were similar between groups. The overall and each specific incidence of postoperative complications were comparable between the two groups, but the incidence of postoperative vomiting (POV) was higher in the after-hour group. There was no significant difference in knee joint function as shown by the KSS and ROM, both on the 3rd day and at 2 years after surgeries. Radiologically, there were no significant differences between the two groups in the femoral notches (P = 0.592). However, better coronal alignment was detected in the day-time group (P = 0.002), consistent with which there were less outliers (P = 0.033).

CONCLUSION

After-hour TKA procedure does not exert an impact on clinical outcomes, but negatively affects lower limb alignment. Besides, after-hour TKA surgery impairs patients' comfort by increasing POV.

Factores de riesgo asociados a la artrosis de rodilla: Revisión sistemática de la literatura

Introducción: la osteoartritis de rodilla (OR) se define como una enfermedad crónica, inflamatoria, degenerativa y progresiva, caracterizada por el deterioro del cartílago articular. Tiene manifestaciones clínicas y etiológicas diferentes según el grupo etario y se encuentra asociada con múltiples factores que intervienen en la fisiopatología, entre los que están: edad, raza, sexo, sobrepeso, obesidad y síndrome metabólico. Objetivo: determinar los factores de riesgo que influyen en el proceso degenerativo de la OR en la adultez temprana y tardía. Materiales y métodos: revisión sistemática de la literatura científica en diferentes bases de datos que incluyeron estudios de cohorte, transversales, casos y controles, evaluando los factores de riesgo predisponentes. Resultados: se seleccionaron 50 artículos que cumplieron con los criterios, identificando diferentes factores que afectan el desarrollo o progresión de la OR como las alteraciones metabólicas, sistémicas y estilo de vida que influyen en esta patología, además de factores modificables y no modificables. Conclusión: la OR es una afección de carácter multifactorial, donde la obesidad, la hipertensión arterial (HTA), el índice de masa corporal (IMC) elevado, los niveles altos de LDL, la debilidad muscular e incluso la profesión del paciente, son los principales factores predisponentes para desarrollar o aumentar su progresión.

Defining and predicting radiographic knee osteoarthritis progression: a systematic review of findings from the osteoarthritis initiative

PURPOSE

The purposes of this systematic review were to (1) identify the commonly used definitions of radiographic KOA progression, (2) summarize the important associative risk factors for disease progression based on findings from the OAI study and (3) summarize findings from radiographic KOA progression prediction modeling studies regarding the characterization of progression and outcomes.

METHODS

A systematic review was performed by conducting a literature search of definitions, risk factors and predictive models for radiographic KOA progression that utilized data from the OAI database. Radiographic progression was further characterized into "accelerated KOA" and "typical progression," as defined by included studies.

RESULTS

Of 314 studies identified, 41 studies were included in the present review. Twenty-eight (28) studies analyzed risk factors associated with KOA progression, and 13 studies created or validated prediction models or risk calculators for progression. Kellgren-Lawrence (KL) grade based on radiographs was most commonly used to characterize KOA progression (50%), followed by joint space width (JSW) narrowing (32%) generally over 48 months. Risk factors with the highest odds ratios (OR) for progression included periarticular bone mineral density (OR 10.40), any knee injury within 1 year (OR 9.22) and baseline bone mineral lesions (OR 7.92). Nine prediction modeling studies utilized both clinical and structural risk factors to inform their models, and combined models outperformed purely clinical or structural models.

CONCLUSION

The cumulative evidence suggests that combinations of structural and clinical risk factors may be able to predict radiographic KOA progression, particularly in patients with accelerated progression. Clinically relevant and feasible prediction models and risk calculators may provide valuable decision-making support when caring for patients at risk of KOA progression, although standardization in modeling and variable identification does not yet exist.

Prediction Models to Estimate the Future Risk of Osteoarthritis in the General Population: A Systematic Review

OBJECTIVE

To evaluate the performance and applicability of multivariable prediction models for osteoarthritis (OA).

METHODS

This was a systematic review and narrative synthesis using 3 databases (EMBASE, PubMed, and Web of Science) from inception to December 2021. We included general population longitudinal studies reporting derivation, comparison, or validation of multivariable models to predict individual risk of OA incidence, defined by recognized clinical or imaging criteria. We excluded studies reporting prevalent OA and joint arthroplasty outcome. Paired reviewers independently performed article selection, data extraction, and risk-of-bias assessment. Model performance, calibration, and retained predictors were summarized.

RESULTS

A total of 26 studies were included, reporting 31 final multivariable prediction models for incident knee (23), hip (4), hand (3) and any-site OA (1), with a median of 121.5 (range 27-12,803) outcome events, a median prediction horizon of 8 years (range 2-41), and a median of 6 predictors (range 3-24). Age, body mass index, previous injury, and occupational exposures were among the most commonly included predictors. Model discrimination after validation was generally acceptable to excellent (area under the curve = 0.70-0.85). Either internal or external validation processes were used in most models, although the risk of bias was often judged to be high with limited applicability to mass application in diverse populations.

CONCLUSION

Despite growing interest in multivariable prediction models for incident OA, focus remains predominantly on the knee, with reliance on data from a small pool of appropriate cohort data sets, and concerns over general population applicability.

Biochemical, clinical, demographic and imaging biomarkers for disease progression in knee osteoarthritis

Aim: To identify prognostic biomarker(s) for knee osteoarthritis (OA) in the Osteoarthritis Initiative (OAI) cohort. Methods: Multilevel regression was used to determine the association between baseline biomarkers and change in biomarkers from baseline to 24 months with clinical and radiographic OA progression over 48 months of follow-up. Results: Higher values of baseline urinary CTXII were consistently associated with an increased risk of OA disease progression outcomes: Kellgren & Lawrence grade (odds ratio [OR]: 1.15, 95% CI: 1.03-1.28); medial joint space narrowing (OR: 1.06, 95% CI: 1.02-1.10); lateral osteophytes (OR: 1.05, 95% CI: 1.01-1.10); joint space width (regression coefficient: -0.005, 95% CI: -0.008-0.001); and Western Ontario and McMaster Universities Arthritis Index pain scores (OR: 1.02, 95% CI: 1.01-1.04). Changes in serum PIIANP and serum COMP over 24 months were associated with clinical disease progression. Conclusion: Urinary CTXII showed stronger associations with radiographic OA and appears to be a reliable prognostic marker, while changes in other biomarkers were found in early symptomatic OA, supporting the phasic nature of OA.

Early-stage symptomatic osteoarthritis of the knee - time for action

Osteoarthritis (OA) remains the most challenging arthritic disorder, with a high burden of disease and no available disease-modifying treatments. Symptomatic early-stage OA of the knee (the focus of this Review) urgently needs to be identified and defined, as efficient early-stage case finding and diagnosis in primary care would enable health-care providers to proactively and substantially reduce the burden of disease through proper management including structured education, exercise and weight management (when needed) and addressing lifestyle-related risk factors for disease progression. Efforts to define patient populations with symptomatic early-stage knee OA on the basis of validated classification criteria are ongoing. Such criteria, as well as the identification of molecular and imaging biomarkers of disease risk and/or progression, would enable well-designed clinical studies, facilitate interventional trials, and aid the discovery and validation of cellular and molecular targets for novel therapies. Treatment strategies, relevant outcomes and ethical issues also need to be considered in the context of the cost-effective management of symptomatic early-stage knee OA. To move forwards, a multidisciplinary and sustained international effort involving all major stakeholders is required.

Associations Between Periosteal Reaction of Proximal Tibial and Medial Compartment Knee Osteoarthritis

Objective

To evaluate and analyze the potential relationship between periosteal reaction and medial compartment knee osteoarthritis (KOA), and to assess the independent risk factors for the development of periosteal reaction associated with medial compartment KOA.

Methods

This is a retrospective comparative study. From January 2019 to December 2019 at the Third Hospital of Hebei Medical University, a total of 363 patients (726 knees) with medial compartment KOA were enrolled in this study according to our inclusion and exclusion criteria, including 91 males and 272 females, with an mean age of 57.9 ± 12.8 years (range, 18–82 years). Among these patients, 206 patients (412 knees) were allocated to the periosteal reaction group (44 males and 162 females) and 157 patients (314 knees) were allocated to the non‐periosteal reaction group (47 males and 110 females). The classification of KOA severity was based on Kellgren and Lawrence (K‐L) grading system. The malalignment of the lower extremities in coronal plane was evaluated as medial proximal tibial angle (MPTA), hip‐knee‐ankle angle (HKA), and lateral distal femoral angle (LDFA). Patients demographics and radiographic parameters were recorded in the two groups. Intra‐observer and inter‐observer reliabilities of all radiological measurements were analyzed by intraclass correlation coefficients (ICCs). Univariate analyses were conducted for comparison of differences with continuous variables between patients with periosteal reaction and without periosteal reaction. Multivariate logistical regression analysis was performed to determine the independent risk factors of radiographic parameters for periosteal reaction.

Results

The overall incidence of periosteal reaction associated with medial compartment KOA was 56.7%. Furthermore, we observed that the incidence of periosteal reaction significantly increased with age and correlated with K‐L grade progression (P < 0.05). There was a statistically significant difference between the two groups. In the multivariate logistical regression analysis, HKA and JLCA were identified as independent risk factors of the development of periosteal reaction in patients with medial compartment KOA (odds ratio [OR], 0.594; 95% confidence interval [CI] 0.544–0.648; P < 0.05; OR, 0.851; 95% confidence interval CI 0.737–0.983; P < 0.05; respectively), with other radiographic parameters including MTPA (OR 0.959; 95% CI 0.511–0.648; P > 0.05), LDFA (OR 0.990; 95% CI 0.899–1.089; P > 0.05), and JSW (OR 1.005; 95% CI 0.865–1.167; P > 0.05).

Conclusions

In this retrospective study, patients with lower HKA and higher JLCA were identified as independent risk factors for the development of periosteal reaction, which occurred most commonly adjacent to the lateral of proximal tibia diaphysis, and thus we concluded that periosteal reaction may be an anatomical adaptation for medial compartment KOA based upon these results.

Causal Discovery in Radiographic Markers of Knee Osteoarthritis and Prediction for Knee Osteoarthritis Severity With Attention-Long Short-Term Memory

The goal of this study is to build a prognostic model to predict the severity of radiographic knee osteoarthritis (KOA) and to identify long-term disease progression risk factors for early intervention and treatment. We designed a long short-term memory (LSTM) model with an attention mechanism to predict Kellgren/Lawrence (KL) grade for knee osteoarthritis patients. The attention scores reveal a time-associated impact of different variables on KL grades. We also employed a fast causal inference (FCI) algorithm to estimate the causal relation of key variables, which will aid in clinical interpretability. Based on the clinical information of current visits, we accurately predicted the KL grade of the patient's next visits with 90% accuracy. We found that joint space narrowing was a major contributor to KOA progression. Furthermore, our causal structure model indicated that knee alignments may lead to joint space narrowing, while symptoms (swelling, grinding, catching, and limited mobility) have little impact on KOA progression. This study evaluated a broad spectrum of potential risk factors from clinical data, questionnaires, and radiographic markers that are rarely considered in previous studies. Using our statistical model, providers are able to predict the risk of the future progression of KOA, which will provide a basis for selecting proper interventions, such as proceeding to joint arthroplasty for patients. Our causal model suggests that knee alignment should be considered in the primary treatment and KOA progression was independent of clinical symptoms.

Setting up distinctive outcome measures for each osteoarthritis phenotype

Osteoarthritis (OA) is an evolving chronic joint disease with a huge global impact. Given the intricate nature of the etiopathogenesis and subsequent high heterogeneity in the clinical course of OA, it is crucial to discriminate between etiopathogenic endotypes and clinical phenotypes, especially in the early stages of the disease. In this sense, we propose that an OA phenotype should be properly assessed with a set of outcome measures including those specifically related to the main underlying pathophysiological mechanisms. Thus, each OA phenotype can be related to different and clinically meaningful outcomes. OA phenotyping would lead to an adequate patient stratification in well-designed clinical trials and the discovery of precise therapeutic approaches. A significant effort will be required in this field in light of inconclusive results of clinical trials of tissue-targeting agents for the treatment of OA.

Risk factors and the natural history of accelerated knee osteoarthritis: a narrative review

BACKGROUND

Osteoarthritis is generally a slowly progressive disorder. However, at least 1 in 7 people with incident knee osteoarthritis develop an abrupt progression to advanced-stage radiographic disease, many within 12 months. We summarize what is known - primarily based on findings from the Osteoarthritis Initiative - about the risk factors and natural history of accelerated knee osteoarthritis (AKOA) - defined as a transition from no radiographic knee osteoarthritis to advanced-stage disease < 4 years - and put these findings in context with typical osteoarthritis (slowly progressing disease), aging, prior case reports/series, and relevant animal models. Risk factors in the 2 to 4 years before radiographic manifestation of AKOA (onset) include older age, higher body mass index, altered joint alignment, contralateral osteoarthritis, greater pre-radiographic disease burden (structural, symptoms, and function), or low fasting glucose. One to 2 years before AKOA onset people often exhibit rapid articular cartilage loss, larger bone marrow lesions and effusion-synovitis, more meniscal pathology, slower chair-stand or walking pace, and increased global impact of arthritis than adults with typical knee osteoarthritis. Increased joint symptoms predispose a person to new joint trauma, which for someone who develops AKOA is often characterized by a destabilizing meniscal tear (e.g., radial or root tear). One in 7 people with AKOA onset subsequently receive a knee replacement during a 9-year period. The median time from any increase in radiographic severity to knee replacement is only 2.3 years. Despite some similarities, AKOA is different than other rapidly progressive arthropathies and collapsing these phenomena together or extracting results from one type of osteoarthritis to another should be avoided until further research comparing these types of osteoarthritis is conducted. Animal models that induce meniscal damage in the presence of other risk factors or create an incongruent distribution of loading on joints create an accelerated form of osteoarthritis compared to other models and may offer insights into AKOA.

CONCLUSION

Accelerated knee osteoarthritis is unique from typical knee osteoarthritis. The incidence of AKOA in the Osteoarthritis Initiative and Chingford Study is substantial. AKOA needs to be taken into account and studied in epidemiologic studies and clinical trials.

The incidence and characteristics of accelerated knee osteoarthritis among women: the Chingford cohort

Background

Prior research on accelerated knee osteoarthritis (AKOA) was primarily confined to the Osteoarthritis Initiative, which was enriched with people with risk factors for knee osteoarthritis (KOA). It is unclear how often AKOA develops in a community-based cohort and whether we can replicate prior findings from the Osteoarthritis Initiative in another cohort. Hence, we determined the incidence and characteristics of AKOA among women in the Chingford Study, which is a prospective community-based cohort.

Methods

The Chingford Study had 1003 women with quinquennial knee radiographs over 15 years. We divided the 15-year observation period into three consecutive 5-year phases. Within each 5-year phase, we selected 3 groups of participants among women who started a phase without KOA (Kellgren-Lawrence [KL] < 2): 1) incident AKOA developed KL grade ≥ 3, 2) typical KOA increased radiographic scoring (excluding AKOA), and 3) no KOA had the same KL grade over time. Study staff recorded each participant’s age, body mass index (BMI), and blood pressure at baseline, 5-year, and 10-year study visits. We used multinomial logistic regression models to test the association between groups (outcome) and age, BMI, and blood pressure at the start of each phase. The cumulative incidences and odds ratios (OR) from each phase were pooled using a fixed-effect meta-analysis model.

Results

The person-based cumulative incidence of AKOA was 3.9% over 5 years (pooled estimate across the three 5-year phases). Among incident cases of KOA, AKOA represented ~ 15% of women with incident KOA. Women with AKOA were older than those with typical (OR = 1.56, 95%CI = 1.16–2.11) or no KOA (OR = 1.84, 95%CI = 1.40–2.43). Women with AKOA had a greater BMI than those without KOA (OR = 1.52, 95%CI = 1.17–1.97). We observed no association between group and blood pressure.

Conclusions

In a community-based cohort, > 1 in 7 women with incident KOA had AKOA. Like the Osteoarthritis Initiative, people with AKOA were more likely to have greater age and BMI.

Effusion-synovitis and infrapatellar fat pad signal intensity alteration differentiate accelerated knee osteoarthritis

OBJECTIVES

To determine whether greater effusion-synovitis volume and infrapatellar fat pad (IFP) signal intensity alteration differentiate incident accelerated knee OA (KOA) from a gradual onset of KOA or no KOA.

METHODS

We classified three sex-matched groups of participants in the Osteoarthritis Initiative who had a knee with no radiographic KOA at baseline (recruited 2004-06; Kellgren-Lawrence <2; n = 125/group): accelerated KOA: ⩾1 knee progressed to Kellgren-Lawrence grade ⩾3 within 48 months; common KOA: ⩾1 knee increased in radiographic scoring within 48 months; and no KOA: both knees had the same Kellgren-Lawrence grade at baseline and 48 months. The observation period included up to 2 years before and after when the group criteria were met. Two musculoskeletal radiologists reported presence of IFP signal intensity alteration and independent readers used a semi-automated method to segment effusion-synovitis volume. We used generalized linear mixed models with group and time as independent variables, as well as testing a group-by-time interaction.

RESULTS

Starting at 2 years before disease onset, adults who developed accelerated KOA had greater effusion-synovitis volume than their peers (accelerated KOA: 11.94 ± 0.90 cm3, KOA: 8.29 ± 1.19 cm3, no KOA: 8.14 ± 0.90 cm3) and have greater odds of having IFP signal intensity alteration than those with no KOA (odds ratio = 2.07, 95% CI = 1.14-3.78). Starting at 1 year prior to disease onset, those with accelerated KOA have greater than twice the odds of having IFP signal intensity alteration than those with common KOA.

CONCLUSION

People with IFP signal intensity alteration and/or greater effusion-synovitis volume in the absence of radiographic KOA may be at high risk for accelerated KOA, which may be characterized by local inflammation.

Intraarticular injection of bone marrow-derived mesenchymal stem cells enhances regeneration in knee osteoarthritis

PURPOSE

This review aimed to evaluate the efficacy of intra-articular injections of bone marrow derived mesenchymal stem cells (BM-MSCs) for the treatment of knee osteoarthritis (KOA).

METHODS

This narrative review evaluates recent English language clinical data and published research articles between 2014 and 2019. Key word search strings of ((("bone marrow-derived mesenchymal stem cell" OR "bone marrow mesenchymal stromal cell" OR "bone marrow stromal cell")) AND ("osteoarthritis" OR "knee osteoarthritis")) AND ("human" OR "clinical"))) AND "intra-articular injection" were used to identify relevant articles using PMC, Cochrane Library, Web Of Science and Scopus databases.

RESULTS

Pre-clinical studies have demonstrated successful, safe and encouraging results for articular cartilage repair and regeneration. This is concluded to be due to the multilineage differential potential, immunosuppressive and self-renewal capabilities of BM-MSCs, which have shown to augment pain and improve functional outcomes. Subsequently, clinical applications of intra-articular injections of BM-MSCs are steadily increasing, with most studies demonstrating a decrease in poor cartilage index, improvements in pain, function and Quality of Life (QoL); with moderate-to-high level evidence regarding safety for therapeutic administration. However, low confidence in clinical efficacy remains due to a plethora of heterogenous methodologies utilised, resulting in challenging study comparisons. A moderate number of cells (40 × 10⁶) were identified as most likely to achieve optimal responses in individuals with grade ≥ 2 KOA. Likewise, significant improvements were reported when using lower (24 × 10⁶) and higher (100 × 10⁶) cell numbers, although adverse effects including persistent pain and swelling were a consequence.

CONCLUSION

Overall, the benefits of intra-articular injections of BM-MSCs were deemed to outweigh the adverse effects; thus, this treatment be considered as a future therapy strategy. To realise this, long-term large-scale randomised clinical trials are required to enable improved interpretations, to determine the validity of efficacy in future studies.

LEVEL OF EVIDENCE

IV.

Treat-to-target strategy for knee osteoarthritis. International technical expert panel consensus and good clinical practice statements

Background:

In this work, we aimed to establish a clinical target in the management of knee osteoarthritis (KOA) and to propose good clinical practice (GCP) statements for carrying out a treat-to-target strategy.

Methods:

A steering committee of seven experts had formulated a provisional set of recommendations that were exposed for discussion and modification to a technical expert panel (TEP) of 25 multidisciplinary experts from Europe, North America, South America and Asia. The level of evidence and strength of each recommendation was discussed. The TEP formulated overarching principles and GCP statements based on the level of agreement for each item with a vote using a 10-point numerical scale.

Results:

Two overarching principles and 10 GCP statements were formulated by the TEP. These GCP statements suggest: treatment should achieve clinical improvement bringing the patient to the Patient Acceptable Symptom State (PASS); pharmacological and nonpharmacological treatment should begin as early as possible, with an early diagnosis of symptomatic KOA; the patient should be evaluated every 3–6 months; risk factors of KOA progression should be identified and managed with patients at the beginning of the treatment and monitored regularly; treatment should be adapted according to patient phenotype and disease severity; healthy lifestyle must be promoted and monitored. The level of agreement average ranged from 8.7 to 9.6 on scale.

Conclusions:

The proposed overarching principles and GCP statements have the aim of involving patients, general practitioners and multidisciplinary specialists in sharing a therapeutic treat-to-target strategy for KOA management based on the best evidence and expert opinions.

Longitudinal MRI structural findings observed in accelerated knee osteoarthritis: data from the Osteoarthritis Initiative

OBJECTIVE

To analyze structural, longitudinal MRI findings during the development of accelerated knee osteoarthritis (AKOA) over 4 years.

MATERIALS AND METHODS

From the Osteoarthritis Initiative (OAI), knees with no radiographic osteoarthritis (KL 0/1) developing advanced-stage osteoarthritis (KL 3/4; AKOA) within a 4-year (y) timeframe were selected. MRIs were graded using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) at the beginning of the 4-year timeframe (index visit), at 2-year, and 4-year follow-up. Morphological and clinical findings associated with KL 3/4 onset within 2 years compared to 4 years were assessed using generalized estimating equations.

RESULTS

AKOA was found in 162 knees of 149 subjects (age 63.25 ± 8.3; 103 females; BMI 29.4 ± 3.9). Moderate to severe meniscal lesions WORMS ≥ 3 were present in 25% (41/162) at the index visit, 64% (104/162) at 2-year and 93% (151/162) at 4-year follow-up. Meniscal extrusion was the most prevalent finding (ranging from 18% at the index visit, 45% at 2-year and 94% at 4-year follow-up) and root tears were the most common types of tears (9% at the index visit; 22% at 2 years and 38% at 4 years). Risk factors associated with KL 3/4 onset within 2 years included root tears at the index visit (adjusted OR, 2.82; 95% CI: 1.33, 6.00; p = 0.007) and incident knee injury (42%, 49/116 vs. 24%, 11/46, p = 0.032).

CONCLUSIONS

Meniscal abnormalities, in particular extrusion and root tears, were the most prevalent morphological features found in subjects with AKOA. These results suggest that meniscal abnormalities have a significant role in accelerated progression of OA.

Role of Magnetic Resonance Imaging in Classifying Individuals Who Will Develop Accelerated Radiographic Knee Osteoarthritis

We assessed whether adding magnetic resonance (MR)-based features to a base model of clinically accessible participant characteristics (i.e., serological, radiographic, demographic, symptoms, and physical function) improved classification of adults who developed accelerated radiographic knee osteoarthritis (AKOA) or not over the subsequent 4 years. We conducted a case-control study using radiographs from baseline and the first four annual visits of the osteoarthritis initiative to define groups. Eligible individuals had no radiographic KOA in either knee at baseline (Kellgren-Lawrence [KL] grade <2). We classified two groups matched on sex (i) AKOA: at least one knee developed advanced-stage KOA (KL = 3 or 4) within 48 months and (ii) did not develop AKOA within 48 months. The MR-based features were assessments of bone, effusion/synovitis, tendons, ligaments, cartilage, and menisci. All characteristics and MR-based features were from the baseline visit. Classification and regression tree analyses were performed to determine classification rules and identify statistically important variables. The CART models with and without MR features each explained approximately 40% of the variability. Adding MR-based features to the model yielded modest improvements in specificity (0.90 vs. 0.82) but lower sensitivity (0.62 vs. 0.70) than the base model. There was consistent evidence that serum glucose, effusion-synovitis volume, and cruciate ligament degeneration are statistically important variables in classifying individuals who will develop AKOA. We found common MR-based measures failed to dramatically improve classification. These findings also show a complex interplay among participant characteristics and a need to identify novel characteristics to improve classification. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2420-2428, 2019.

Association Between Declining Walking Speed and Increasing Bone Marrow Lesion and Effusion Volume in Individuals with Accelerated Knee Osteoarthritis

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.

Accelerated knee osteoarthritis is associated with pre-radiographic degeneration of the extensor mechanism and cruciate ligaments: data from the Osteoarthritis Initiative

Background

To determine if adults with incident accelerated knee osteoarthritis (KOA) are more likely to have degenerative knee ligaments or tendons compared to individuals with typical or no KOA.

Methods

We identified 3 sex-matched groups among Osteoarthritis Initiative participants who had a knee without radiographic KOA at baseline (Kellgren-Lawrence [KL] < 2): 1) accelerated KOA: at least 1 knee had KL grade ≥ 3 in ≤48 months, 2) typical KOA: at least 1 knee increased in radiographic scoring within 48 months, 3) no KOA: both knees had the same KL grade at baseline and 48 months. We evaluated knee magnetic resonance images up to 2 years before and after a visit when the accelerated or typical KOA criteria were met (index visit). Radiologists reported degenerative signal changes for cruciate and collateral ligaments, and extensor mechanism and proximal gastrocnemius tendons. We used generalized linear mixed models with 2 independent variables: group and time.

Results

Starting at least 2 years before onset, adults with accelerated KOA were twice as likely to have degenerative cruciate ligaments than no KOA (odds ratio = 2.10, 95% CI = 1.18, 3.74). A weaker association (not statistically significant) was detected for adults with accelerated versus typical KOA (OR = 1.72, 95%CI = 0.99, 3.02). Regardless of time, adults with accelerated (odds ratio = 2.13) or typical KOA (odds ratio = 2.16) were twice as likely to have a degenerative extensor mechanism than no KOA. No other structural features were statistically significant.

Conclusions

Degenerative cruciate ligaments or extensor mechanism antedate radiographic onset of accelerated KOA. Hence, knee instability may precede accelerated KOA, which might help identify patients at high-risk for accelerated KOA and novel prevention strategies.

Early pre-radiographic structural pathology precedes the onset of accelerated knee osteoarthritis

BACKGROUND

Accelerated knee osteoarthritis (AKOA) is characterized by more pain, impaired physical function, and greater likelihood to receive a joint replacement compared to individuals who develop the typical gradual onset of disease. Prognostic tools are needed to determine which structural pathologies precede the development of AKOA compared to individuals without AKOA. Therefore, the purpose of this manuscript was to determine which pre-radiographic structural features precede the development of AKOA.

METHODS

The sample comprised participants in the Osteoarthritis Initiative (OAI) who had at least one radiographically normal knee at baseline (Kellgren-Lawrence [KL] grade < 1). Participants were classified into 2 groups based on radiographic progression from baseline to 48 months: AKOA (KL grade change from < 1 to > 3) and No AKOA. The index visit was the study visit when participants met criteria for AKOA or a matched timepoint for those who did not develop AKOA. Magnetic resonance (MR) images were assessed for 12 structural features at the OAI baseline, and 1 and 2 years prior to the index visit. Separate logistic regression models (i.e. OAI baseline, 1 and 2 years prior) were used to determine which pre-radiographic structural features were more likely to antedate the development of AKOA compared to individuals not developing AKOA.

RESULTS

At the OAI baseline visit, degenerative cruciate ligaments (Odds Ratio [OR] = 2.2, 95% Confidence Interval [CI] = 1.3,3.5), infrapatellar fat pad signal intensity alteration (OR = 2.0, 95%CI = 1.2,3.2), medial/lateral meniscal pathology (OR = 2.1/2.4, 95%CI = 1.3,3.4/1.5,3.8), and greater quantitative knee effusion-synovitis (OR = 2.2, 95%CI = 1.4,3.4) were more likely to antedate the development of AKOA when compared to those that did not develop AKOA. These results were similar at one and two years prior to disease onset. Additionally, medial meniscus extrusion at one year prior to disease onset (OR = 3.5, 95%CI = 2.1,6.0) increased the likelihood of developing AKOA.

CONCLUSIONS

Early ligamentous degeneration, effusion/synovitis, and meniscal pathology precede the onset of AKOA and may be prognostic biomarkers.

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

OBJECTIVE

To determine whether accelerated knee osteoarthritis (KOA) is preceded by, and characterized over time by, destabilizing meniscal tears or other pathologic changes.

METHODS

We selected 3 sex-matched groups of subjects from the first 48 months of the Osteoarthritis Initiative, comprising adults who had a knee without KOA (Kellgren/Lawrence [K/L] radiographic grade <2) at baseline. Subjects in the accelerated KOA group developed KOA of K/L grade ≥3, those with typical KOA showed increased K/L radiographic scores, and those with no KOA had the same K/L grade over time. An index visit was the visit when the radiographic criteria for accelerated KOA and typical KOA were met (the no KOA group was matched to the accelerated KOA group). The observation period was up to 2 years before and after an index visit. Radiologists reviewed magnetic resonance (MR) images of the index knee and identified destabilizing meniscal tears (root tears, radial tears, complex tears), miscellaneous pathologic features (acute ligamentous or tendinous injuries, attrition, subchondral insufficiency fractures, other incidental findings), and meniscal damage in >2 of 6 regions (3 regions per meniscus: anterior horn, body, posterior horn). In addition, bone marrow lesions (BMLs) and cartilage damage on MR images were quantified. Linear mixed regression models were performed to analyze the results.

RESULTS

At 1 year before the index visit, >75% of adults with accelerated KOA had meniscal damage in ≥2 regions (odds ratio 3.19 [95% confidence interval 1.70-5.97] versus adults with typical KOA). By the index visit, meniscal damage in ≥2 regions was ubiquitous in adults with accelerated KOA, including 42% of subjects having evidence of a destabilizing meniscal tear (versus 14% of subjects with typical KOA). These changes corresponded to findings of larger BMLs and greater cartilage loss in the accelerated KOA group.

CONCLUSION

Accelerated KOA is characterized by destabilizing meniscal tears in a knee compromised by meniscal damage in >2 regions, and also characterized by the presence of large BMLs and greater cartilage loss.

Inflammation and glucose homeostasis are associated with specific structural features among adults without knee osteoarthritis: a cross-sectional study from the osteoarthritis initiative

Background

Greater age and body mass index are strong risk factors for osteoarthritis (OA). Older and overweight individuals may be more susceptible to OA because these factors alter tissue turnover in menisci, articular cartilage, and bone via altered glucose homeostasis and inflammation. Understanding the role of inflammation and glucose homeostasis on structural features of early-stage OA may help identify therapeutic targets to delay or prevent the onset of OA among subsets of adults with these features. We examined if serum concentrations of glucose homeostasis (glucose, glycated serum protein [GSP]) or inflammation (C-reactive protein [CRP]) were associated with prevalent knee bone marrow lesions (BMLs) or effusion among adults without knee OA.

Methods

We conducted a cross-sectional study using baseline data from the Osteoarthritis Initiative. We selected participants who had no radiographic knee OA but were at high risk for knee OA. Blinded staff conducted assays for CRP, GSP, and glucose. Readers segmented BML volume and effusion using semi-automated programs. Our outcomes were prevalent BML (knee with a BML volume > 1 cm³) and effusion (knee with an effusion volume > 7.5 cm³). We used logistic regression models with CRP, GSP, or glucose concentrations as the predictors. We adjusted for age, sex, body mass index (BMI), and Physical Activity Scale for the Elderly (PASE) scores.

Results

We included 343 participants: mean age = 59 ± 9 years, BMI = 27.9 ± 4.5 kg/m², PASE score = 171 ± 82, and 64% female. Only CRP was associated with BML prevalence (odds ratio [OR] = 1.43, 95% confidence interval [CI] = 1.09 to 1.87). For effusion, we found an interaction between BMI and CRP: only among adults with a BMI <25 kg/m² was there a significant trend towards a positive association between CRP and effusion (OR = 1.40, 95% CI = 1.00 to 1.97). We detected a U-shaped relationship between GSP and effusion prevalence. Fasting glucose levels were not significantly associated with the presence of baseline effusion or BML.

Conclusions

Among individuals without knee OA, CRP may be related to the presence of BMLs and effusion among normal weight individuals. Abnormal GSP may be associated with effusion. Future studies should explore whether inflammation and glucose homeostasis are predictive of symptomatic knee OA.