1
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Ge L, Zhang X, Zhu R, Cai G. Bone marrow lesions in osteoarthritis: biomarker or treatment target? A narrative review. Skeletal Radiol 2024:10.1007/s00256-024-04725-0. [PMID: 38877110 DOI: 10.1007/s00256-024-04725-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Abstract
Osteoarthritis (OA) is a leading cause of pain, functional impairment, and disability in older adults. However, there are no effective treatments to delay and reverse OA. Magnetic resonance imaging (MRI) can assess structural abnormalities of OA by directly visualizing damage and inflammatory reactions within the tissues and detecting abnormal signals in the subchondral bone marrow region. While some studies have shown that bone marrow lesions (BMLs) are one of the early signs of the development of OA and predict structural and symptomatic progression of OA, others claimed that BMLs are prevalent in the general population and have no role in the progression of OA. In this narrative review, we screened and summarized studies with different designs that evaluated the association of BMLs with joint symptoms and structural abnormalities of OA. We also discussed whether BMLs may serve as an imaging biomarker and a treatment target for OA based on existing clinical trials.
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Affiliation(s)
- Liru Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xiaoyue Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Rui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
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2
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Maksymowych WP, Jaremko JL, Pedersen SJ, Eshed I, Weber U, McReynolds A, Bird P, Wichuk S, Lambert RG. Comparative validation of the knee inflammation MRI scoring system and the MRI osteoarthritis knee score for semi-quantitative assessment of bone marrow lesions and synovitis-effusion in osteoarthritis: an international multi-reader exercise. Ther Adv Musculoskelet Dis 2023; 15:1759720X231171766. [PMID: 37457557 PMCID: PMC10345937 DOI: 10.1177/1759720x231171766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/05/2023] [Indexed: 07/18/2023] Open
Abstract
Background Bone marrow lesions (BMLs) and synovitis on magnetic resonance imaging (MRI) are associated with symptoms and predict degeneration of articular cartilage in osteoarthritis (OA). Validated methods for their semiquantitative assessment on MRI are available, but they all have similar scoring designs and questionable sensitivity to change. New scoring methods with completely different designs need to be developed and compared to existing methods. Objectives To compare the performance of new web-based versions of the Knee Inflammation MRI Scoring System (KIMRISS) with the MRI OA Knee Score (MOAKS) for quantification of BMLs and synovitis-effusion (S-E). Design Retrospective follow-up cohort. Methods We designed web-based overlays outlining regions in the knee that are scored for BML in MOAKS and KIMRISS. For KIMRISS, both BML and S-E are scored on consecutive sagittal slices. The performance of these methods was compared in an international reading exercise of 8 readers evaluating 60 pairs of scans conducted 1 year apart from cases recruited to the OA Initiative (OAI) cohort. Interobserver reliability for baseline status and baseline to 1 year change in BML and S-E was assessed by intra-class correlation coefficient (ICC) and smallest detectable change (SDC). Feasibility was assessed using the System Usability Scale (SUS). Results Mean change in BML and S-E was minimal over 1 year. Pre-specified targets for acceptable reliability (ICC ⩾ 0.80 and ⩾ 0.70 for status and change scores, respectively) were achieved more frequently for KIMRISS for both BML and synovitis. Mean (95% CI) ICC for change in BML was 0.88 (0.83-0.92) and 0.69 (0.60-0.78) for KIMRISS and MOAKS, respectively. KIMRISS mean SUS usability score was 85.7 and at the 95th centile of ranking for usability versus a score of 55.4 and 20th centile for MOAKS. Conclusion KIMRISS had superior performance metrics to MOAKS for quantification of BML and S-E. Both methods should be further compared in trials of new therapies for OA.
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Affiliation(s)
| | - Jacob L. Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
| | - Susanne J. Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Iris Eshed
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | - Andrew McReynolds
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton, AB, Canada
| | - Paul Bird
- Division of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Stephanie Wichuk
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Robert G. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
- Medical Imaging Consultants, Edmonton, AB, Canada
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3
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Hansen RT, Chenu C, Sofat N, Pitsillides AA. Bone marrow lesions: plugging the holes in our knowledge using animal models. Nat Rev Rheumatol 2023; 19:429-445. [PMID: 37225964 DOI: 10.1038/s41584-023-00971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/26/2023]
Abstract
Bone marrow lesions (BMLs), which are early signs of osteoarthritis (OA) that are associated with the presence, onset and severity of pain, represent an emerging imaging biomarker and clinical target. Little is known, however, regarding their early spatial and temporal development, structural relationships or aetiopathogenesis, because of the sparsity of human early OA imaging and paucity of relevant tissue samples. The use of animal models is a logical approach to fill the gaps in our knowledge, and it can be informed by appraising models in which BMLs and closely related subchondral cysts have already been reported, including in spontaneous OA and pain models. The utility of these models in OA research, their relevance to clinical BMLs and practical considerations for their optimal deployment can also inform medical and veterinary clinicians and researchers alike.
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Affiliation(s)
- Rebecca T Hansen
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Chantal Chenu
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, London, UK
| | - Nidhi Sofat
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Department of Rheumatology, St George's, University Hospitals NHS Foundation Trust, London, UK
| | - Andrew A Pitsillides
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, London, UK.
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4
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Martel-Pelletier J, Paiement P, Pelletier JP. Magnetic resonance imaging assessments for knee segmentation and their use in combination with machine/deep learning as predictors of early osteoarthritis diagnosis and prognosis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231165560. [PMID: 37151912 PMCID: PMC10155034 DOI: 10.1177/1759720x231165560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/23/2023] [Indexed: 05/09/2023] Open
Abstract
Knee osteoarthritis (OA) is a prevalent and disabling disease that can develop over decades. This disease is heterogeneous and involves structural changes in the whole joint, encompassing multiple tissue types. Detecting OA before the onset of irreversible changes is crucial for early management, and this could be achieved by allowing knee tissue visualization and quantifying their changes over time. Although some imaging modalities are available for knee structure assessment, magnetic resonance imaging (MRI) is preferred. This narrative review looks at existing literature, first on MRI-developed approaches for evaluating knee articular tissues, and second on prediction using machine/deep-learning-based methodologies and MRI as input or outcome for early OA diagnosis and prognosis. A substantial number of MRI methodologies have been developed to assess several knee tissues in a semi-quantitative and quantitative fashion using manual, semi-automated and fully automated systems. This dynamic field has grown substantially since the advent of machine/deep learning. Another active area is predictive modelling using machine/deep-learning methodologies enabling robust early OA diagnosis/prognosis. Moreover, incorporating MRI markers as input/outcome in such predictive models is important for a more accurate OA structural diagnosis/prognosis. The main limitation of their usage is the ability to move them in rheumatology practice. In conclusion, MRI knee tissue determination and quantification provide early indicators for individuals at high risk of developing this disease or for patient prognosis. Such assessment of knee tissues, combined with the development of models/tools from machine/deep learning using, in addition to other parameters, MRI markers for early diagnosis/prognosis, will maximize opportunities for individualized risk assessment for use in clinical practice permitting precision medicine. Future efforts should be made to integrate such prediction models into open access, allowing early disease management to prevent or delay the OA outcome.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412B,
Montreal, QC H2X 0A9, Canada
| | - Patrice Paiement
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of
Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
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5
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Walsh DA, Sofat N, Guermazi A, Hunter DJ. Osteoarthritis Bone Marrow Lesions. Osteoarthritis Cartilage 2023; 31:11-17. [PMID: 36191832 DOI: 10.1016/j.joca.2022.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
Assessment and treatment of Bone Marrow Lesions (BMLs) could ultimately make step changes to the lives of people with osteoarthritis (OA). We here review the imaging and pathological characteristics of OA-BMLs, their differential diagnosis and measurement, and cross-sectional and longitudinal associations with pain and OA structural progression. We discuss how biomechanical and cellular factors may contribute to BML pathogenesis, and how pharmacological and non-pharmacological interventions that target BMLs might reduce pain and OA structural progression. We critically appraise semiquantitative and quantitative methods for assessing BMLs, and their potential utilities for identifying people at risk of symptomatic and structural OA progression, and evaluating treatment responses. New interventions that target OA-BMLs should both confirm their importance, and reduce the unacceptable burden of OA.
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Affiliation(s)
- D A Walsh
- Professor of Rheumatology, Pain Centre Versus Arthritis, NIHR Nottingham Biomedical Research Centre, Academic Rheumatology, Division of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham, NG5 1PB, United Kingdom; Consultant Rheumatologist, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, United Kingdom.
| | - N Sofat
- Professor of Rheumatology, Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, SW17 ORE, United Kingdom; Consultant Rheumatologist, St George's University Hospitals NHS Trust, London, SW17 OPQ, United Kingdom.
| | - A Guermazi
- Professor of Radiology, Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States.
| | - D J Hunter
- Professor of Medicine, Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
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6
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Jena A, Goyal N, Rana P, Taneja S, Vaish A, Botchu R, Vaishya R. Differential 18F-NaF uptake in various compartments in knee osteoarthritis: an observational study using PET/MRI. Clin Radiol 2022; 77:613-620. [PMID: 35589431 DOI: 10.1016/j.crad.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
Abstract
AIM To investigate if the pattern of fluorine-18-labelled sodium fluoride (18F-NaF) uptake on integrated positron-emission tomography (PET)/magnetic resonance imaging (MRI) of bone marrow lesions (BML) and osteophytes differs between different knee compartments. MATERIALS AND METHODS Sixteen patients with no prior history of knee injury with or without pain were recruited for the study. The images of both knees were acquired on simultaneous PET/MRI. The acquisition was done after 45 minutes of intravenous injection of 18F-NaF 185-370 MBq (5-10 mCi) for 40 minutes. Each knee was divided into eight compartments patella, trochlea, medial central femur, lateral central femur, medial posterior femur, lateral posterior femur, medial tibia, lateral tibia, and cruciate ligament insertion specifically for BML. BML and osteophytes were scored using MRI Osteoarthritis Knee Score (MOAKS) criteria and their corresponding maximum standardised uptake values (SUVmax) recorded. RESULTS BML and osteophytes both showed statistically significant differences among knee compartments, i.e., p-value <0.000 and < 0.043 respectively. SUVmax for BML and osteophytes was greatest in the medial tibia. CONCLUSION 18F-NaF PET/MRI showed that BML and osteophytes had differential uptake values due to bone remodelling amongst the various knee compartments and this may help to design disease-modifying osteoarthritis drugs in the future.
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Affiliation(s)
- A Jena
- PET Suite (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - N Goyal
- Department of Radiodiagnosis and Imaging, Indraprastha Apollo Hospitals, New Delhi, India
| | - P Rana
- PET Suite (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India; Apollo Hospitals Education & Research Foundation, Indraprastha Apollo Hospitals, New Delhi, India
| | - S Taneja
- PET Suite (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - A Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - R Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK.
| | - R Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
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7
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Common Biochemical and Magnetic Resonance Imaging Biomarkers of Early Knee Osteoarthritis and of Exercise/Training in Athletes: A Narrative Review. Diagnostics (Basel) 2021; 11:diagnostics11081488. [PMID: 34441422 PMCID: PMC8391340 DOI: 10.3390/diagnostics11081488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis (OA) is the most common joint disease of the world population. Although considered a disease of old age, OA also affects young individuals and, more specifically among them, those practicing knee-joint-loading sports. Predicting OA at an early stage is crucial but remains a challenge. Biomarkers that can predict early OA development will help in the design of specific therapeutic strategies for individuals and, for athletes, to avoid adverse outcomes due to exercising/training regimens. This review summarizes and compares the current knowledge of fluid and magnetic resonance imaging (MRI) biomarkers common to early knee OA and exercise/training in athletes. A variety of fluid biochemical markers have been proposed to detect knee OA at an early stage; however, few have shown similar behavior between the two studied groups. Moreover, in endurance athletes, they are often contingent on the sport involved. MRI has also demonstrated its ability for early detection of joint structural alterations in both groups. It is currently suggested that for optimal forecasting of early knee structural alterations, both fluid and MRI biomarkers should be analyzed as a panel and/or combined, rather than individually.
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8
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Cai G, Aitken D, Laslett LL, Hill C, Wluka AE, March L, Cicuttini F, Pelletier JP, Martel-Pelletier J, Jones G. The association between change in bone marrow lesion size and change in tibiofemoral cartilage volume and knee symptoms. Rheumatology (Oxford) 2021; 60:2791-2800. [PMID: 33253381 DOI: 10.1093/rheumatology/keaa716] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/26/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To describe the association between change in subchondral bone marrow lesions (BMLs) and change in tibiofemoral cartilage volume and knee symptoms in patients with symptomatic knee OA. METHODS In total, 251 participants (mean 61.7 years, 51% female) were included. Tibiofemoral cartilage volume was measured at baseline and 24 months, and BML size at baseline, 6 and 24 months. Knee pain and function scores were evaluated at baseline, 6 and 24 months. Change in total and compartment-specific BML size was categorized according to the Least Significance Criterion. Linear mixed-effects models were used to evaluate the associations of change in BMLs over 6 and 24 months with change in cartilage volume over 24 months and knee symptoms over 6 and 24 months. RESULTS Total BML size enlarged in 26% of participants, regressed in 31% and remained stable in 43% over 24 months. Compared with stable BMLs in the same compartment, enlarging BMLs over 24 months were associated with greater cartilage loss (difference: -53.0mm3, 95% CI: -100.0, -6.0), and regressing BMLs were not significantly associated with reduced cartilage loss (difference: 32.4mm3, 95% CI: -8.6, 73.3) over 24 months. Neither enlargement nor regression of total BML size over 6 and 24 months was associated with change in knee pain and function over the same time intervals. CONCLUSIONS In subjects with symptomatic knee osteoarthritis and BMLs, enlarging BMLs may lead to greater cartilage loss but regressing lesions are not associated with reduced cartilage loss while neither is associated with change in knee symptoms.
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Affiliation(s)
- Guoqi Cai
- Department of Endocrinology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China.,Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
| | - Laura L Laslett
- Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
| | - Catherine Hill
- Department of Rheumatology, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia
| | - Lyn March
- Institute of Bone and Joint Research, The University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, TAS, Hobart, Australia
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9
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Maksymowych WP, McReynolds A, Pedersen SJ, Weber U, Paschke J, Wichuk S, Jaremko JL, Lambert RG. The OMERACT Knee Inflammation MRI Scoring System: Validation of quantitative methodologies and tri-compartmental overlays in osteoarthritis. Semin Arthritis Rheum 2021; 51:925-928. [PMID: 34167825 DOI: 10.1016/j.semarthrit.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To validate a revised version of the KIMRISS method for quantification of BML and synovitis-effusion in the knee by comparison with an established method, MOAKS. METHODS Novel calibration tools were developed for both methods. We compared reliability for status and change scores of BML and synovitis-effusion on baseline and one-year MRI scans. RESULTS Significant increase in both BML and synovitis-effusion was evident using KIMRISS but only for synovitis-effusion using MOAKS. Pre-specified targets for acceptable reliability (≥0.80 and ≥0.70 for status and change scores, respectively) were achieved more frequently for KIMRISS for both BML and synovitis. CONCLUSION Per OFISA criteria, KIMRISS should progress to assessment of discrimination.
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Affiliation(s)
- Walter P Maksymowych
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton T6G 2G3, Alberta, Canada; CARE Arthritis, CARE Arthritis Ltd. 316 Windermere Road NW Unit 210, Edmonton T6W 2Z8, Alberta, Canada.
| | - Andrew McReynolds
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WC Mackenzie Health Sciences Centre, 8440 112 Street NW, T6G 2B7, Medical Imaging Consultants, 202-11010 - 101 Street NW, T5H 4B9, Edmonton, Alberta, Canada
| | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Valdemar Hansen Vej 17, 2600 Glostrup, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | | | - Joel Paschke
- CARE Arthritis, CARE Arthritis Ltd. 316 Windermere Road NW Unit 210, Edmonton T6W 2Z8, Alberta, Canada
| | - Stephanie Wichuk
- Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton T6G 2G3, Alberta, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WC Mackenzie Health Sciences Centre, 8440 112 Street NW, T6G 2B7, Medical Imaging Consultants, 202-11010 - 101 Street NW, T5H 4B9, Edmonton, Alberta, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 2A2.41 WC Mackenzie Health Sciences Centre, 8440 112 Street NW, T6G 2B7, Medical Imaging Consultants, 202-11010 - 101 Street NW, T5H 4B9, Edmonton, Alberta, Canada
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10
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Aso K, Shahtaheri SM, McWilliams DF, Walsh DA. Association of subchondral bone marrow lesion localization with weight-bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative. Arthritis Res Ther 2021; 23:35. [PMID: 33468243 PMCID: PMC7816469 DOI: 10.1186/s13075-021-02422-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Subchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA. Methods We analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analyzed with the MRI Osteoarthritis Knee Score for 4 subchondral regions (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline and changes in the BML scores and changes in pain after 24-month follow-up. Results Greater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex, and body mass index (BMI) (medial femorotibial; B = 0.08, p = 0.02. patellofemoral; B = 0.13, p = 0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B = 0.11, p = 0.01, and B = 0.10, p = 0.04, respectively). Lateral patellofemoral BML scores were associated with pain on climbing, respectively (B = 0.14, p = 0.02). Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B = 0.10, p = 0.01). Conclusions Subchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically induced OA pain. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02422-0.
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Affiliation(s)
- Koji Aso
- Pain Centre Versus Arthritis & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, UK. .,Department of Orthopedic Surgery, Kochi Medical School, Kochi University, 185-1 Oko-cho Kohasu, Nankoku, 783-8505, Japan.
| | - Seyed Mohsen Shahtaheri
- Pain Centre Versus Arthritis & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, UK
| | - Daniel F McWilliams
- Pain Centre Versus Arthritis & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, UK
| | - David A Walsh
- Pain Centre Versus Arthritis & NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, UK
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11
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Tu G, Qin Z, Huo D, Zhang S, Yan A. Fingerprint-based computational models of 5-lipo-oxygenase activating protein inhibitors: Activity prediction and structure clustering. Chem Biol Drug Des 2020; 96:931-947. [PMID: 33058463 DOI: 10.1111/cbdd.13657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/04/2019] [Accepted: 12/17/2019] [Indexed: 01/24/2023]
Abstract
Inflammatory diseases can be treated by inhibiting 5-lipo-oxygenase activating protein (FLAP). In this study, a data set containing 2,112 FLAP inhibitors was collected. A total of 25 classification models were built by five machine learning algorithms with five different types of fingerprints. The best model, which was built by support vector machine algorithm with ECFP_4 fingerprint had an accuracy and a Matthews correlation coefficient of 0.862 and 0.722 on the test set, respectively. The predicted results were further evaluated by the application domain dSTD-PRO (a distance between one compound to models). Each compound had a dSTD-PRO value, which was calculated by the predicted probabilities obtained from all 25 models. The application domain results suggested that the reliability of predicted results depended mainly on the compounds themselves rather than algorithms or fingerprints. A group of customized 10-bit fingerprint was manually defined for clustering the molecular structures of 2,112 FLAP inhibitors into eight subsets by K-Means. According to the clustering results, most of inhibitors in two subsets (subsets 2 and 4) were highly active inhibitors. We found that aryl oxadiazole/oxazole alkanes, biaryl amino-heteroarenes, two aromatic rings (often N-containing) linked by a cyclobutene group, and 1,2,4-triazole group were typical fragments in highly active inhibitors.
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Affiliation(s)
- Guiping Tu
- State Key Laboratory of Chemical Resource Engineering, Department of Pharmaceutical Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Zijian Qin
- State Key Laboratory of Chemical Resource Engineering, Department of Pharmaceutical Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Donghui Huo
- State Key Laboratory of Chemical Resource Engineering, Department of Pharmaceutical Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Shengde Zhang
- State Key Laboratory of Chemical Resource Engineering, Department of Pharmaceutical Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Aixia Yan
- State Key Laboratory of Chemical Resource Engineering, Department of Pharmaceutical Engineering, Beijing University of Chemical Technology, Beijing, China
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12
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Castellanos R, Tighe S. Injectable Amniotic Membrane/Umbilical Cord Particulate for Knee Osteoarthritis: A Prospective, Single-Center Pilot Study. PAIN MEDICINE 2020; 20:2283-2291. [PMID: 31418794 PMCID: PMC6830267 DOI: 10.1093/pm/pnz143] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the short-term safety and effectiveness of amniotic membrane/umbilical cord particulate (AMUC) in managing pain in patients with various severities of knee osteoarthritis (OA). DESIGN Single-center, prospective, investigator-initiated pilot study. SETTING Private practice. SUBJECTS A total of 20 knee OA patients aged ≥18 years were enrolled with pain >40 mm, as determined by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-A. METHODS Patients received an ultrasound-guided, intra-articular injection of 50 mg of AMUC particulate reconstituted in 2 mL of preservative-free saline. All patients were then monitored at six weeks, 12 weeks, and 24 weeks postinjection. Patients who did not show >30% reduction in pain received a second injection of AMUC at six weeks. WOMAC, Patient Global Assessment, medication usage, and magnetic resonance imaging (MRI) were assessed. RESULTS Knee OA pain significantly decreased from 74.3 ± 17.2 at baseline to 45.0 ± 25.4 at six weeks (P < 0.01), 35.4 ± 26.6 at 12 weeks (P < 0.001), and 37.4 ± 26.7 at 24 weeks (P < 0.001). This pain reduction was associated with a significant improvement in physical function (WOMAC-C) at all time points (P < 0.05) and stiffness (WOMAC-B) at 12 weeks (P = 0.01). Eleven patients received a second injection, which was significantly correlated with body mass index >30 kg/m2 (P = 0.025). MRI evaluation of the overall population revealed an improvement in the severity of bone marrow lesions in seven patients. No adverse events were observed. CONCLUSIONS AMUC particulate injection relieved pain and improved physical function in patients with symptomatic knee OA.
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Affiliation(s)
| | - Sean Tighe
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.,TissueTech, Miami, Florida, USA
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13
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Oo WM, Yu SPC, Daniel MS, Hunter DJ. Disease-modifying drugs in osteoarthritis: current understanding and future therapeutics. Expert Opin Emerg Drugs 2018; 23:331-347. [PMID: 30415584 DOI: 10.1080/14728214.2018.1547706] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) is a leading cause of pain and disability among adults with a current prevalence of around 15% and a predicted prevalence of 35% in 2030 for symptomatic OA. It is increasingly recognized as a heterogeneous multi-faceted joint disease with multi-tissue involvement of varying severity. Current therapeutic regimens for OA are only partially effective and often have significant associated toxicities. There are no disease-modifying drugs approved by the regulatory bodies. Areas covered: We reviewed the opportunities within key OA pathogenetic mechanism: cartilage catabolism/anabolism, pathological remodeling of subchondral bone and synovial inflammation to identify targeted disease-modifying osteoarthritis drugs, based on compounds currently in Phase II and III stages of clinical development in which x-ray and/or MRI was used as the structural outcome with/without symptomatic outcomes according to regulatory requirements. Expert opinion: Given the heterogeneity of the OA disease process and complex overlapping among these phenotypes, a 'one size fits all' approach used in most clinical trials would unlikely be practical and equally effective in all patients, as well as in all anatomical OA sites. On the other hand, it is a challenge to develop a targeted drug with high activity, specificity, potency, and bioavailability in the absence of toxicity for long-term use in this chronic disease of predominantly older adults. Further research and insight into evaluation methods for drug-targeted identification of early OA and specific characterization of phenotypes, improvement of methodological designs, and development/refinement of sensitive imaging and biomarkers will help pave the way to the successful discovery of disease-modifying drugs and the optimal administration strategies in clinical practice.
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Affiliation(s)
- Win Min Oo
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - Shirley Pei-Chun Yu
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - Matthew Sean Daniel
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - David John Hunter
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
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Association of childhood adiposity measures with adulthood knee cartilage defects and bone marrow lesions: a 25-year cohort study. Osteoarthritis Cartilage 2018; 26:1055-1062. [PMID: 29775733 DOI: 10.1016/j.joca.2018.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/04/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the associations between childhood adiposity measures and adulthood knee cartilage defects and bone marrow lesions (BMLs) measured 25 years later. METHODS 327 participants from the Australian Schools Health and Fitness Survey (ASHFS) of 1985 (aged 7-15 years) were followed up 25 years later (aged 31-41 years). Childhood measures (weight, height and skinfolds) were collected in 1985. Body mass index (BMI), overweight status and fat mass were calculated. Participants underwent 1.5 T knee magnetic resonance imaging (MRI) during 2008-2010, and cartilage defects and BMLs were scored from knee MRI scans. Log binomial regressions were used to examine the associations. RESULTS Among 327 participants (47.1% females), 21 (6.4%) were overweight in childhood. Childhood adiposity measures were associated with the increased risk of adulthood patellar cartilage defects (Weight relative risk (RR) 1.05/kg, 95% confidence interval (CI) 1.01-1.09; BMI 1.10/kg/m2, 1.01-1.19; Overweight 2.22/yes, 1.21-4.08; fat mass 1.11/kg, 1.01-1.22), but not tibiofemoral cartilage defects. Childhood adiposity measures were not significantly associated with adulthood knee BMLs except for the association between childhood overweight status and adulthood patellar BMLs (RR 2.87/yes, 95% CI 1.10-7.53). These significant associations persisted after adjustment for corresponding adulthood adiposity measure. CONCLUSION Childhood adiposity measures were associated with the increased risk of adulthood patellar cartilage defects and, to a lesser extent, BMLs, independent of adulthood adiposity measures. These results suggest that adiposity in childhood has long-term effects on patellar structural abnormalities in young adults.
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15
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Mattap SM, Aitken D, Wills K, Laslett L, Ding C, Pelletier JP, Martel-Pelletier J, Graves SE, Lorimer M, Cicuttini F, Jones G. How Do MRI-Detected Subchondral Bone Marrow Lesions (BMLs) on Two Different MRI Sequences Correlate with Clinically Important Outcomes? Calcif Tissue Int 2018; 103:131-143. [PMID: 29441423 DOI: 10.1007/s00223-018-0402-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/05/2018] [Indexed: 01/30/2023]
Abstract
The aim of this study is to describe the association of bone marrow lesions (BMLs) present on two different MRI sequences with clinical outcomes, cartilage defect progression, cartilage volume loss over 2.7 years, and total knee replacement (TKR) over 13.3 years. 394 participants (50-80 years) were assessed at baseline and 2.7 years. BML presence at baseline was scored on T1-weighted fat-suppressed 3D gradient-recalled acquisition (T1) and T2-weighted fat-suppressed 2D fast spin-echo (T2) sequences. Knee pain, function, and stiffness were assessed using WOMAC. Cartilage volume and defects were assessed using validated methods. Incident TKR was determined by data linkage. BMLs were mostly present on both MRI sequences (86%). BMLs present on T2, T1, and both sequences were associated with greater knee pain and functional limitation (odds ratio = 1.49 to 1.70; all p < 0.05). Longitudinally, BMLs present on T2, T1, and both sequences were associated with worsening knee pain (β = 1.12 to 1.37, respectively; p < 0.05) and worsening stiffness (β = 0.45 to 0.52, respectively; all p < 0.05) but not worsening functional limitation or total WOMAC. BMLs present on T2, T1, and both sequences predicted site-specific cartilage defect progression (relative risk = 1.22 to 4.63; all p < 0.05) except at the medial tibial and inferior patellar sites. Lateral tibial and superior patellar BMLs present on T2, T1, and both sequences predicted site-specific cartilage volume loss (β = - 174.77 to - 140.67; p < 0.05). BMLs present on T2, T1, and both sequences were strongly associated with incident TKR. BMLs can be assessed on either T2- or T1-weighted sequences with no clinical predictive advantage of either sequence.
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Affiliation(s)
- Siti Maisarah Mattap
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Laura Laslett
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
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Kaukinen P, Podlipská J, Guermazi A, Niinimäki J, Lehenkari P, Roemer FW, Nieminen MT, Koski JM, Saarakkala S, Arokoski JPA. Magnetic resonance imaging (MRI)-defined cartilage degeneration and joint pain are associated with poor physical function in knee osteoarthritis - the Oulu Knee Osteoarthritis study. Osteoarthritis Cartilage 2017; 25:1829-1840. [PMID: 28698105 DOI: 10.1016/j.joca.2017.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/14/2017] [Accepted: 07/01/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The main aim was to investigate the associations between Magnetic Resonance Imaging (MRI)-defined structural pathologies of the knee and physical function. DESIGN A cohort study with frequency matching on age and sex with eighty symptomatic subjects with knee pain and suspicion or diagnosis of knee osteoarthritis (OA) and 57 asymptomatic subjects was conducted. The subjects underwent knee MRI, and the severity of structural changes was graded by MRI Osteoarthritis Knee Score (MOAKS) in separate knee locations. WOMAC function subscores were recorded and physical function tests (20-m and 5-min walk, stair ascending and descending, timed up & go and repeated sit-to-stand tests) performed. The association between MRI-defined structural pathologies and physical function tests and WOMAC function subscores were evaluated by linear regression analysis with adjustment for demographic factors, other MRI-features and pain with using effect size (ES) as a measure of the magnitude of an association. RESULTS Cartilage degeneration showed significant association with poor physical performance in TUG-, stair ascending and descending-, 20-m- and 5-min walk-tests (ESs in the subjects with cartilage degeneration anywhere between 0.134 [95%CI 0.037-0.238] and 0.224 [0.013-0.335]) and with increased WOMAC function subscore (ES in the subjects with cartilage degeneration anywhere 0.088 [0.012-0.103]). Also, lateral meniscus maceration and extrusion were associated with poor performance in stair ascending test (ESs 0.067 [0.008-0.163] and 0.077 [0.012-0.177]). CONCLUSIONS After adjustments cartilage degeneration was associated with both decreased self-reported physical function and poor performance in the physical function tests. Furthermore, subjects with lateral meniscus maceration and extrusions showed significantly worse performance in stair ascending tests.
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Affiliation(s)
- P Kaukinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.
| | - J Podlipská
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - J Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - P Lehenkari
- Department of Anatomy, University of Oulu, Oulu, Finland; Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland.
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Finland.
| | - J M Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Finland.
| | - J P A Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland.
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Sayre EC, Guermazi A, Esdaile JM, Kopec JA, Singer J, Thorne A, Nicolaou S, Cibere J. Associations between MRI features versus knee pain severity and progression: Data from the Vancouver Longitudinal Study of Early Knee Osteoarthritis. PLoS One 2017; 12:e0176833. [PMID: 28472071 PMCID: PMC5417516 DOI: 10.1371/journal.pone.0176833] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/18/2017] [Indexed: 01/22/2023] Open
Abstract
Objective To determine associations between features of osteoarthritis (OA) on MRI and knee pain severity and knee pain progression. Design Baseline, 3.3- and 7.5-year assessments were performed for 122 subjects with baseline knee pain (age 40–79), sample-weighted for population (with knee pain) representativeness. MRIs were scored for: osteophytes (0:absent to 3:large); cartilage (0:normal to 4:full thickness defect; 0/1 collapsed); subchondral sclerosis (0:none to 3:>50% of site), subchondral cyst (0:absent to 3:severe), bone marrow lesions (0:none to 3:≥50% of site); and meniscus (0:normal to 3:maceration/resection), in 6–8 regions each. Per feature, scores were averaged across regions. Effusion/synovitis (0:absent to 3:severe) was analyzed as ≥2 vs. <2. Linear models predicted WOMAC knee pain severity (0–100), and binary models predicted 10+ (minimum perceptible clinical improvement [MPCI]) and 20+ (minimum clinically important difference [MCID]) increases. Models were adjusted for age, sex, BMI (and follow-up time for longitudinal models). Results Pain severity was associated with osteophytes (7.17 per unit average; 95% CI = 3.19, 11.15) and subchondral sclerosis (11.03; 0.68, 21.39). MPCI-based pain increase was associated with osteophytes (odds ratio per unit average 3.20; 1.36, 7.55), subchondral sclerosis (5.69; 1.06, 30.44), meniscal damage (1.68; 1.08, 2.61) and effusion/synovitis ≥2 (2.25; 1.07, 4.71). MCID-based pain increase was associated with osteophytes (3.79; 1.41, 10.20) and cartilage defects (2.42; 1.24, 4.74). Conclusions Of the features investigated, only osteophytes were consistently associated with pain cross-sectionally and longitudinally in all models. This suggests an important role of bone in early knee osteoarthritis.
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Affiliation(s)
- Eric C. Sayre
- Arthritis Research Canada, Richmond, BC, Canada
- * E-mail:
| | - Ali Guermazi
- Radiology, Boston University School of Medicine, Boston, MA, United States of America
| | - John M. Esdaile
- Arthritis Research Canada, Richmond, BC, Canada
- Medicine, University of British Columbia, Vancouver, BC, Canada
- Medicine, University of Calgary, Calgary, AB, Canada
- School of Medicine, University of Queensland, Brisbane St. Lucia, QLD, Australia
| | - Jacek A. Kopec
- Arthritis Research Canada, Richmond, BC, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joel Singer
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anona Thorne
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Richmond, BC, Canada
- Medicine, University of British Columbia, Vancouver, BC, Canada
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Gersing AS, Schwaiger BJ, Nevitt MC, Joseph GB, Chanchek N, Guimaraes JB, Mbapte Wamba J, Facchetti L, McCulloch CE, Link TM. Is Weight Loss Associated with Less Progression of Changes in Knee Articular Cartilage among Obese and Overweight Patients as Assessed with MR Imaging over 48 Months? Data from the Osteoarthritis Initiative. Radiology 2017; 284:508-520. [PMID: 28463057 DOI: 10.1148/radiol.2017161005] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose To investigate the association of weight loss with progression of cartilage changes at magnetic resonance (MR) imaging over 48 months in overweight and obese participants compared with participants of stable weight. Materials and Methods The institutional review boards of the four participating centers approved this HIPAA-compliant study. Included were (a) 640 participants (mean age, 62.9 years ± 9.1 [standard deviation]; 398 women) who were overweight or obese (body mass index cutpoints of 25 and 30 kg/m2, respectively) from the Osteoarthritis Initiative, with risk factors for osteoarthritis or mild to moderate radiographic findings of osteoarthritis, categorized into groups with (a) weight loss of more than 10% (n = 82), (b) weight loss of 5%-10% (n = 238), or (c) stable weight (n = 320) over 48 months. Participants were frequency-matched for age, sex, baseline body mass index, and Kellgren-Lawrence score. Two radiologists assessed cartilage and meniscus defects on right knee 3-T MR images at baseline and 48 months by using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Progression of the subscores was compared between the weight loss groups by using multivariable logistic regression models. Results Over 48 months, adjusted mean increase of cartilage WORMS was significantly smaller in the 5%-10% weight loss group (1.6; 95% confidence interval [CI]: 1.3, 1.9; P = .002) and even smaller in the group with more than 10% weight loss (1.0; 95% CI: 0.6, 1.4; P = .001) when compared with the stable weight group (2.3; 95% CI: 2.0, 2.7). Moreover, percentage of weight change was significantly associated with increase in cartilage WORMS (β = 0.2; 95% CI: 0.02, 0.4; P = .007). Conclusion Participants who lost weight over 48 months showed significantly lower cartilage degeneration, as assessed with MR imaging; rates of progression were lower with greater weight loss. © RSNA, 2017.
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Affiliation(s)
- Alexandra S Gersing
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Benedikt J Schwaiger
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Michael C Nevitt
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Gabby B Joseph
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Nattagan Chanchek
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Julio B Guimaraes
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - John Mbapte Wamba
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Luca Facchetti
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Charles E McCulloch
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
| | - Thomas M Link
- From the Department of Radiology and Biomedical Imaging (A.S.G., B.J.S., G.B.J., N.C., J.B.G., J.M.W., L.F., T.M.L.) and Department of Epidemiology and Biostatistics (M.C.N., C.E.M.), University of California San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94107. From the 2015 RSNA Annual Meeting
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Jaremko JL, Jeffery D, Buller M, Wichuk S, McDougall D, Lambert RG, Maksymowych WP. Preliminary validation of the Knee Inflammation MRI Scoring System (KIMRISS) for grading bone marrow lesions in osteoarthritis of the knee: data from the Osteoarthritis Initiative. RMD Open 2017; 3:e000355. [PMID: 28123780 PMCID: PMC5255891 DOI: 10.1136/rmdopen-2016-000355] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/08/2016] [Accepted: 12/23/2016] [Indexed: 01/10/2023] Open
Abstract
Objective Bone marrow lesions (BML) are an MRI feature of osteoarthritis (OA) offering a potential target for therapy. We developed the Knee Inflammation MRI Scoring System (KIMRISS) to semiquantitatively score BML with high sensitivity to small changes, and compared feasibility, reliability and responsiveness versus the established MRI Osteoarthritis Knee Score (MOAKS). Methods KIMRISS incorporates a web-based graphic overlay to facilitate detailed regional BML scoring. Observers scored BML by MOAKS and KIMRISS on sagittal fluid-sensitive sequences. Exercise 1 focused on interobserver reliability in Osteoarthritis Initiative observational data, with 4 readers (two experienced/two new to KIMRISS) scoring BML in 80 patients (baseline/1 year). Exercise 2 focused on responsiveness in an open-label trial of adalimumab, with 2 experienced readers scoring BML in 16 patients (baseline/12 weeks). Results Scoring time was similar for KIMRISS and MOAKS. Interobserver reliability of KIMRISS was equivalent to MOAKS for BML status (ICC=0.84 vs 0.79), but consistently better than MOAKS for change in BML: Exercise 1 (ICC 0.82 vs 0.53), Exercise 2 (ICC 0.90 vs 0.32), and in new readers (0.87–0.92 vs 0.32–0.51). KIMRISS BML was more responsive than MOAKS BML: post-treatment BML improvement in Exercise 2 reached statistical significance for KIMRISS (SRM −0.69, p=0.015), but not MOAKS (SRM −0.12, p=0.625). KIMRISS BML also more strongly correlated to WOMAC scores than MOAKS BML (r=0.80 vs 0.58, p<0.05). Conclusions KIMRISS BML scoring was highly feasible, and was more reliable for assessment of change and more responsive to change than MOAKS BML for expert and new readers.
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Affiliation(s)
- Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada
| | - Dean Jeffery
- Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada
| | - M Buller
- Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada
| | - Stephanie Wichuk
- Faculty of Medicine, Division of Rheumatology , University of Alberta Hospital , Edmonton, Alberta , Canada
| | - Dave McDougall
- Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada
| | - Robert Gw Lambert
- Department of Radiology & Diagnostic Imaging , University of Alberta Hospital , Edmonton, Alberta , Canada
| | - Walter P Maksymowych
- Faculty of Medicine, Division of Rheumatology , University of Alberta Hospital , Edmonton, Alberta , Canada
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Grösch S, Niederberger E, Geisslinger G. Investigational drugs targeting the prostaglandin E2 signaling pathway for the treatment of inflammatory pain. Expert Opin Investig Drugs 2017; 26:51-61. [PMID: 27841017 DOI: 10.1080/13543784.2017.1260544] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAID) are the most commonly used drugs for the treatment of pain, inflammation and fever. Although they are effective for a huge number of users, their analgesic properties are not sufficient for several patients and the occurrence of side effects still constitutes a big challenge during long term therapy. Areas covered: This review gives an overview about the first and second generations of NSAIDs (COX1/2 non-selective, COX-2 selective), and their main side effects which gave still an urgent need for safer drugs and for the establishment of novel treatment strategies (improved safety, tolerability, patient convenience). The current developments of a possible third generation NSAID class comprise changes in the formulation of already approved drugs, combination therapies, dual cyclooxygenase-lipoxygenase inhibitors, NO- and H2S-releasing NSAIDs, prostaglandin synthase inhibitors and EP receptor modulators, respectively. Literature search has been done with PubMed NCBI. Expert opinion: Currently, there is no newly developed drug that is superior to the already approved selective and non-selective NSAIDs. Several novel approaches show promising analgesic efficacy but side effects are still an important problem. Solutions might be constituted by combination therapies allowing administration of lower drug doses or by individualized therapies targeting molecules apart from COX, respectively.
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Affiliation(s)
- Sabine Grösch
- a Pharmazentrum frankfurt/ZAFES , Institut für Klinische Pharmakologie, Klinikum der Goethe-Universität Frankfurt , Frankfurt am Main , Germany
| | - Ellen Niederberger
- a Pharmazentrum frankfurt/ZAFES , Institut für Klinische Pharmakologie, Klinikum der Goethe-Universität Frankfurt , Frankfurt am Main , Germany
| | - Gerd Geisslinger
- a Pharmazentrum frankfurt/ZAFES , Institut für Klinische Pharmakologie, Klinikum der Goethe-Universität Frankfurt , Frankfurt am Main , Germany
- b Fraunhofer Institute for Molecular Biology and Applied Ecology (IME), Project Group for Translational Medicine & Pharmacology (TMP) , Frankfurt/Main , Germany
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Patellofemoral Bone Marrow Lesions: Natural History and Associations With Pain and Structure. Arthritis Care Res (Hoboken) 2016; 68:1647-1654. [DOI: 10.1002/acr.22871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/13/2016] [Accepted: 02/16/2016] [Indexed: 11/07/2022]
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Kaukinen P, Podlipská J, Guermazi A, Niinimäki J, Lehenkari P, Roemer FW, Nieminen MT, Koski JM, Arokoski JPA, Saarakkala S. Associations between MRI-defined structural pathology and generalized and localized knee pain - the Oulu Knee Osteoarthritis study. Osteoarthritis Cartilage 2016; 24:1565-76. [PMID: 27174007 DOI: 10.1016/j.joca.2016.05.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/07/2016] [Accepted: 05/02/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the associations between multi-feature structural pathology assessed using magnetic resonance imaging (MRI) and the presence of knee pain, and to determine the associations between the locations of structural changes and different knee pain patterns. METHOD Eighty symptomatic subjects with knee pain and suspicion or diagnosis of knee OA and 63 asymptomatic subjects underwent knee MRI. Severity of structural changes was graded by MRI Osteoarthritis Knee Score (MOAKS) in separate knee locations. The associations between cartilage damage, bone marrow lesions (BMLs), osteophytes, Hoffa's synovitis, effusion-synovitis, meniscal damage and structural pathologies in ligaments, tendons and bursas and both the presence of pain and the knee pain patterns were assessed. RESULTS The presence of Hoffa's synovitis (adjusted RR 1.6, 95% CI 1.2-1.3) and osteophytes in any region (2.07, 1.19-3.60) was significantly associated with the presence of pain. Any Hoffa's synovitis was associated with patellar pain (adjusted RR 4.70, 95% CI 1.19-3.60) and moderate-to-severe Hoffa's synovitis with diffuse pain (2.25, 1.13-4.50). Medial knee pain was associated with cartilage loss in the medial tibia (adjusted RR 2.66, 95% CI 1.22-5.80), osteophytes in the medial tibia (2.66, 1.17-6.07) and medial femur (2.55, 1.07-6.09), medial meniscal maceration (2.20, 1.01-4.79) and anterior meniscal extrusions (2.78, 1.14-6.75). CONCLUSIONS Hoffa's synovitis and osteophytes were strongly associated with the presence of knee pain. Medial pain was associated most often with medially located structural pathologies.
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Affiliation(s)
- P Kaukinen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.
| | - J Podlipská
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - J Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - P Lehenkari
- Department of Anatomy, University of Oulu, Oulu, Finland; Department of Surgery, Medical Research Center, Oulu University Hospital, Oulu, Finland.
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Finland.
| | - J M Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland.
| | - J P A Arokoski
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital and University of Oulu, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Finland.
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Abstract
Imaging of osteoarthritis (OA) in the elderly is gaining importance because of the aging population. It requires knowledge about findings relevant for patient management and others which are abnormal findings, but part of normal aging without relevance for patient management due to lack of clinical symptoms. This review will provide information on what imaging techniques are best used for knee OA and how to systematically assess knee joint structures in order to cover the most common asymptomatic and symptomatic MR findings in OA. We will discuss which findings are typically found in older patients and which are likely to progress to severe pain and disability, finally leading to total joint replacement. The review may aid radiologists and referring clinicians to better understand the evolution of symptomatic OA and the current or future clinical significance of the most common symptomatic and asymptomatic findings.
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Affiliation(s)
- Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA 94158, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 400 Parnassus Ave, A-367, San Francisco, CA 94131, USA
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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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Hunter DJ, Altman RD, Cicuttini F, Crema MD, Duryea J, Eckstein F, Guermazi A, Kijowski R, Link TM, Martel-Pelletier J, Miller CG, Mosher TJ, Ochoa-Albíztegui RE, Pelletier JP, Peterfy C, Raynauld JP, Roemer FW, Totterman SM, Gold GE. OARSI Clinical Trials Recommendations: Knee imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage 2015; 23:698-715. [PMID: 25952343 DOI: 10.1016/j.joca.2015.03.012] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
Significant advances have occurred in our understanding of the pathogenesis of knee osteoarthritis (OA) and some recent trials have demonstrated the potential for modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply knee imaging in knee OA trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance (QA)/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
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Affiliation(s)
- D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia; Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
| | - R D Altman
- Department of Medicine, Division of Rheumatology and Immunology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - F Cicuttini
- School of Public health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne 3004, Australia
| | - M D Crema
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
| | - J Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brazil
| | - F Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - R Kijowski
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - T M Link
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, USA
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | | | - T J Mosher
- Department of Radiology, Penn State University, Hershey, PA, USA; Department of Orthopaedic Surgery, Penn State University, Hershey, PA, USA
| | - R E Ochoa-Albíztegui
- Department of Radiology, The American British Cowdray Medical Center, Mexico City, Mexico
| | - J-P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, Florida, USA
| | - J-P Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - G E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
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Roubille C, Martel-Pelletier J, Raynauld JP, Abram F, Dorais M, Delorme P, Pelletier JP. Meniscal extrusion promotes knee osteoarthritis structural progression: protective effect of strontium ranelate treatment in a phase III clinical trial. Arthritis Res Ther 2015; 17:82. [PMID: 25888851 PMCID: PMC4407552 DOI: 10.1186/s13075-015-0579-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/23/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction To evaluate the impact of meniscal extrusion (Ext) on knee osteoarthritis (OA) structural progression and on response to strontium ranelate (SrRan) treatment at 36 months in patients with (+) or without (-) Ext, in association (+) or not (-) with bone marrow lesions (BML) in the medial compartment using X-rays (JSW) and qMRI. Methods Patients from the qMRI substudy of the SEKOIA trial (SrRan 1 g/day, n = 113; SrRan 2 g/day, n = 105; placebo, n = 112) were stratified based on whether meniscal extrusion and/or BML were present or not in the medial compartment. Results In the placebo group, Ext+ patients (n = 26) had more JSW loss (p = 0.002) and cartilage volume loss in the global knee (p = 0.034) and plateau (p = 0.005), and medial compartment (p = 0.0005) than Ext- patients (n = 86). Ext-BML+ patients (n = 18) demonstrated more JSW loss (p = 0.003) and cartilage volume loss in the global (p = 0.020) and medial femur (p = 0.055) than Ext-BML- (n = 68). Compared to Ext+ BML- (n = 14), Ext+ BML+ patients (n = 12) had more cartilage volume loss in the global femur (p = 0.028), with no change in JSW. The JSW loss (p = 0.0004) and cartilage volume loss (global knee, p = 0.033, medial compartment, p = 0.0005) were greater when Ext and BML were simultaneously present in the medial compartment. SrRan 2 g/day treatment demonstrated a reduction in OA knee structural progression with qMRI, but not with JSW, in which less cartilage volume loss was found in the plateaus (p = 0.007) in Ext+ patients (n = 15), and in the medial plateau (p = 0.046) in patients in whom both Ext and BML were co-localized. Conclusion The findings of this study are novel and could have an impact on future strategies regarding clinical trials. Indeed, data first argue for a combined, cumulative effect of meniscal extrusion and bone marrow lesions on cartilage loss and, secondly, they showed that SrRan may have protective effects in OA patients with meniscal extrusion as well as when both meniscal extrusion and BML are co-localized.
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Affiliation(s)
- Camille Roubille
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Pavillon R, Suite R11.412A, Montreal, Quebec, H2X 0A9, Canada.
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Pavillon R, Suite R11.412A, Montreal, Quebec, H2X 0A9, Canada.
| | - Jean-Pierre Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Pavillon R, Suite R11.412A, Montreal, Quebec, H2X 0A9, Canada.
| | - François Abram
- Medical Imaging Research & Development, ArthroLab Inc, Montreal, Quebec, Canada.
| | - Marc Dorais
- StatSciences Inc, Notre-Dame-de-l'Île-Perrot, Quebec, Canada.
| | - Philippe Delorme
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Pavillon R, Suite R11.412A, Montreal, Quebec, H2X 0A9, Canada.
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Pavillon R, Suite R11.412A, Montreal, Quebec, H2X 0A9, Canada.
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Haugen IK, Slatkowsky Christensen B, Bøyesen P, Sesseng S, van der Heijde D, Kvien TK. Increasing synovitis and bone marrow lesions are associated with incident joint tenderness in hand osteoarthritis. Ann Rheum Dis 2015; 75:702-8. [DOI: 10.1136/annrheumdis-2014-206829] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 02/19/2015] [Indexed: 11/04/2022]
Abstract
ObjectivesTo explore whether changes of MRI-defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort.MethodsWe included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0–3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA.ResultsAmong joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant.ConclusionsThe Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs.
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Roubille C, Raynauld JP, Abram F, Paiement P, Dorais M, Delorme P, Bessette L, Beaulieu AD, Martel-Pelletier J, Pelletier JP. The presence of meniscal lesions is a strong predictor of neuropathic pain in symptomatic knee osteoarthritis: a cross-sectional pilot study. Arthritis Res Ther 2014; 16:507. [PMID: 25497320 PMCID: PMC4295293 DOI: 10.1186/s13075-014-0507-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 12/09/2014] [Indexed: 01/12/2023] Open
Abstract
Introduction Pain in osteoarthritis (OA) has been classically attributed to joint structural damage. Disparity between the degree of radiographic structural damage and the severity of symptoms implies that factors other than the joint pathology itself contribute to the pain. Peripheral and central sensitization have been suggested as two of the underlying mechanisms that contribute to pain in OA. The aim of this study was to explore in symptomatic knee OA patients, the structural changes assessed by magnetic resonance imaging (MRI) that could be used as markers of neuropathic pain (NP). Methods This cross-sectional observational pilot study included 50 knee OA patients with moderate to severe pain (VAS ≥40) in the target knee. The presence of NP was determined based on the PainDETECT questionnaire. Among the 50 patients included, 25 had PainDETECT score ≤12 (unlikely NP), 9 had PainDETECT score between 13 and 18 (uncertain NP) and 16 had PainDETECT score ≥19 (likely NP). WOMAC, PainDETECT, and VAS pain scores as well as knee MRI were assessed. Results Data showed no significant difference in demographic characteristics between the three groups. However, a positive and statistically significant association was found between the WOMAC pain (P <0.001), function (P <0.001), stiffness (P = 0.007) and total (P <0.001) scores as well as higher VAS pain score (P = 0.023), and PainDETECT scores. Although no difference was found in the cartilage volume between groups, the presence of meniscal extrusion in both medial (P = 0.006) and lateral (P = 0.023) compartments, and presence of meniscal tears in the lateral compartment (P = 0.011), were significantly associated with increasing PainDETECT score. Moreover, the presence of bone marrow lesions in the lateral plateau and the extent of the synovial membrane thickness in the lateral recess were associated with increasing PainDETECT scores (P = 0.032, P = 0.027, respectively). Conclusions In this study, meniscal lesions, particularly extrusion, were found to be among the strongest risk factors for NP in knee OA patients. Trial registration ClinicalTrials.gov NCT01733277. Registered 16 November 2012.
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Imaging of cartilage and bone: promises and pitfalls in clinical trials of osteoarthritis. Osteoarthritis Cartilage 2014; 22:1516-32. [PMID: 25278061 PMCID: PMC4351816 DOI: 10.1016/j.joca.2014.06.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/22/2014] [Accepted: 06/22/2014] [Indexed: 02/02/2023]
Abstract
Imaging in clinical trials is used to evaluate subject eligibility, and/or efficacy of intervention, supporting decision making in drug development by ascertaining treatment effects on joint structure. This review focusses on imaging of bone and cartilage in clinical trials of (knee) osteoarthritis. We narratively review the full-text literature on imaging of bone and cartilage, adding primary experience in the implementation of imaging methods in clinical trials. Aims and constraints of applying imaging in clinical trials are outlined. The specific uses of semi-quantitative and quantitative imaging biomarkers of bone and cartilage in osteoarthritis trials are summarized, focusing on radiography and magnetic resonance imaging (MRI). Studies having compared both imaging methodologies directly and those having established a relationship between imaging biomarkers and clinical outcomes are highlighted. To make this review of practical use, recommendations are provided as to which imaging protocols are ideal for capturing specific aspects of bone and cartilage tissue, and pitfalls in their usage are highlighted. Further, the longitudinal sensitivity to change, of different imaging methods is reported for various patient strata. From these power calculations can be accomplished, provided the strength of the treatment effect is known. In conclusion, current imaging methodologies provide powerful tools for scoring and measuring morphological and compositional aspects of most articular tissues, capturing longitudinal change with reasonable to excellent sensitivity. When employed properly, imaging has tremendous potential for ascertaining treatment effects on various joint structures, potentially over shorter time scales than required for demonstrating effects on clinical outcomes.
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Walters ET. Neuroinflammatory contributions to pain after SCI: roles for central glial mechanisms and nociceptor-mediated host defense. Exp Neurol 2014; 258:48-61. [PMID: 25017887 DOI: 10.1016/j.expneurol.2014.02.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 01/23/2014] [Accepted: 02/02/2014] [Indexed: 12/30/2022]
Abstract
Neuropathic pain after spinal cord injury (SCI) is common, often intractable, and can be severely debilitating. A number of mechanisms have been proposed for this pain, which are discussed briefly, along with methods for revealing SCI pain in animal models, such as the recently applied conditioned place preference test. During the last decade, studies of animal models have shown that both central neuroinflammation and behavioral hypersensitivity (indirect reflex measures of pain) persist chronically after SCI. Interventions that reduce neuroinflammation have been found to ameliorate pain-related behavior, such as treatment with agents that inhibit the activation states of microglia and/or astroglia (including IL-10, minocycline, etanercept, propentofylline, ibudilast, licofelone, SP600125, carbenoxolone). Reversal of pain-related behavior has also been shown with disruption by an inhibitor (CR8) and/or genetic deletion of cell cycle-related proteins, deletion of a truncated receptor (trkB.T1) for brain-derived neurotrophic factor (BDNF), or reduction by antisense knockdown or an inhibitor (AMG9810) of the activity of channels (TRPV1 or Nav1.8) important for electrical activity in primary nociceptors. Nociceptor activity is known to drive central neuroinflammation in peripheral injury models, and nociceptors appear to be an integral component of host defense. Thus, emerging results suggest that spinal and systemic effects of SCI can activate nociceptor-mediated host defense responses that interact via neuroinflammatory signaling with complex central consequences of SCI to drive chronic pain. This broader view of SCI-induced neuroinflammation suggests new targets, and additional complications, for efforts to develop effective treatments for neuropathic SCI pain.
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Affiliation(s)
- Edgar T Walters
- Department of Integrative Biology and Pharmacology, University of Texas Medical School at Houston, TX, USA.
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Weak associations between structural changes on MRI and symptoms, function and muscle strength in relation to knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2014; 22:2013-25. [PMID: 23377800 DOI: 10.1007/s00167-013-2434-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 01/23/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore associations between MRI-defined structural abnormalities and clinical features related to knee osteoarthritis (OA). METHODS Structural and clinical knee OA features were assessed in 87 women (45 with knee OA symptoms). Structural features were quantified by the Kellgren and Lawrence grade on radiography and by the Boston-Leeds Osteoarthritis Knee Score on MRI. Clinical features were assessed using the Knee Injury and Osteoarthritis Outcome Score, functional tests and muscle strength measurements. Associations were examined using regression analyses. RESULTS Limited significant associations between structural and clinical features were found. An increased meniscal signal was associated with more pain/symptoms (P < 0.027). An anterior cruciate ligament tear was associated with poorer stair climbing test performance (P = 0.045). In a stepwise linear regression model, patellofemoral cartilage integrity and pain explained 28 % of the isometric quadriceps strength variability. The amount of cartilage lesions, loose bodies and pain explained 38 % of the isokinetic quadriceps strength variability. Synovitis/effusion and patellofemoral cartilage integrity combined with pain explained 34 % of the isometric hamstring strength variability. CONCLUSION Although MRI-detected cartilage lesions, synovitis/effusion and loose bodies did explain part of the muscle strength variability, results suggest that MRI does not improve the link between joint degeneration and the clinical expression of knee OA. MRI contributes less than expected to the understanding of pain and function in knee OA and possibly offers little opportunity to develop structure-modifying treatments in knee OA that could influence the patient's pain and function. LEVEL OF EVIDENCE Case series with no comparison groups, Level IV.
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Pang J, Driban JB, McAlindon TE, Tamez-Peña JG, Fripp J, Miller EL. On the use of coupled shape priors for segmentation of magnetic resonance images of the knee. IEEE J Biomed Health Inform 2014; 19:1153-67. [PMID: 25014973 DOI: 10.1109/jbhi.2014.2329493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Active contour techniques have been widely employed for medical image segmentation. Significant effort has been focused on the use of training data to build prior statistical models applicable specifically to problems where the objects of interest are embedded in cluttered background. Usually, the training data consist of whole shapes of certain organs or structures obtained manually by clinical experts. The resulting prior models enforce segmentation accuracy uniformly over the entire structure or structures to be identified. In this paper, we consider a new coupled prior shape model which is demonstrated to provide high accuracy, specifically in the region of the interest where precision is most needed for the application of the segmentation of the femur and tibia in magnetic resonance (MR) images. Experimental results for the segmentation of MR images of human knees demonstrate that the combination of the new coupled prior shape and a directional edge force provides the improved segmentation performance. Moreover, the new approach allows for equivalent accurate identification of bone marrow lesions, a promising biomarker related to osteoarthritis, to the current state of the art but requires significantly less manual interaction.
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Kwoh CK, Roemer FW, Hannon MJ, Moore CE, Jakicic JM, Guermazi A, Green SM, Evans RW, Boudreau R. Effect of oral glucosamine on joint structure in individuals with chronic knee pain: a randomized, placebo-controlled clinical trial. Arthritis Rheumatol 2014; 66:930-9. [PMID: 24616448 DOI: 10.1002/art.38314] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/05/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the short-term efficacy of oral glucosamine supplementation by evaluating structural lesions in the knee joints, as assessed using 3T magnetic resonance imaging (MRI). METHODS This study was designed as a randomized, double-blind, placebo-controlled trial. Recruitment was performed via mass mailings and an arthritis registry in southwestern Pennsylvania. In total, 201 participants with mild-to-moderate pain in one or both knees, as defined by a Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score ≥25 and ≤100, were enrolled. Of these subjects, 69.2% had a Kellgren/Lawrence grade ≥2 in at least 1 knee. Participants received 24 weeks of treatment with 1,500 mg glucosamine hydrochloride in beverage form or a placebo beverage. The primary outcome was decreased worsening of cartilage damage on 3T MRI of both knees, assessed according to a validated scoring system, the Whole-Organ MRI Score (WORMS). Secondary outcomes included change in bone marrow lesion (BML) scores in all knees and change in excretion of urinary C-terminal crosslinking telopeptide of type II collagen (CTX-II). RESULTS The adjusted odds ratio (OR) for the likelihood of decreased cartilage damage over 24 weeks in any WORMS-scored subregion of the knee in the glucosamine treatment group compared to the control group was 0.938 (95% confidence interval [95% CI] 0.528, 1.666). Compared to subjects treated with glucosamine, control subjects showed more improvement in BMLs (adjusted OR 0.537, 95% CI 0.291, 0.990) but no difference in worsening BMLs (adjusted OR 0.691, 95% CI 0.410, 1.166) over 24 weeks. There was no indication that treatment with glucosamine decreased the excretion of urinary CTX-II (β = -0.10, 95% CI -0.21, 0.002). CONCLUSION The results of this short-term study provide no evidence of structural benefits (i.e., improvements in MRI morphologic features or urinary CTX-II excretion) from glucosamine supplementation in individuals with chronic knee pain.
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Affiliation(s)
- C Kent Kwoh
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; University of Arizona, Tucson
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Lim YZ, Wang Y, Wluka AE, Davies-Tuck ML, Teichtahl A, Urquhart DM, Cicuttini FM. Are biomechanical factors, meniscal pathology, and physical activity risk factors for bone marrow lesions at the knee? A systematic review. Semin Arthritis Rheum 2014; 43:187-94. [PMID: 24157092 DOI: 10.1016/j.semarthrit.2013.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To systematically review the literature to determine whether biomechanical factors, meniscal pathology, and physical activity are risk factors for bone marrow lesions (BMLs) at the knee identified from magnetic resonance imaging in pre-osteoarthritis and osteoarthritis populations. METHODS Electronic searches of MEDLINE and EMBASE were performed from January 1, 1996 to October 31, 2012 using the keywords of bone marrow lesion(s), bone marrow (o)edema, osteoarthritis, and knee. Studies examining biomechanical factors, meniscal pathology, or physical activity in relation to the presence, incidence, or change in BMLs at the knee were included. Two independent reviewers extracted the data and assessed the methodological quality of selected studies. Due to the heterogeneity of the studies, we performed a best evidence synthesis. RESULTS Fifteen studies were included in this review, of which 9 were considered high quality. The study populations were heterogeneous in terms of the symptoms and radiographic knee osteoarthritis. There was strong evidence for relationships of mechanical knee alignment and meniscal pathology with BMLs in osteoarthritis populations. There was a paucity of evidence for a relationship between physical activity and BMLs. CONCLUSION Despite the heterogeneity of included studies, these data suggest that mechanical knee alignment and meniscal pathology are risk factors for BMLs in knee osteoarthritis. It suggests that BMLs in individuals with osteoarthritis are more susceptible to mechanical knee alignment. Given the role of BMLs in the pathogenesis of knee osteoarthritis, identifying strategies to modify these risk factors will be important in slowing the progression and reducing the burden of knee osteoarthritis.
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Affiliation(s)
- Yuan Z Lim
- Department of Epidemiology and Preventive Medicine, School Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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Henriksen M, Christensen R, Hunter DJ, Gudbergsen H, Boesen M, Lohmander LS, Bliddal H. Structural changes in the knee during weight loss maintenance after a significant weight loss in obese patients with osteoarthritis: a report of secondary outcome analyses from a randomized controlled trial. Osteoarthritis Cartilage 2014; 22:639-46. [PMID: 24636948 DOI: 10.1016/j.joca.2014.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 02/03/2014] [Accepted: 03/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare structural knee joint changes in obese patients with knee osteoarthritis (OA) that after an intensive weight loss therapy were randomized to continuous dietetic support, a specialized knee exercise program, or 'no attention' for 1 year. METHODS 192 obese individuals with knee OA underwent an intensive 16-week weight loss program with subsequent randomization to one of the three treatment groups. Changes in cartilage loss, bone marrow lesions (BMLs), synovitis, and effusion were assessed using semi quantitative assessments of magnetic resonance imaging (MRI) obtained at weeks 0 and 68 applying the BLOKS score. RESULTS During the 52 weeks maintenance period the continuous dietary maintenance group support on average gained 1.1 kg (95% CI: -0.3:2.5) body mass, the exercise group gained 6.6 kg (95% CI 5.4:7.8) and the no-attention group gained 4.8 kg (95% CI: 2.9:6.7). There were no statistically significant between-group differences in changes in cartilage loss, synovitis or effusion at the follow-up (analysis of covariance; ANCOVA, P > 0.16), while there was an increased number of medial tibiofemoral BMLs in the exercise group (ANCOVA, P = 0.015) compared to both diet (difference: -0.21 [95%CI -0.40:-0.03]) and "no attention" (difference: -0.26 [95%CI -0.44:-0.07]) groups. CONCLUSION In this 1 year follow-up after weight-loss in obese knee OA patients, we found a potentially increased number of BMLs in the exercise group compared to the diet and no attention groups, with no between-group differences in changes in cartilage loss, synovitis or effusion. These findings should be interpreted with caution for exercise compliance, MRI methodology and follow-up time. (ClinicalTrials.gov identifier: NCT00655941).
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Affiliation(s)
- M Henriksen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, DK-2000 Copenhagen F, Denmark.
| | - R Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, DK-2000 Copenhagen F, Denmark; Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, DK-5230 Odense, Denmark
| | - D J Hunter
- Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - H Gudbergsen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, DK-2000 Copenhagen F, Denmark
| | - M Boesen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, DK-2000 Copenhagen F, Denmark; Department of Radiology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, DK-2000 Copenhagen F, Denmark
| | - L S Lohmander
- Institute of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, DK-5230 Odense, Denmark; Department of Orthopedics, Clinical Sciences Lund, Lund University, Sweden
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospitals, Bispebjerg and Frederiksberg, DK-2000 Copenhagen F, Denmark
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Role of Modern Imaging Techniques in Hand Osteoarthritis Research and Clinical Practice. Curr Rheumatol Rep 2013; 16:399. [DOI: 10.1007/s11926-013-0399-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Martel-Pelletier J, Roubille C, Abram F, Hochberg MC, Dorais M, Delorme P, Raynauld JP, Pelletier JP. First-line analysis of the effects of treatment on progression of structural changes in knee osteoarthritis over 24 months: data from the osteoarthritis initiative progression cohort. Ann Rheum Dis 2013; 74:547-56. [PMID: 24336337 DOI: 10.1136/annrheumdis-2013-203906] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine, using data from participants enrolled in the progression cohort of the OAI, the effects of conventional osteoarthritis (OA) pharmacological treatment and those of the combination of glucosamine and chondroitin sulfate (Glu/CS) on knee structural changes. METHODS Six hundred patients with knee OA were stratified based on whether or not they received for 24 consecutive months the OA conventional pharmacological treatment and/or Glu/CS. The main outcomes were knee structural changes, including the loss of joint space width (JSW) and of cartilage volume measured by quantitative MRI. RESULTS Participants reported taking (+) (n=300) or not taking (-) (n=300) OA treatment (analgesic/NSAIDs). The +analgesic/NSAIDs participants had higher Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p<0.001) and smaller JSW (p=0.01), reflecting more severe disease at baseline. In the -analgesic/NSAIDs group, participants taking Glu/CS had significantly reduced loss of cartilage volume at 24 months in the medial central plateau (p=0.007). Further subdivision revealed that this effect of Glu/CS occurred in participants with a higher severity of the disease (JSW≤median). In the +analgesic/NSAIDs group, those taking Glu/CS had significantly reduced loss of cartilage volume in the global plateau at 12 months (p=0.05), and in the central plateau at 24 months (p=0.05). These effects occurred in participants with less disease severity (JSW>median). By contrast, no significant reduction in JSW was found between all groups. CONCLUSIONS In +analgesic/NSAIDs groups and -analgesic/NSAIDs groups, participants who took Glu/CS had reduced loss of cartilage volume over 24 months in subregions when assessed with qMRI, arguing for a disease-modifying effect of Glu/CS which could not be identified by X-rays.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Camille Roubille
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - François Abram
- Imaging Research & Development, ArthroLab Inc., Montreal, Quebec, Canada
| | - Marc C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Marc Dorais
- StatSciences Inc., Notre-Dame de l'Île-Perrot, Quebec, Canada
| | - Philippe Delorme
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Jean-Pierre Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
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Lim YZ, Wang Y, Wluka AE, Davies-Tuck ML, Hanna F, Urquhart DM, Cicuttini FM. Association of obesity and systemic factors with bone marrow lesions at the knee: a systematic review. Semin Arthritis Rheum 2013; 43:600-12. [PMID: 24287353 DOI: 10.1016/j.semarthrit.2013.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 09/17/2013] [Accepted: 10/22/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to systematically review the literature to determine whether obesity and systemic factors, including age, gender, heritability, dietary factors, smoking, serum and urine biomarkers of cartilage or bone metabolism, bone-related factors, and medication, are associated with knee bone marrow lesions (BMLs) identified on magnetic resonance imaging in asymptomatic pre-osteoarthritis and osteoarthritis populations. METHODS Electronic searches of MEDLINE and EMBASE were performed from January 1, 1996 to September 30, 2012 using the following keywords: bone marrow lesion(s), bone marrow (o)edema, osteoarthritis, and knee. Studies examining obesity and non-biomechanical factors in relation to the presence, incidence, or change in BMLs were included. Two independent reviewers extracted data and assessed methodological quality of selected studies. Due to the heterogeneity of the studies, we performed a best evidence synthesis. RESULTS Among 30 studies, 17 were considered high quality. The study populations were heterogeneous in terms of symptoms and radiographic knee osteoarthritis. There was strong evidence for an association between serum lipids and BMLs and no association between age and BMLs. There was moderate evidence for a relationship between obesity and BMLs. There was limited evidence for gender, smoking, C-telopeptide of type I collagen, anti-bone-resorptive treatments, licofelone, and chondroitin sulfate. There was a paucity of evidence for heritability and conflicting evidence for dietary fatty acids. CONCLUSION There is strong evidence for serum lipids and moderate evidence for obesity as risk factors for knee BMLs. Given the role of BMLs in the pathogenesis of knee osteoarthritis, identification of modifiable risk factors of BMLs and therapeutic interventions targeting BMLs has the potential to reduce the burden of knee osteoarthritis.
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Affiliation(s)
- Yuan Z Lim
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria 3004, Australia
| | - Yuanyuan Wang
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria 3004, Australia
| | - Anita E Wluka
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria 3004, Australia
| | - Miranda L Davies-Tuck
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria 3004, Australia
| | - Fahad Hanna
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria 3004, Australia; School of Rural Health, Monash University, Victoria, Australia
| | - Donna M Urquhart
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria 3004, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria 3004, Australia.
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Kim IJ, Kim DH, Jung JY, Song YW, Guermazi A, Crema MD, Hunter DJ, Kim HA. Association between bone marrow lesions detected by magnetic resonance imaging and knee pain in community residents in Korea. Osteoarthritis Cartilage 2013; 21:1207-13. [PMID: 23973132 DOI: 10.1016/j.joca.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 04/10/2013] [Accepted: 05/01/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the frequency of bone marrow lesions (BMLs) detected by magnetic resonance imaging (MRI), and to examine the association of BMLs with knee pain severity in community residents in Korea. METHODS Participants were randomly chosen from the population-based Hallym Aging Study, irrespective of whether they had knee osteoarthritis (OA) or pain. Demographic and knee pain data were obtained by questionnaire. Radiographic evaluations consisted of weight-bearing knee anteroposterior radiographs and 1.5-T MRI scans. MRI was performed in the dominant knees of subjects without knee pain and in the more symptomatic knees of subjects with knee pain. BMLs were graded according to the whole-organ MRI score. RESULTS The mean age of the 358 study subjects was 71.8 years, and 34.5% of subjects had radiographically detected knee OA. The prevalences of BMLs and large BMLs in the tibiofemoral compartments were 80.3% and 40.4%, respectively. After adjusting for age, sex, and body mass index, total and medial compartment BML scores were significantly associated with the presence of knee pain, and the association was stronger as the summary score for BML increased. In proportional regression analysis, knee pain severity increased with BML severity in any compartment and in the medial compartment. CONCLUSION BMLs detected by MRI were highly prevalent in this elderly Asian population. BMLs were significantly linked to knee pain, and BML severity correlated with knee pain severity. BMLs may be important surrogate targets for monitoring pain and structure modification in OA therapeutics.
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Affiliation(s)
- I J Kim
- Department of Internal Medicine, Hallym University, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
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Pelletier JP, Cooper C, Peterfy C, Reginster JY, Brandi ML, Bruyère O, Chapurlat R, Cicuttini F, Conaghan PG, Doherty M, Genant H, Giacovelli G, Hochberg MC, Hunter DJ, Kanis JA, Kloppenburg M, Laredo JD, McAlindon T, Nevitt M, Raynauld JP, Rizzoli R, Zilkens C, Roemer FW, Martel-Pelletier J, Guermazi A. What is the predictive value of MRI for the occurrence of knee replacement surgery in knee osteoarthritis? Ann Rheum Dis 2013; 72:1594-604. [PMID: 23887285 DOI: 10.1136/annrheumdis-2013-203631] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Knee osteoarthritis is associated with structural changes in the joint. Despite its many drawbacks, radiography is the current standard for evaluating joint structure in trials of potential disease-modifying osteoarthritis drugs. MRI is a non-invasive alternative that provides comprehensive imaging of the whole joint. Frequently used MRI measurements in knee osteoarthritis are cartilage volume and thickness; others include synovitis, synovial fluid effusions, bone marrow lesions (BML) and meniscal damage. Joint replacement is considered a clinically relevant outcome in knee osteoarthritis; however, its utility in clinical trials is limited. An alternative is virtual knee replacement on the basis of symptoms and structural damage. MRI may prove to be a good alternative to radiography in definitions of knee replacement. One of the MRI parameters that predicts knee replacement is medial compartment cartilage volume/thickness, which correlates with radiographic joint space width, is sensitive to change, and predicts outcomes in a continuous manner. Other MRI parameters include BML and meniscal lesions. MRI appears to be a viable alternative to radiography for the evaluation of structural changes in knee osteoarthritis and prediction of joint replacement.
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Affiliation(s)
- J-P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, Quebec, Canada.
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Wildi LM, Martel-Pelletier J, Abram F, Moser T, Raynauld JP, Pelletier JP. Assessment of Cartilage Changes Over Time in Knee Osteoarthritis Disease-Modifying Osteoarthritis Drug Trials Using Semiquantitative and Quantitative Methods: Pros and Cons. Arthritis Care Res (Hoboken) 2013; 65:686-94. [DOI: 10.1002/acr.21890] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 10/11/2012] [Indexed: 01/08/2023]
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Guermazi A, Roemer FW, Haugen IK, Crema MD, Hayashi D. MRI-based semiquantitative scoring of joint pathology in osteoarthritis. Nat Rev Rheumatol 2013; 9:236-51. [DOI: 10.1038/nrrheum.2012.223] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Raynauld JP, Wildi LM, Abram F, Moser T, Pelletier JP, Martel-Pelletier J. Reliability and sensitivity to change of IW-TSE versus DESS magnetic resonance imaging sequences in the assessment of bone marrow lesions in knee osteoarthritis patients: Longitudinal data from the Osteoarthritis Initiative (OAI) cohort. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.63a043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Valverde-Franco G, Pelletier JP, Fahmi H, Hum D, Matsuo K, Lussier B, Kapoor M, Martel-Pelletier J. In vivo bone-specific EphB4 overexpression in mice protects both subchondral bone and cartilage during osteoarthritis. ACTA ACUST UNITED AC 2012; 64:3614-25. [DOI: 10.1002/art.34638] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Knoop J, Dekker J, Klein JP, van der Leeden M, van der Esch M, Reiding D, Voorneman RE, Gerritsen M, Roorda LD, Steultjens MPM, Lems WF. Biomechanical factors and physical examination findings in osteoarthritis of the knee: associations with tissue abnormalities assessed by conventional radiography and high-resolution 3.0 Tesla magnetic resonance imaging. Arthritis Res Ther 2012; 14:R212. [PMID: 23039323 PMCID: PMC3580524 DOI: 10.1186/ar4050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/05/2012] [Indexed: 01/11/2023] Open
Abstract
Introduction We aimed to explore the associations between knee osteoarthritis (OA)-related tissue abnormalities assessed by conventional radiography (CR) and by high-resolution 3.0 Tesla magnetic resonance imaging (MRI), as well as biomechanical factors and findings from physical examination in patients with knee OA. Methods This was an explorative cross-sectional study of 105 patients with knee OA. Index knees were imaged using CR and MRI. Multiple features from CR and MRI (cartilage, osteophytes, bone marrow lesions, effusion and synovitis) were related to biomechanical factors (quadriceps and hamstrings muscle strength, proprioceptive accuracy and varus-valgus laxity) and physical examination findings (bony tenderness, crepitus, bony enlargement and palpable warmth), using multivariable regression analyses. Results Quadriceps weakness was associated with cartilage integrity, effusion, synovitis (all detected by MRI) and CR-detected joint space narrowing. Knee joint laxity was associated with MRI-detected cartilage integrity, CR-detected joint space narrowing and osteophyte formation. Multiple tissue abnormalities including cartilage integrity, osteophytes and effusion, but only those detected by MRI, were found to be associated with physical examination findings such as crepitus. Conclusion We observed clinically relevant findings, including a significant association between quadriceps weakness and both effusion and synovitis, detected by MRI. Inflammation was detected in over one-third of the participants, emphasizing the inflammatory component of OA and a possible important role for anti-inflammatory therapies in knee OA. In general, OA-related tissue abnormalities of the knee, even those detected by MRI, were found to be discordant with biomechanical and physical examination features.
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Schütz UHW, Schmidt-Trucksäss A, Knechtle B, Machann J, Wiedelbach H, Ehrhardt M, Freund W, Gröninger S, Brunner H, Schulze I, Brambs HJ, Billich C. The TransEurope FootRace Project: longitudinal data acquisition in a cluster randomized mobile MRI observational cohort study on 44 endurance runners at a 64-stage 4,486 km transcontinental ultramarathon. BMC Med 2012; 10:78. [PMID: 22812450 PMCID: PMC3409063 DOI: 10.1186/1741-7015-10-78] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 07/19/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The TransEurope FootRace 2009 (TEFR09) was one of the longest transcontinental ultramarathons with an extreme endurance physical load of running nearly 4,500 km in 64 days. The aim of this study was to assess the wide spectrum of adaptive responses in humans regarding the different tissues, organs and functional systems being exposed to such chronic physical endurance load with limited time for regeneration and resulting negative energy balance. A detailed description of the TEFR project and its implemented measuring methods in relation to the hypotheses are presented. METHODS The most important research tool was a 1.5 Tesla magnetic resonance imaging (MRI) scanner mounted on a mobile unit following the ultra runners from stage to stage each day. Forty-four study volunteers (67% of the participants) were cluster randomized into two groups for MRI measurements (22 subjects each) according to the project protocol with its different research modules: musculoskeletal system, brain and pain perception, cardiovascular system, body composition, and oxidative stress and inflammation. Complementary to the diverse daily mobile MR-measurements on different topics (muscle and joint MRI, T2*-mapping of cartilage, MR-spectroscopy of muscles, functional MRI of the brain, cardiac and vascular cine MRI, whole body MRI) other methods were also used: ice-water pain test, psychometric questionnaires, bioelectrical impedance analysis (BIA), skinfold thickness and limb circumference measurements, daily urine samples, periodic blood samples and electrocardiograms (ECG). RESULTS Thirty volunteers (68%) reached the finish line at North Cape. The mean total race speed was 8.35 km/hour. Finishers invested 552 hours in total. The completion rate for planned MRI investigations was more than 95%: 741 MR-examinations with 2,637 MRI sequences (more than 200,000 picture data), 5,720 urine samples, 244 blood samples, 205 ECG, 1,018 BIA, 539 anthropological measurements and 150 psychological questionnaires. CONCLUSIONS This study demonstrates the feasibility of conducting a trial based centrally on mobile MR-measurements which were performed during ten weeks while crossing an entire continent. This article is the reference for contemporary result reports on the different scientific topics of the TEFR project, which may reveal additional new knowledge on the physiological and pathological processes of the functional systems on the organ, cellular and sub-cellular level at the limits of stress and strain of the human body. Please see related articles: http://www.biomedcentral.com/1741-7015/10/76 and http://www.biomedcentral.com/1741-7015/10/77.
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Affiliation(s)
- Uwe H W Schütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Germany.
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Racaza GZ, Salido EO, Penserga EG. Clinical profile of Filipino patients with osteoarthritis seen at two arthritis clinics. Int J Rheum Dis 2012; 15:399-406. [PMID: 22898220 DOI: 10.1111/j.1756-185x.2012.01758.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM To describe a cohort of Filipinos with primary osteoarthritis (OA). METHOD Charts with diagnosis of OA from two arthritis clinics (Philippine General Hospital and a private clinic) from January 2008 to May 2011, were reviewed for demographics, clinical presentation, risk factors and management. Descriptive statistics were applied. RESULTS Eight hundred and fifty-nine (859) patients had primary OA. Female-to-male ratio was 3 : 1. Mean age at diagnosis was 63 years, onset at 59 years. Men consulted 10 months later. Mean body mass index was 27.1 kg/m(2). Women were overweight, men, obese. Co-morbid conditions included hypertension (53%), dyslipidemia (16%) and diabetes (13%). Women (94.7%) developed symptoms 12 years after menopause. One-third of patients were of low socioeconomic status. Chief complaint was pain in 92.8%. Joint findings included crepitus (70.8%) and Heberden's nodes (13.0%) for knees and hands, respectively. Commonly involved joints were knees (62.5%), knees and hands (14.3%), and generalized joint involvement (13.5%). The hip was involved in 2.9% of cases. Radiographs showed Kellgren-Lawrence score of 2 in 56.6%. Less than 25% received physical therapy. Most prescribed drugs were glucosamine sulfate (45.5%), paracetamol (42.8%) and coxibs (40.6%). Less than 8% received intra-articular treatment, or were referred for surgery. CONCLUSION We described a large cohort of Filipino OA patients. Clinical characteristics show more women than men, with knees as the most common and hips as the least involved joints. Medical management was based on a local practice guideline. Compared to the literature, this cohort had more overweight than obese subjects and low surgical referral. A coordinated registry with orthopedics and physiatry departments is currently underway.
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Affiliation(s)
- Geraldine Zamora Racaza
- Section of Rheumatology, Department of Medicine, University of the Philippines College of Medicine - Philippine General Hospital, Manila, Philippines
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Guermazi A, Roemer FW, Burstein D, Hayashi D. Why radiography should no longer be considered a surrogate outcome measure for longitudinal assessment of cartilage in knee osteoarthritis. Arthritis Res Ther 2011; 13:247. [PMID: 22136179 PMCID: PMC3334624 DOI: 10.1186/ar3488] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Imaging of cartilage has traditionally been achieved indirectly with conventional radiography. Loss of joint space width, or 'joint space narrowing', is considered a surrogate marker for cartilage thinning. However, radiography is severely limited by its inability to visualize cartilage, the difficulty of ascertaining the optimum and reproducible positioning of the joint in serial assessments, and the difficulty of grading joint space narrowing visually. With the availability of advanced magnetic resonance imaging (MRI) scanners, new pulse sequences, and imaging techniques, direct visualization of cartilage has become possible. MRI enables visualization not only of cartilage but also of other important features of osteoarthritis simultaneously. 'Pre-radiographic' cartilage changes depicted by MRI can be measured reliably by a semiquantitative or quantitative approach. MRI enables accurate measurement of longitudinal changes in quantitative cartilage morphology in knee osteoarthritis. Moreover, compositional MRI allows imaging of 'pre-morphologic' changes (that is, visualization of subtle intrasubstance matrix changes before any obvious morphologic alterations occur). Detection of joint space narrowing on radiography seems outdated now that it is possible to directly visualize morphologic and pre-morphologic changes of cartilage by using conventional as well as complex MRI techniques.
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Affiliation(s)
- Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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Driban JB, Lo GH, Lee JY, Ward RJ, Miller E, Pang J, Price LL, McAlindon TE. Quantitative bone marrow lesion size in osteoarthritic knees correlates with cartilage damage and predicts longitudinal cartilage loss. BMC Musculoskelet Disord 2011; 12:217. [PMID: 21961433 PMCID: PMC3190349 DOI: 10.1186/1471-2474-12-217] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 09/30/2011] [Indexed: 11/10/2022] Open
Abstract
Background Bone marrow lesions (BMLs), common osteoarthritis-related magnetic resonance imaging findings, are associated with osteoarthritis progression and pain. However, there are no articles describing the use of 3-dimensional quantitative assessments to explore the longitudinal relationship between BMLs and hyaline cartilage loss. The purpose of this study was to assess the cross-sectional and longitudinal descriptive characteristics of BMLs with a simple measurement of approximate BML volume, and describe the cross-sectional and longitudinal relationships between BML size and the extent of hyaline cartilage damage. Methods 107 participants with baseline and 24-month follow-up magnetic resonance images from a clinical trial were included with symptomatic knee osteoarthritis. An 'index' compartment was identified for each knee defined as the tibiofemoral compartment with greater disease severity. Subsequently, each knee was evaluated in four regions: index femur, index tibia, non-index femur, and non-index tibia. Approximate BML volume, the product of three linear measurements, was calculated for each BML within a region. Cartilage parameters in the index tibia and femur were measured based on manual segmentation. Results BML volume changes by region were: index femur (median [95% confidence interval of the median]) 0.1 cm3 (-0.5 to 0.9 cm3), index tibia 0.5 cm3 (-0.3 to 1.7 cm3), non-index femur 0.4 cm3 (-0.2 to 1.6 cm3), and non-index tibia 0.2 cm3 (-0.1 to 1.2 cm3). Among 44 knees with full thickness cartilage loss, baseline tibia BML volume correlated with baseline tibia full thickness cartilage lesion area (r = 0.63, p< 0.002) and baseline femur BML volume with longitudinal change in femoral full thickness cartilage lesion area (r = 0.48 p< 0.002). Conclusions Many regions had no or small longitudinal changes in approximate BML volume but some knees experienced large changes. Baseline BML size was associated to longitudinal changes in area of full thickness cartilage loss.
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Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111, USA.
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