Vertebral fracture severity assessment on anteroposterior radiographs with a new semi-quantitative technique

We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes.

PURPOSE

The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs.

METHODS

On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs.

RESULTS

The height-to-width ratio of the half vertebrae varied 1.32-1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively.

CONCLUSION

We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs.

Associations between anterior knee pain and 2-year patellofemoral cartilage worsening: The MOST study

OBJECTIVE

Anterior knee pain (AKP) is associated with patellofemoral osteoarthritis (PFOA), but longitudinal studies are lacking. If AKP precedes PFOA, it may create an opportunity to identify and intervene earlier in the disease process. The purpose of this study was to examine the longitudinal relation of AKP to worsening patellofemoral (PF) cartilage over two years.

DESIGN

Participants were recruited from the Multicenter Osteoarthritis Study, a longitudinal study of individuals with or at risk for knee osteoarthritis (OA). Exclusion criteria included bilateral knee replacements, arthritis other than OA, and radiographic PFOA. At baseline, participants completed a knee pain map questionnaire and underwent knee magnetic resonance imaging (MRI). Imaging was repeated at 2-year follow-up. Exposure was presence of frequent AKP. Outcome was worsening cartilage damage in the PF joint defined as increase in MRI Osteoarthritis Knee Score from baseline to 2 years. Log-binomial models were used to calculate risk ratios (RR).

RESULTS

One knee from 1083 participants (age 56.7 ± 6.6 years; body mass index 28.0 ± 4.9 kg/m2) was included. Frequent AKP and frequent isolated AKP were present at baseline in 14.5% and 3.6%, respectively. Frequent AKP was associated with an increased risk (RR: 1.78, 95% confidence interval: 1.21, 2.62) of 2-year worsening cartilage damage in the lateral PF compartment. No association was found between frequent AKP and worsening in the medial PF joint.

CONCLUSION

Frequent AKP at baseline was associated with worsening cartilage damage in the lateral PF joint over 2 years.

Prevalence of intra-articular mineralization on knee computed tomography: the multicenter osteoarthritis study

OBJECTIVE

The aim of this work was to report the prevalence of computed tomography (CT)-detected intra-articular mineralization.

DESIGN

We included participants from the Multicenter Osteoarthritis (MOST) Study. At the 12th year visit of the MOST study, bilateral knee CTs were first obtained. All participants also had posteroanterior and lateral radiographs of bilateral knees and completed standard questionnaires. Knee radiographs were assessed for Kellgren & Lawrence grade (KLG) and radiographic evidence of intra-articular mineralization. CT images were scored using the Boston University Calcium Knee Score (BUCKS) for cartilage, menisci, ligaments, capsule, and vasculature. Prevalence of intra-articular mineralization was computed for the total sample, and stratified by age, sex, race, Body Mass Index (BMI), presence of frequent knee pain, and KLG. We also determined distribution of mineralization in the cartilage and meniscus, and co-localization.

RESULTS

4140 bilateral knees from 2070 participants were included (56.7% female, mean age 61.1 years, mean BMI: 28.8 kg/m2). On radiographs 240 knees (5.8%) had intraarticular mineralization, while CT-detected mineralization was present in 9.8% of knees. Prevalence of hyaline articular and meniscus mineralization increased with age and KL grade, and was similar by sex, BMI categories, and comparable in subjects with and without frequent knee pain. Mineralization tended to be ubiquitous in the joint, most commonly involving all three (medial/lateral tibiofemoral and patellofemoral) compartments (3.1%), while the patellofemoral compartment was the most involved compartment in isolation (1.4%).

CONCLUSIONS

CT of the knee provides greater visualization of intra-articular mineralization than radiographs and allows better localization of the crystal deposition within the joint. Further studies should focus on the co-localization of intra-articular crystal deposition and corresponding magnetic resonance imaging (MRI)-features of knee osteoarthritis (OA).

Osteoarthritis Bone Marrow Lesions

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.

Imaging in Osteoarthritis

Osteoarthritis (OA) is the most frequent form of arthritis with major implications on both individual and public health care levels. The field of joint imaging, and particularly magnetic resonance imaging (MRI), has evolved rapidly due to the application of technical advances to the field of clinical research. This narrative review will provide an introduction to the different aspects of OA imaging aimed at an audience of scientists, clinicians, students, industry employees, and others who are interested in OA but who do not necessarily focus on OA. The current role of radiography and recent advances in measuring joint space width will be discussed. The status of cartilage morphology assessment and evaluation of cartilage biochemical composition will be presented. Advances in quantitative three-dimensional morphologic cartilage assessment and semi-quantitative whole-organ assessment of OA will be reviewed. Although MRI has evolved as the most important imaging method used in OA research, other modalities such as ultrasound, computed tomography, and metabolic imaging play a complementary role and will also be discussed.

POS0177 HETEROGENOUS CARTILAGE DAMAGE SEEN ON MRI AMONG KNEES WITH KELLGREN-LAWRENCE 2 & 3 OSTEOARTHRITIS: WHAT ARE THE IMPLICATIONS FOR CLINICAL TRIALS?

Background

The most recent update of the Global Burden of Disease figures (GBD 2013) estimated that 242 million people were living in the world with symptomatic and activity-limiting OA of the hip and/or knee. Many potential disease-modifying osteoarthritis drugs (DMOADs) have been investigated, but to date no DMOADs that slow or stop disease progression have been approved by the Food and Drug Administration (FDA) or the European Medicines Agency (EMA). A potential reason for the lack of demonstrated efficacy may be reliance on radiographs for defining structural inclusion and exclusion criteria for clinical trials, such as use of joint space width and Kellgren-Lawrence (KL) grade as surrogates for cartilage damage.

Objectives

To estimate the distribution of cartilage damage seen on knee MRI in a sample of knees with radiographic KL 2 and 3 OA that would potentially qualify for a DMOAD trial.

Methods

We selected knees from the Osteoarthritis Initiative (OAI), a longitudinal cohort study of knees with or at risk of developing symptomatic radiographic OA, that met common structural inclusion criteria for DMOAD trial enrollment at OAI baseline: knees with radiographs centrally graded as KL 2 or 3 and medial minimum joint space width (mJSW) ≥ 1.5mm. A musculoskeletal radiologist with 10 years of experience in semi-quantitative MRI assessment scored knee cartilage damage in the medial and lateral tibiofemoral and patellofemoral compartments using WORMS (Whole-Organ Magnetic Resonance Imaging Score). Coronal intermediate weighted (IW) TSE and sagittal fat-suppressed IW TSE sequences on 3T MRI were used. The WORMS cartilage scores, which are based on both the extent and depth of cartilage damage, were collapsed into 4 categories: no cartilage damage (WORMS 0 and 1), focal partial or full-thickness (PT/FT) cartilage damage (WORMS 2 and 2.5), diffuse partial thickness (PT) cartilage damage (WORMS 3 and 4), and diffuse full-thickness (FT) cartilage damage (WORMS 5 and 6). We estimated the prevalence of each category of cartilage damage in KL2 and KL3 knees; 95% confidence intervals (CI) accounted for clustering at the participant-level since some participants contributed two knees to the analysis.

Results

We identified 2,372 participants contributing 3,446 knees with radiographic OA (KL 2 and 3) and medial mJSW ≥ 1.5mm. There were 2,318 KL2 knees and 1,128 KL3 knees. The distribution of cartilage damage in each compartment by KL grade is presented in Table 1. We found no cartilage damage in any compartments in 9.8% (95%CI: 8.5, 11.1) of KL2 knees and 2.0% (95%CI: 1.1, 2.9) of KL3 knees. Cartilage damage was absent in the medial tibiofemoral compartment in 52.4% (95%CI: 50.1, 54.6) of KL2 knees, and 14.4% (95%CI: 12.2, 16.6) of KL3 knees, versus 61% (95%CI: 58.8, 63.2) of KL2 knees and 53.6% (95%CI: 50.4, 56.7) of KL3 knees in the lateral compartment. When medial and lateral compartments were combined, cartilage damage was absent in 34.8% (95%CI: 32.7, 36.9) of the KL2 knees, and 4.3% (95%CI: 3.0, 5.5) of the KL3 knees. Diffuse FT cartilage lesions in the medial compartment were found in 6.1% (95%CI: 5.0, 7.1) of KL2 knees and 42.5% (95%CI: 39.4, 45.6) of KL3 knees.

Conclusion

MRI screening prior to clinical trial enrollment may identify a substantial percentage of knees with normal cartilage, as well as knees with diffuse FT cartilage lesions that may not be responsive to DMOADs, depending on the mode of action of a given pharmacological compound.

Disclosure of Interests

Mohamed Jarraya: None declared, Frank Roemer Shareholder of: Boston Imaging Core Lab, Consultant of: California Institute of Biomedical Research, Erin Ashbeck: None declared, John Lynch: None declared, C. Kent Kwoh Consultant of: Novartis, Regeneron, LG Chem, Kolon Tissue Gene, Avalor, Grant/research support from: Pfizer, Lilly, Cumberland, Ali Guermazi Shareholder of: Stock options in BICL, Consultant of: Pfizer, TissueGene, MerckSerono, Regeneron, Novartis, AstraZeneca

Tunisian mothers facing the covid-19 pandemic: what are the risks for their mental health?

Introduction

Covid-19 pandemic put parents under great pressure, and the most vulnerable parents may have become too overwhelmed to find appropriate ways to be supportive caregivers and to address children’s fears and insecurities.

Objectives

Assess the level of parental stress experienced by mothers during the COVID-19 pandemic and compare it with that experienced by fathers.

Methods

This was a descriptive and comparative analytical study, shared on social networks during the period from 8 to 20 April 2021, targeting mothers of children aged 2 to 18 years. The mother answered the questionnaire for herself and her child. The level of stress experienced by the mother in the parent-child relationship during the COVID-19 pandemic was assessed by the brief version of the Parental Stress Index (PSI-SF).

Results

The total number of participants was 65 mothers. Parental stress level in mothers was high in 58.5%, the average PSI score was 94.25; the mean score of the parental distress subscale was 34.06; the mean score of the dysfunctional child-parent interaction subscale was 27.86; and the average score of the child difficulty subscale was 32.32. The mean scores of the parental distress subscale, the child difficulty subscale, as well as the mean PSI total score were significantly higher in mothers than in fathers, with p= 0.010; p= 0.022 and p=0.017 respectively.

Conclusions

Our results highlight a higher level of stress in mothers than in fathers. This can be explained the parental, marital and professional responsibilities imposed on women, underlining the urgent need to provide mothers with adequate support.

Disclosure

No significant relationships.

Fatigue in multiple sclerosis and its relation with depression

Introduction

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). It can be defined as a subjective lack of physical and mental energy.

Objectives

To study the prevalence of fatigue in patients with MS and to determine the factors related to it, including depression.

Methods

This was a cross-sectional, descriptive and analytical study, which took place in the neurology department in Sfax (Tunisia). It focused on patients with MS in remission phase. We used the Expanded Disability Status Scale (EDSS) to determine the degree of disability caused by MS, the Chalder Fatigue Scale to evaluate the fatigue, and the Hospital Anxiety and Depression Scale (HADS) to assess depressive symptoms.

Results

The 93 patients included in the study had a mean age of 36.59 ± 10.69 years. The socio-economic level was low to medium in 52.7% of cases. The EDSS score ranged from 0 to 8 (median = 3.5). The total number of relapses ranged from 1 to 30 (median = 3.5). MS patients had fatigue in 72.4% of cases and depression in 26.9% of cases. Patients with a low to medium socio-economic level were more fatigued (p=0.027). High number of MS relapses, severity of disability on the EDSS, and presence of depression were associated with fatigue (p=0.014, p<10^-3 and p=0.001, respectively).

Conclusions

In MS patients, fatigue is a common symptom. Patients with reduced physical activity and greater MS-related disability have more severe fatigue, which negatively affects psychosocial functioning, increasing the risk of depression.

Disclosure

No significant relationships.

Psychiatric manifestations of measles encephalitis: About a case report

Introduction

Acute measles encephalitis is a pathology of the central nervous system. It is most frequent in children but can also be described in adults. Given the rarity of this pathology, we present the case of this patient.

Objectives

present a rare neuropsychiatric complication of measles

Methods

Présentation d’un cas clinique d’encéphalite rougeoleuse et revue de la littérature

Results

Mrs. HJ, 45 years old, without any somatic history, was followed for an antisocial personality with a substance use disorder. She consulted the emergency for psychomotor agitation, a fever of 39, and a rash on the face, thorax, and limbs. At the psychiatric interview, she was disoriented and very unstable. She seemed to be hallucinating.

The brain imaging and the lumbar puncture (CT scan and brain MRI) were without abnormality. The rapid test (HIV) was negative and the biological check-up showed a hyperleukocytosis at 12660 and a crp at 138. The patient was put on double antibiotic therapy.

The evolution was marked by the non-improvement of the symptomatology with the persistence of agitation. Her speech was almost absent with a refusal to answer and to execute orders. She maintained certain postures. The patient was put on 400 mg of amisulpride.

After recovery of the viral serology, the diagnosis of a measles encephalopathy was confirmed (IgM positive) and the patient improved after a few days of hospitalization and was addressed to the psychiatric outpatient clinic.

Conclusions

Measles encephalitis is a rare but serious complication that requires multidisciplinary management

Disclosure

No significant relationships.

Quality of life of patients with schizophrenia

Introduction

Schizophrenia (SCZ) is considered one of the most disabling mental illnesses with significant family, social and occupational repercussions resulting in impaired quality of life (QOL).

Objectives

To assess the QOL of patients with SCZ or schizoaffective disorder (SAD) and to analyze the sociodemographic and clinical factors associated with its alteration.

Methods

This was a cross-sectional, descriptive and analytical study, which began in December 2019, conducted with 60 subjects followed for SCZ or SAD, at the psychiatry outpatient unit of the Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

Results

Patients enrolled had SCZ in 78.2% and SAD in 21.8% of cases. The mean age was 47.2 years and the sex ratio M/F was 4.5. They were single in 63.7% of cases and unemployed in 61.8%. Psychiatric family history, the presence of personal somatic illnesses and tobacco use were found in 43.6%, 61.8% and 67.3% of cases, respectively. The average QOL score was 57.7, the average physical health score was 61.1, and the average mental health score was 54.3. Female sex (p=0.02), being single (p=0.039), lack of work activity (p=0.00), tobacco use (p=0.05), and presence of medical history (p=0.034) were statistically correlated with impaired QOL.

Conclusions

QOL in SCZ and SAD is impaired. This result encourages us to conceive of the patient in his whole life and not only from the point of view of the disease.

Disclosure

No significant relationships.

Study of resilience in a population of tunisian residents and interns in medicine

Introduction

Resilience is the ability to bounce back or cope successfully with stress. Fostering resilience is a promising way to mitigate the negative effects of stressors and prevent burnout.

Objectives

Study the level of resilience among Tunisian medical interns and residents.

Methods

We conducted a cross-sectional descriptive study between March 1 and April 15, 2021. Medical interns and residents were invited to complete an online self-questionnaire. We used the Brief Resilience Scale (BRS) to assess the level of resilience.

Results

The total number of participants was 56 of which 28.6% were male. The average age was 26.76±2.52 years. Most of the students had studied at the Faculty of Medicine in Sfax, 58.9%. 64.3% of the participants were residents, 55.4% of them in a medical specialty. 75% of participants were working in a medical department. The average years of practice was 2.27±1.23. The number of working hours per week exceeding 40 hours was found in 60.7% of participants. The number of shifts per month exceeding 4 shifts was found in 67.9%. 46.4% of the participants wanted to change their profession and 44.6% regretted choosing medicine. The mean score by BRS was 2.79±0.48. The level of resilience was high in 42.9% of the participants and normal in the rest of the respondents.

Conclusions

The level of resilience was normal to high in Tunisian medical interns and residents. Assessing the presence of burnout and the coping strategies used could provide insight into the quality of work life.

Disclosure

No significant relationships.

Burden level among parents of children with epilepsy

Introduction

Family caregiving role of children with epilepsy involves managing the daily lives of these children with disabilities. This can lead to impaired physical and psychological health of the caregiver.

Objectives

To assess the level of burden among caregivers of children with epilepsy and to determine the factors associated with it.

Methods

It was a descriptive and analytical survey. It involved the caregivers of children with epilepsy who were admitted to the pediatric neurology department at the Hedi Chaker University Hospital in Sfax during the period from July to October 2020. We used the 12-item Zarit (ZBI-12), the State-Trait-Anxiety Inventory (STAI), and the “BECK” Depression Inventory (BDI-13) to assess caregiver burden, anxiety and depression respectively.

Results

Forty-four caregivers participated in the survey. Their average age was 36 years and their relationship with patient was mother in 93.2% of cases. Among 44 children with epilepsy, 56.8% were boys and 34.1% were schooled. They had psychiatric comorbidity in 15.9% of cases. According to the ZBI scale, the level of burden was high in 45.5% of cases. The total ZBI score was significantly higher among caregivers with primary school level (p=0.05) and those with somatic disease (p=0.004). It was not correlated with the presence of child’s dependence on the others (p=0.20). High levels of depression, anxiety-state, and anxiety-trait among caregivers were correlated with the level of burden (p 0.000; 0.000 and 0.001, respectively).

Conclusions

Being a caregiver of a child with epilepsy is a burdensome circumstance. Hence the importance of offering psychological assistance for these caregivers.

Disclosure

No significant relationships.

Psychological problems in tunisian children during the covid-19 pandemic

Introduction

The Covid-19 outbreak and the subsequent lockdown have profoundly impacted families’ daily life. Children may be among the most exposed to the psychosocial consequences of the pandemic.

Objectives

To assess the psychological well-being of children during the COVID-19 pandemic.

Methods

This was a descriptive study shared on social media during the period from 8 to 20 April 2021, targeting mothers of children aged 2 to 18 years. The first part included socio-demographic data of mothers and children. Then, to assess the behavior and coping skills of children and adolescents, we administered the Strengths and Difficulties Questionnaire (SDQ).

Results

Our study included 65 middle-aged moms = 35.28 years. Among mothers, 1.5% reported having at least one child with a psychiatric, medical or genetic illness. The average age of the children was 8.54 years, the sex ratio was 1.03 and they were in primary school in 52.3%. Moms had talked to their child about COVID in 93.8%, using scientific data in 69.4% of cases. The total average SDQ score was 10.82; and overall mental health was at risk in 15.4% of the children. They had risky emotional symptoms in 9.2%, risky aggressive behaviors in 12.3%, risky hyperactivity-inattention symptoms in 16.9%, relationship behaviors with at-risk pairs in 24.6%, and risky prosocial behavior in 9.2% of cases.

Conclusions

Researchers and government officials should be more concerned about the mental health of children who are often neglected as a result of the pandemic due to their comparatively lower mortality than older adults.

Disclosure

No significant relationships.

Body Image disturbance in patients with cancer

Introduction

Cancer and its treatments have been shown to have a negative psychological effect on many cancer patients. One of these effects is often described as body image disturbance.

Objectives

To assess body image in cancer patients and its association with clinical variables.

Methods

This was a cross-sectional study, conducted over 1 month, involving 100 cancer patients followed in the oncology department at the Habib Bourguiba University Hospital in Sfax (Tunisia). All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction.

Results

These results showed that half of the patients were female, and 70% of them were married. Their mean age was 51.96 years with extremes ranging from 41 to 60 years. Their level of education did not exceed primary school in 61% of cases, and 68% of them were unemployed. A total of 58% of patients received chemotherapy and 44%, 25%, and 11% of persons were affected by breast, digestive and cavum cancer, respectively. Impaired body image was noted in 81% of cases with an average BIS score of 15.39. An altered body image was statistically correlated with female sex (p = 0.005), absence of professional activity (p = 0.032), and the presence of anxiety-depressive symptoms (p = 0.008).

Conclusions

In this study most of the cancer patients had body image disturbances. Therefore, it is to the health team and nurses that take the concept of body image more serious and make use of some interventions to minimize the possible side effects.

Disclosure

No significant relationships.

Sexual functioning in patients with cancer

Introduction

Sexuality is a growing field in the context of the management of chronic diseases and cancer in particular. Cancer treatments and the traumatic nature of the cancer experience frequently elicit considerable sexual difficulties.

Objectives

To assess the prevalence of sexual dysfunction (SD) in patients with cancer, and to determine the associated factors.

Methods

This was a cross-sectional study, conducted over 1 month, involving 100 cancer patients followed in the oncology department at the Habib Bourguiba University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. Sexual function was assessed with the “Female sexual Function Index” and the “International Index of Erectile Function”.

Results

These results showed that half of the patients were female, and 70% of them were married. Their mean age was 51.96, and 68% of them were unemployed. Unemployment in men and treatment with chemotherapy were statistically associated with erectile dysfunction (p=0.049 and p= 0.001 respectively). treatment with radiotherapy was statistically associated with decreased desire in men (p=0.048). Depression correlated with a decreased orgasm (p=0.032) and erectile dysfunction (p=0.043) in men, mean score of IIEF (p= 0.019) and with a decreased sexual arousal (p=0.006) in women.

Conclusions

Sexual dysfunction is common in cancer patients. They can be of iatrogenic or psychological origin and can depend on the dynamics of the couple relationship. Training to raise awareness of the importance of sexuality first among cancer patients should be considered given the lack of communication between doctors and patients regarding sexuality issues.

Disclosure

No significant relationships.

The assessment of family caregivers’ anxiety in pediatric epilepsy : a cross-sectional sudy

Introduction

Pediatric epilepsy is a debilitating disease that impacts not only children with epilpsy but also persons arround them. It is often considered as a source of anxiety for family caregivers.

Objectives

Assess the level of anxiety in caregivers of children with epilepsy and to identify factors related to it.

Methods

We conducted a cross-sectional, descriptive and analytical study between July and October 2020. It included caregivers of children with epilepsy hospitalized in the pediatric neurology department of Sfax. We used the STAI-Y scale to assess the level of state anxiety (STAI-AE).

Results

Forty four womens participated in our study. Low socio-economic level was found in 31.8% of cases. The average age of children was 4.9 years. The mean duration of epilepsy was 2.2 years. It was comorbid with an autism spectrum disorder or an intellectual disability in 15.9% of cases. In 70.5% of the cases, the children were dependent on their caregivers in their daily lives. The level of anxiety was moderate in 27.3% and high to very high in 13.6% of them. A higher state-anxiety score was correlated with a longer duration of epilepsy (p=0.033), a lower familial socioeconomic level (p=0.013) and a higher number of children in family (p=0.048).

Conclusions

Pediatric epilepsy is associated with significant level of anxiety in family caregivers. This anxiety increases with the duration of the disease and with the presence of socioeconomic and family difficulties. Thus, psychosocial support for caregivers should be integrated into a global approach of the disease.

Disclosure

No significant relationships.

Burden level among parents of children with epilepsy

Introduction

Family caregiving role of children with epilepsy involves managing the daily lives of these children with disabilities. This can lead to impaired physical and psychological health of the caregiver.

Objectives

To assess the level of burden among caregivers of children with epilepsy and to determine the factors associated with it.

Methods

It was a descriptive and analytical survey. It involved the caregivers of children with epilepsy who were admitted to the pediatric neurology department at the Hedi Chaker University Hospital in Sfax during the period from July to October 2020. We used the 12-item Zarit (ZBI-12), the State-Trait-Anxiety Inventory (STAI), and the “BECK” Depression Inventory (BDI-13) to assess caregiver burden, anxiety and depression respectively.

Results

Forty-four caregivers participated in the survey. Their average age was 36 years and their relationship with patient was mother in 93.2% of cases. Among 44 children with epilepsy, 56.8% were boys and 34.1% were schooled. They had psychiatric comorbidity in 15.9% of cases. According to the ZBI scale, the level of burden was high in 45.5% of cases. The total ZBI score was significantly higher among caregivers with primary school level (p=0.05) and those with somatic disease (p=0.004). It was not correlated with the presence of child’s dependence on the others (p=0.20). High levels of depression, anxiety-state, and anxiety-trait among caregivers were correlated with the level of burden (p 0.000; 0.000 and 0.001, respectively).

Conclusions

Being a caregiver of a child with epilepsy is a burdensome circumstance. Hence the importance of offering psychological assistance for these caregivers.

Disclosure

No significant relationships.

cognitive complaints in schizophrenia: characteristics and relationship with insight

Introduction

Patients with schizophrenia suffer from cognitive difficulties expressed in the form of complaints as well as poor insight. The interaction of these two factors makes the management of these patients more difficult.

Objectives

To assess subjective cognitive complaints in a population of schizophrenics and study its relationship to insight.

Methods

Our study was a cross-sectional, descriptive, and analytical study of 72 stabilized schizophrenics followed up at the outpatient clinic. Subjective cognitive complaints were assessed by the SSTICS, clinical symptoms by the PANSS, and insight by the SAI-E.

Results

The mean age of our population was 46.83± 11.6 years. The patients had a low socio-economic level in 70.1%. They were unemployed in 46.9% , consumed alcohol in 23.6%, and consumed tobacco in 58,6% of the cases. the total score on the PANSS scale was 46. They had an average score of 25 on the total SSTICS score and 20,1 on the SAI-E. Cognitive complaint scores were significantly correlated with improved insight (p=0,00),low socio-economic level (p=0.04),alcoholism (p=0.001) and smoking (p=0.01)

Conclusions

Cognitive complaints in schizophrenia could be influenced by the level of clinical insight and reflect a deep malaise, requiring a more targeted and optimized management

Disclosure

No significant relationships.

Sexual dysfunction and quality of life among Tunisian patients with schizophrenia

Introduction

Sexual dysfunction (SD) is prevalent among psychiatric patients than general population.

Objectives

To assess the SD and quality of life (QOL) of patients with schizophrenia, and to identify the factors associated with it.

Methods

This was a cross-sectional, descriptive and analytical study, which began in December 2019, conducted with 60 subjects followed for SCZ or SAD, at the psychiatry outpatient unit of the Hédi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. The Arizona Sexual Experiences Scale (ASEX) and the 36 item Short-Form Health Survey (SF-36) were used to evaluate subjective sexual dysfunction and QOL respectively.

Results

Patients enrolled had SCZ in 78.2% and SAD in 21.8% of cases. The mean age was 47.2 years. Psychiatric family history, the presence of personal somatic illnesses and tobacco use were found in 43.6%, 61.8% and 67.3% of cases, respectively. The average score of ASEX was 18.21. QOL was altered in 73.3% of participants with an SGM of 53.29. The psychic component was more altered than the physical one with average scores estimated respectively at 48 and 58.44. Participants with SD were more likely to have tobacco consumption (p= 0.025), history of suicide attempt (p=0.023) and they are treated by a combination of several treatments (p=0.025). Impaired QOL was not statistically correlated with SD (p=0.5)

Conclusions

The physicians should pay attention to SD during the assessment and treatment of patients with schizophrenia.

Disclosure

No significant relationships.

Association between hamstring coactivation during isokinetic quadriceps strength testing and knee cartilage worsening over 24 months

OBJECTIVE

This study aimed to determine longitudinal associations, including sex-specific differences, between greater knee flexor antagonist coactivation and worsening cartilage morphology in knees with or at risk for osteoarthritis (OA).

DESIGN

Baseline measurements were collected at the 60-month visit of a longitudinal osteoarthritis study following community-dwelling participants (MOST). Knee flexor and extensor muscle activity were measured with surface electromyography during a maximal isokinetic knee extension task. MRI analyzed knee cartilage morphology at baseline and 24-month follow-up. Multivariable adjusted logistic regression models were used to assess associations between coactivation level and cartilage morphology worsening.

RESULTS

Analysis of 373 women (mean ± SD age 67.4 ± 7.3 years and BMI 29.7 ± 5.0 kg/m2) and 240 men (66.5 ± 7.8 years and 29.9 ± 4.5 kg/m2) revealed that women had greater medial (P < 0.001), lateral (P < 0.001), and combined (P < 0.001) hamstring coactivation than men. In both sexes, combined hamstring coactivation was associated with patellofemoral cartilage morphology worsening [1.23 (1.02, 1.49)] and to a less significant degree with whole knee cartilage morphology worsening [1.21 (0.98, 1.49)]. In men, greater combined hamstring coactivation was associated with increased risk for whole knee [1.59 (1.06, 2.39)] and patellofemoral [1.38 (1.01, 1.88)] cartilage morphology worsening and point estimates suggested association between medial hamstring coactivation and medial tibiofemoral cartilage morphology worsening. No significant associations were detected between greater hamstring coactivation and cartilage morphology worsening in women.

CONCLUSIONS

These findings suggest a longitudinal relationship between antagonist hamstring coactivation during isokinetic knee extensor testing and worsening of cartilage morphology over 24 months in men with or at risk for knee OA.

Heterogeneity of cartilage damage in Kellgren and Lawrence grade 2 and 3 knees: the MOST study

OBJECTIVE

Eligibility for clinical trials in osteoarthritis (OA) is usually limited to Kellgren-Lawrence (KL) grades 2 and 3 knees. Our aim was to describe the prevalence and severity of cartilage damage in KL 2 and 3 knees by compartment and articular subregion.

DESIGN

The Multicenter Osteoarthritis (MOST) study is a cohort study of individuals with or at risk for knee OA. All baseline MRIs with radiographic disease severity KL2 and 3 were included. Knee MRIs were read for cartilage damage in 14 subregions. We determined the frequencies of no, any and widespread full-thickness cartilage damage by knee compartment, and the prevalence of any cartilage damage in 14 articular subregions.

RESULTS

665 knees from 665 participants were included (mean age 63.8 ± 7.9 years, 66.5% women). 372 knees were KL2 and 293 knees were KL3. There was no cartilage damage in 78 (21.0%) medial tibio-femoral joint (TFJ), 157 (42.2%) lateral TFJ and 62 (16.7%) patello-femoral joint (PFJ) compartments of KL2 knees, and 17 (5.8%), 115 (39.3%) and 35 (12.0%) compartments, respectively, of KL3 knees. There was widespread full-thickness damage in 94 (25.3%) medial TFJ, 36 (9.7%) lateral TFJ and 176 (47.3%) PFJ compartments of KL2 knees, and 217 (74.1%), 70 (23.9%) and 104 (35.5%) compartments, respectively, of KL3 knees. The subregions most likely to have any damage were central medial femur (80.5%), medial patella (69.8%) and central medial tibia (69.9).

CONCLUSIONS

KL2 and KL3 knees vary greatly in cartilage morphology. Heterogeneity in the prevalence, severity and location of cartilage damage in in KL2 and 3 knees should be considered when planning disease modifying trials for knee OA.

Should return to pivoting sport be avoided for the secondary prevention of osteoarthritis after anterior cruciate ligament reconstruction? A prospective cohort study with MRI, radiographic and symptomatic outcomes

OBJECTIVE

To evaluate if returning to pivoting sport following anterior cruciate ligament reconstruction (ACLR) is associated with longitudinal structural and symptomatic osteoarthritis outcomes.

DESIGN

Eighty-one adults aged 18-50 years were followed prospectively 1- to 5-years post-ACLR. Return to pivoting sport was assessed at 1-, 3- and 5-years. Longitudinal changes in osteoarthritis features were evaluated from 1- and 5-year magnetic resonance imaging (MRI)s using MRI Osteoarthritis Knee Score (MOAKS). Radiographic osteoarthritis and self-reported knee symptoms, function and quality of life were assessed using the Osteoarthritis Research Society International (OARSI) atlas and Knee injury Osteoarthritis Outcome Score (KOOS), respectively, at 5 years post-ACLR. Generalised linear models (adjusted for baseline characteristics) assessed whether returning to pivoting sport was associated with risk of worsening osteoarthritis features on MRI, radiographic osteoarthritis and KOOS.

RESULTS

Thirty participants returned to pivoting sport 1-year post-ACLR and 50 returned at any time (i.e., 1-, 3- or 5-years). Returning to pivoting sport was not associated with worsening of any MRI osteoarthritis feature (risk ratio (RR) range: 0.59-2.91) or 5-year KOOS (β range: -2.73-3.69). Returning to pivoting sport at 1-year and up to 5-years post-ACLR was associated with a 50% (RR 0.49, 95%CI 0.10-2.37) and 40% (RR 0.60, 95%CI 0.16-2.17) reduced risk of radiographic osteoarthritis, respectively, but these risk reductions were inconclusive due to wide confidence intervals.

CONCLUSION

After ACLR, returning to pivoting sport was not associated with increased risk of worsening knee osteoarthritis features on MRI, radiographic osteoarthritis or knee symptoms. Participation in pivoting sport need not be avoided as part of osteoarthritis secondary prevention strategies.

Relation of MRI-Detected Features of Patellofemoral Osteoarthritis to Pain, Performance-Based Function, and Daily Walking: The Multicenter Osteoarthritis Study

OBJECTIVE

The study objective was to determine the relationship of magnetic resonance imaging (MRI)-detected features of patellofemoral joint osteoarthritis to pain and functional outcomes.

METHODS

We sampled 1,099 participants from the 60-month visit of the Multicenter Osteoarthritis Study (mean ± SD age: 66.8 ± 7.5 years; body mass index: 29.6 ± 4.8; 65% female). We determined the prevalence of MRI-detected features of patellofemoral joint osteoarthritis (eg, cartilage damage, bone marrow lesions, and osteophytes) and assessed the relationship between these features and knee pain severity, knee pain on stairs, chair stand time, and walking less than 6,000 steps per day. We evaluated the relationship of MRI features to each outcome using logistic and linear regression, adjusting for potential covariates.

RESULTS

Participants with cartilage damage in 3-4 subregions had the highest mean pain severity (22.0/100; 95% confidence interval [CI]: 17.6-26.4 mm). They also showed higher odds of having at least mild pain on stairs (odds ratio [OR]: 3.3; 95% CI: 1.7-6.5) and of walking less than 6,000 steps per day (OR: 2.3; 95% CI: 1.1-4.4) compared with those without cartilage damage. Participants with bone marrow lesions in 3-4 subregions had higher odds of at least mild pain on stairs than those without (OR: 3.3; 95% CI: 2.2-5.2). Participants with osteophytes in 3-4 subregions also had higher odds of walking less than 6,000 steps/day (OR 2.1, 95% CI: 1.3-3.5, respectively).

CONCLUSION

MRI-detected features of osteoarthritis of the patellofemoral joint are related to pain and functional performance. This knowledge highlights the need to develop treatments for those with patellofemoral joint osteoarthritis to improve pain and maximize function.

Chronic inflammatory bowel diseases and sexuality: Inevitable disorders?

Introduction

Improving the quality of sexual life of patients has become a major therapeutic objective in the management of Chronic Inflammatory Bowel Diseases (CIBD).

Objectives

To assess the prevalence of sexual dysfunction (SD) in patients with CIBD in remission and compare it to healthy controls (HC), and to determine the associated factors

Methods

This was a cross-sectional study, conducted over 8 months, involving 36 patients with CIBD, who attended the gastroenterology outpatient of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 36 HC. Sexual function was assessed with the “Female sexual Function Index” and the “International Index of Erectile Function”.

Results

In the sample of CIBD, the prevalence of SD was 65.4% in women and 50% in men. Compared to controls, patients with male gender had significantly more impaired erection and orgasm (p=0.005; p=0.002 respectively), and those with female gender had significantly more impaired sexual arousal and desire (p=0.003; p=0.028 respectively). In the sample of patients, having a poor marital harmony and a fewer sexual attraction towards partner were correlated with decreased desire (p=0.017) in men and with sexual arousal (p=0.024) and decreased desire (p=0.048) in women. The number of relapses negatively affects erection (p=0.038) and orgasm (p=0.048). Depression correlated with a decreased orgasm (p=0.001) and desire (p=0.048) in men, and with a decreased sexual arousal (p=0.006) in women.

Conclusions

SD is common in CIBD, hence the need for a multidisciplinary approach to allow improvement of the quality of life of these patients, and of their partners.

Quality of life and mood disorders

Introduction

Many researches addressing quality of life (QOL) has been demonstrated its impairment during acute episodes of bipolar disorder (BD) and major depressive disorder (MDD).

Objectives

To compare QOL between patients with remitted MDD and remitted BD and healthy controls (HC).

Methods

A comparative and analytical study, conducted over 3 months in the outpatient psychiatric department of Hedi Chaker University Hospital in Sfax (Tunisia) among 30 patients with remitted BD, 30 patients with remitted MDD and 34 HC. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

Results

Compared with HC, the MDD and the BD groups had significantly lower scores for the total of the SF-36 and its sub-domains (table 1). Physical scores were lower in patients with MDD, compared with patients with BD (table 1). Table 1: Comparison of SF-36 sub-domain scores between MDD, BD patients, and HC.Sub-domains of the SF36MDDBDHCPMean physical score - Physical functioning - limitation due to physical health - Pain - General health45.5 67 42.5 60 48.559,28 69,00 44,17 67,13 56,8377,86 84,26 71,03 83,50 72,050.000 0.003 0.005 0.001 0.000Mean psychic score - limitation due to emotional problems - Social functioning - Energy/fatigue - Emotional well-being 47.25 41 55.8 40 5248,19 48.89 43.48 46.5 53.8668,66 76.97 75.52 56.02 66.120,000 0.000 0.000 0.002 0.007Mean global score50.8853,7373,780,000

Conclusions

QOL of patients with mood disorders such as MDD and BD suffered damage even in euthymic periods.

Study of risk factors for suicide attempts in patients with bipolar disorder

Introduction

Bipolar disorder (BD) has the highest suicide attempt rate among psychiatric disorders. Many factors are associated with the risk of suicide attempt in BD, but the relation between them has still not been explicitly stated.

Objectives

This study aimed to examine the clinical variables characterizing patients with BD with prior suicide attempt (PSA).

Methods

This was a descriptive and analytical study, conducted over 3 months, involving 31 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. Quality of life (QOL) was assessed with the «36 item Short-Form Health Survey» (SF-36). Impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11).

Results

The mean age was 47.25 years and the sex ratio was 1.6. Family history of suicide attempts was found in 25% of cases. Mean score of SF36 was 34 and high degree of impulsivity was noted in 62.5% of cases. The frequency of BD patients with PSA was 12.3% (N=8), with two of these (25%) having more than one PSA. Comorbid alcohol abuse (p=0.000), somatic illness (p=0.013), high degree of impulsivity (p=0.032), and impaired quality of live (p=0.003) were significantly more frequent in BD patients with PSA.

Conclusions

We found several clinical variables associated with PSA in BD patients. Even though these retrospective findings did not address causality, they could be clinically relevant to better understanding suicidal behavior in BD and adopting proper strategies to prevent suicide in higher risk patients.

Quality of life in euthymic patients with bipolar disorder

Introduction

Patients with bipolar disorder (BD) frequently experience residual symptoms, problems in psychosocial functioning, cognitive impairment, and poor quality of life (QOL).

Objectives

* To evaluate the QOL of euthymic patients with BD compared to healthy controls (HC). * To identify factors associated with its deterioration.

Methods

This is a comparative and analytical study, conducted over 3 months, involving 30 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). They were compared to 34 HC. General, clinical and therapeutic data were collected using a pre-established questionnaire. QOL was assessed with the «36 item Short-Form Health Survey» (SF-36).

Results

The mean ages of BD patients and HC were 44.17 years and 40.1 years, respectively. Compared with HC, patients with BD had decreased overall SF-36 scores (53.73 vs 73.78; p=0.000) and decreased physical and psychological subdomain scores (p=0.001; p=0.000). The study of the relationship between the dimensional average scores and different variables revealed correlations between; physical health problems and somatic disease (p=0.021) and unemployment (p=0.001), impaired general health and somatic disease (p=0.02) and psychotropic association (p=0.021), emotional health problems and psychiatric family history (p=0.023), pain and psychotropic association (p=0.031), and impaired global QOL and psychiatric family history (p=0.05).

Conclusions

Our results confirm the impairment of the QOL of patients with BD even in euthymic periods. Many factors have been associated, including demographic and clinical variables. The improvement of QOL is to consider these factors in the management of these patients.

Depression in quarantined patients during the COVID-19 pandemic

Introduction

Quarantine for suspected patients of being infected by the COVID-19 can lead to negative consequences for mental health and the appearance of depressive symptoms.

Objectives

To assess the prevalence of depression in quarantined patients, and to analyze the associated factors.

Methods

This was a descriptive and analytical survey, carried out from April 4 to May 30, 2020, with 149 patients consulting the COVID-19 sorting box at the Hedi Chaker CHU in Sfax. Suspected COVID-19 patients were contacted by phone during their quarantine and invited to participate in our study. The Patient Health Questionnaire (PHQ-9) scale was used to assess the severity of depression. Cutoffs of 5, 10, 15, and 20 represent minimal, mild, moderate, moderately severe, and severe levels of depression based on PHQ-9 scores. A cutoff score of 10 determines major depression.

Results

The results showed a prevalence of major depression of 10.7%. Of all patients, 89.3% had minimal to mild depression; 10% had moderate to moderately severe depression and 0.7% had severe depression. The PHQ-9 score was statistically correlated with travel to a suspect area during the 14 days preceding the consultation (p = 0.008), contact with a subject confirmed COVID-19 (p = 0.01), previous follow-up in psychiatry (p = 0.047), the change of residence during quarantine (p = 0.045), the fear of transmitting the disease to relatives (p = 0.00) and the positive result of the nasopharyngeal swab (p = 0.00).

Conclusions

Psychological distress was felt in our patients. We recommend that necessary measures should be taken to combat depression.

A descriptive study of fratricide in tunisia

Introduction

Violence between brothers and / or sisters is one of the most important forms of violence within families. To understand homicides between them, the hypothesis of rivalry has been put forward. But how is it really in reality?

Objectives

To construct both the clinical and medicolegal profile of perpetrators of fratricide and sororicide.

Methods

This is a retrospective study of 12 cases of fratricide, which were examined in the context of criminal psychiatric expertise in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2002 and December 2018.

Results

The mean age of offenders was 31.9 years; they were all male. Eight fratricide perpetrators were unmarried and had an irregular occupation. They had a psychiatric follow-up prior to homicide in 5 cases. Previous criminal records were noted in one third of the cases. Three perpetrators of fratricide were using psychoactive substances. History of violence against the victim was presented in 7/12 of cases, and the victim was younger than the perpetrator in 5 cases. Aggression was premeditated in 4 cases. The knife was the most used weapon (11/12). Seven offenders suffered from a major mental illness. The most common diagnosis was schizophrenia (6/12). The experts had concluded that 8 cases were in a state of insanity at the time of the offense.

Conclusions

Our data indicates that fratricides are lack preparation and most often preceded by violence. It seems to be important to do other researches to assess psychopathology and assess risk factors for fratricide.

Perceived stress among suspected patients during the COVID-19 outbreak in Tunisia

Introduction

Widespread outbreaks of infectious disease, such as COVID-19, are associated with psychological distress and symptoms of mental illness especially for patients with suggestive symptoms.

Objectives

Predict the prevalence of perceived stress and study associated factors among patients with suspected COVID-19 infection.

Methods

A cross sectional study was conducted between April and May 2020. Patients consulting the sorting box at the Hedi Chaker Hospital of Sfax and declared suspect to be infected by COVID-19 were invited to participate in our study after given their cosent. Perceived Stress Scale-10 was used to evaluate prevalence of perceived stress.

Results

In total, 149 participants participated. The mean age was 38.8±15.39 years. Medical or surgical history and psychiatric history were identified respectively in 30,2% and 12.1% of participants. Among all respondents, 74.5% took a nasopharyngeal swab to look for COVID-19 and only 6.4% had a positive test. Close contact with someone with a positive COVID-19 infection was found in 8.05%. Several participants (79,2%) expressed fear of transmitting the disease to their family members. The mean of the PSS-10 score was 11.97±9.83. Moderate to severe perceived stress was found in 44.3% of patients. Significantly higher scores were observed among participants with a positive pharyngeal swab for COVID-19 as well as those who perceived worry of transmetting the disease. No significant differences in perceived stress’ scores according to socio-demographic data.

Conclusions

Perceived stress was high among patients with suspected COVID-19 infection. Perceiving worry of transmetting the disease and having a positive pharyngeal swab for COVID-19 were the principal risk factors.

Disclosure

No significant relationships.

Evaluating the structural effects of intra-articular sprifermin on cartilage and non-cartilaginous tissue alterations, based on sqMRI assessment over 2 years

OBJECTIVE

Sprifermin (recombinant human fibroblast growth factor-18), a potential disease-modifying osteoarthritis (OA) drug, demonstrated dose-dependent effects on femorotibial cartilage thickness (by quantitative magnetic resonance imaging [MRI]) in the phase II FORWARD study. This post-hoc analysis evaluated the potential effects of sprifermin on several articular structures in the whole joint over 24 months using semi-quantitative MRI assessment.

DESIGN

Patients aged 40-85 years with symptomatic radiographic knee OA, Kellgren-Lawrence grade 2 or 3, and medial minimum joint space width ≥2.5 mm in the target knee were randomized (1:1:1:1:1) to receive three double-blinded, once-weekly, intra-articular injections of sprifermin 30 μg or 100 μg or placebo every 6 (q6mo) or 12 months. 1.5- or 3 T MRIs were read using the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system at baseline and 24 months. Change from baseline at 24 months on compartment and/or whole knee level was assessed for cartilage morphology, bone marrow lesions (BMLs), and osteophytes by delta-subregional and delta-sum (DSM) approaches. Menisci, Hoffa-synovitis, and effusion-synovitis were also evaluated for worsening.

RESULTS

549 patients were included. Dose-dependent treatment effects from baseline to 24 months were observed on cartilage morphology (sprifermin 100 μg q6mo vs placebo; mean DSM (95% confidence interval [CI]) -0.6 (-1.5, 0.2); less cartilage worsening) in the entire knee and BMLs sprifermin 100 μg q6mo vs placebo; mean DSM (95% CI) -0.2 (-0.5, 0.1) in the patellofemoral compartment. No effects over 24 months were observed on osteophytes, menisci, Hoffa-synovitis or effusion-synovitis.

CONCLUSIONS

Positive effects associated with sprifermin were observed for cartilage morphology changes, and BML improvement. There were no meaningful negative or positive effects associated with sprifermin in the other joint tissues examined.

Association of knee OA structural phenotypes to risk for progression: a secondary analysis from the Foundation for National Institutes of Health Osteoarthritis Biomarkers study (FNIH)

PURPOSE

Aim was to stratify the knee MRIs of the Foundation for National Institutes of Health Osteoarthritis Biomarkers Consortium (FNIH) cohort into distinct structural phenotypes based on semiquantitative assessment and to determine risk for pain and structural progression over 48 months.

METHODS

The study sample from the FNIH project was selected as a nested case-control study with knees showing either 1) radiographic and pain progression (i.e., "composite" cases), 2) radiographic progression only ("JSL"), 3) pain progression only, and 4) neither radiographic nor pain progression. MRI was performed on 3T systems. MRIs were read according to the MOAKS scoring system. Knees were stratified into subchondral bone, cartilage/meniscus and inflammatory phenotypes using the baseline visits. The relation of each phenotype to risk of being in the combined JSL plus composite outcome or composite case only group compared to those not having that phenotype was determined using logistic regression. Only KL2 and 3 and those without root tears were included.

RESULTS

485 knees were included. 362 (75%) did not have any phenotype, while 95 (20%) had the bone phenotype, 22 (5%) the cartilage/meniscus phenotype and 19 (4%) the inflammatory phenotype. The bone phenotype was associated with a higher odds of the combined JSL plus composite outcome and composite outcome only (OR 1.81; [95%CI 1.14,2.85] and 1.65; 95%CI [1.04,2.61]) while the inflammatory (OR 0.96 [95%CI 0.38,2.42] and 1.25; 95%CI [0.48,3.25]) and the cartilage/meniscus phenotypes were not significantly associated with outcome (OR 1.30 95%CI [0.55,3.07] and 0.99; 95%CI [0.40,2,49]).

CONCLUSIONS

The bone phenotype was associated with increased risk of having both radiographic and pain progression. Phenotypic stratification may be useful to consider when selecting patients for inclusion in clinical trials.

Association of baseline and change in tibial and femoral cartilage thickness and development of widespread full-thickness cartilage loss in knee osteoarthritis - data from the Osteoarthritis Initiative

OBJECTIVE

To investigate whether baseline cartilage thickness and its longitudinal change are associated with incident widespread full-thickness cartilage loss (wsFTCL) in knee osteoarthritis, and whether there are optimal cut-off values for predicting wsFTCL.

METHODS

Central medial tibial (cMT) and femoral (cMF) cartilage were assessed using quantitative magnetic resonance imaging data from the Osteoarthritis Initiative cohort (N = 600 knees). Cartilage thickness was measured at baseline and 12 months. wsFTCL was defined semi-quantitatively (scores 2 and 3 from the MRI Osteoarthritis Knee Score) and its incidence at 24 months recorded. Logistic regression was used to determine the odds of developing wsFTCL for baseline and for each 0.1 mm decrease in cartilage thickness. Cut-off values were investigated using the minimal-p method and area under the Receiver Operating Characteristic curves (AUC).

RESULTS

Incident wsFTCL was observed in 66 (12%) and 73 (14%) knees in cMT and cMF, respectively. Lower baseline cMT and cMF cartilage thickness values were associated with wsFTCL (OR = 1.20; 95% CI: 1.11, 1.28 and OR = 1.15; 95% CI: 1.06 to 1.24, respectively). Optimal cut-off AUCs for the tibia and femur were 0.64 (0.57-0.70) and 0.63 (0.57-0.69), respectively. Longitudinal decrease in femoral, but not tibial, cartilage thickness was associated with incident wsFTCL (OR = 1.77; 95% CI: 1.30 to 2.40); optimal cut-off AUC 0.65 (95% CI: 0.58-0.72).

CONCLUSION

Lower baseline cMT and baseline/change (decrease) over 12 months in cMF cartilage thickness were associated with incident, location-specific, wsFTCL at 24 months. Optimal cut-off values were relatively low and of uncertain utility for predicting incident wsFTCL.

OP0183 DO CARTILAGE LAMINAR COMPOSITIONAL CHANGES AS ASSESSED BY T2 RELAXOMETRY PREDICT INCIDENT AND WORSENING OF STRUCTURAL MORPHOLOGIC DAMAGE IN THE SAME PLATE 3 YEARS LATER?

Background:

To address the question whether laminar changes in knee cartilage T2 are relevant for prediction of lesion onset or progression in the same articular plate we included two different samples from the Osteoarthritis Initiative (OAI) study without radiographic osteoarthritis (ROA), i.e. so-called “healthy controls” with no ROA in either knee and being free of risk factors, and those with K-L 0 in one knee and ROA in the contralateral knee. Given the concept of the osteochondral unit, we hypothesize that superficial T2 is elevated in cartilage plates with subsequent surface damage development or worsening and deep layer T2 is elevated for those with subsequent bone marrow lesion (BML) development or worsening.

Objectives:

To analyze whether knees with subsequent morphologic cartilage and BML development or worsening exhibit elevated cartilage T2 compared to those that do not develop such structural damage in the same plate 3 years later.

Methods:

We included 63 knees from the OAI without ROA (K-L 0), but with definite ROA (K-L ≥2) in the contralateral knee, and 78 participants from the OAI healthy reference cohort.

Cartilage integrity or damage and subchondral bone marrow lesions (BMLs) were assessed for year 1 (i.e. baseline (BL) in this analysis) and year 4 (Y4) in chronological order using the semi-quantitative MOAKS scoring system.

BL deep and superficial layer cartilage T2 was computed from sagittal multi-echo spin echo MR images. Because cartilage T2 is known to display spatial variation with tissue depth, the segmented cartilages were computationally divided into superficial and deep 50%, based on the distance between the segmented cartilage surface and bone interface. Statistical analyses were performed for the femoro-tibial (FT) joint on a plate level, i.e. medial femur (MF), medial tibia (MT), lateral femur (LF) and lateral tibia (LT), using UNIANOVA with adjustment for age, body mass index, sex, and sample.

Results:

141 participants were included. Of these 79 (56%) were women, had a mean age of 59.4 ± 9.1 years and a mean body mass index of 25.8 ± 4.1 m/kg2.

52 (37%) had prevalent cartilage lesions in the medial FT joint and 67 (48%) in the lateral FT joint. For BMLs these numbers were 15 (11%) medially and 14 (10%) laterally. Worsening of FT cartilage lesions from BL to Y4 were seen in 10 (7%) medially and 21 (15%) in the lateral FT compartment. Incident FT cartilage lesions were seen in 11 (11.5%) medially and 8 knees laterally. No worsening BMLs were seen medially and 2 knees showed worsening BMLs laterally. 10 (7%) knees showed incident BMLs medially and 8 (6%) knees in the lateral FT compartment.

Deep layer T2 showed prolongation in the LT in knees with incident LT cartilage lesions (n=8, 34.5 vs. 32.7 ms, p=0.02) and for MF in knees with MF cartilage lesion worsening (n=9, 47.6 vs. 41.4 ms, p=0.01) and MF BML incidence (n=6, 45.4 vs.41.6 ms, p=0.000). Superficial T2 showed prolongation in the MT only in those knees with MT cartilage lesion worsening (n=2, 47.3 vs. 43.4 ms, p=0.03). No additional associations were seen for the superficial layer.

Conclusion:

For knees without ROA, BL deep layer T2 prolongation was seen for those who developed incident cartilage damage in the LT, and those with worsening cartilage damage and incident BMLs in the MF, respectively. Superficial T2 showed prolongation only in the MT for those with MT cartilage lesion worsening.

In summary and contrary to our hypothesis the deep cartilage layer seems to be more relevant for cartilage damage development or worsening in the same FT plate than the superficial layer.

Acknowledgment:

German Bundesministerium für Bildung und Forschung (BMBF – 01EC1408D -OVERLOAD-PREVOP)

Disclosure of Interests:

Frank Roemer: None declared, Felix Eckstein Grant/research support from: Merck, Orthotrphix, Servier, Galapagos, Kolon Tissuegene, Samumed, Novartis, Consultant of: Merck, Bioclinica, Servier, Samumed, Roche, Kolon Tissuegene, Galapagos and Novartis, Employee of: co-owner and employment with Chondrometrics, Georg Duda: None declared, Susanne Maschek Shareholder of: Stock/stock options at Condrometrics GmbH, Employee of: Employment at Condrometrics GmbH, Ali Guermazi Consultant of: AventisGalapagos, Pfizer, Roche, AstraZeneca, Merck Serono, and TissuGene, Wolfgang Wirth: None declared

FRI0421 RATES OF PROGRESSION DIFFER BETWEEN STRUCTURAL PHENOTYPES OF KNEE OSTEOARTHRITIS: A SECONDARY ANALYSIS FROM THE FNIH COHORT

Background:

Imaging plays an important role in determining structural disease severity and potential suitability of patients recruited to disease-modifying osteoarthritis drug (DMOAD) trials. It has been suggested that there may be three main structural phenotypes in OA, i.e., inflammation, meniscus/cartilage and subchondral bone. These may progress differently and may represent distinct tissue targets for DMOAD approaches.

Objectives:

To stratify the Foundation for National Institutes of Health Osteoarthritis Biomarkers Consortium (FNIH) cohort, a well-defined subsample of the larger Osteoarthritis Initiative (OAI) study, into distinct structural phenotypes based on semiquantitative MRI assessment and to determine their risk for progression over 48 months.

Methods:

The FNIH was designed as a case-control study with knees showing either 1) radiographic and pain progression (i.e., “composite” cases), 2) radiographic progression only (“JSL”), 3) pain progression only, and 4) neither radiographic nor pain progression. MRI of both knees was performed on 3 T systems at the four OAI clinical sites. Two musculoskeletal radiologists read the baseline MRIs according to the MOAKS scoring system. Knees were stratified into subchondral bone, meniscus/cartilage and inflammatory phenotypes1. A secondary, less stringent definition for inflammatory and meniscus/cartilage phenotype was used for sensitivity analyses. The relation of each phenotype to risk of being in the JSL or composite case group compared to those not having that phenotype was determined using conditional logistic regression. Only KL2 and 3 and those without root tears were included.

Results:

485 knees were included. 362 (75%) did not have any phenotype, while 95 (20%) had the bone phenotype, 22 (5%) the cartilage/meniscus phenotype and 19 (4%) the inflammatory phenotype. The bone phenotype was associated with a higher risk of the JSL and composite outcome (OR 1.81;[95%CI 1.14,2.85] and 1.65; 95%CI [1.04,2.61]) while the inflammatory (OR 0.96 [95%CI 0.38,2.42] and 1.25; 95%CI [0.48,3.25]) and the meniscus/cartilage phenotypes were not (OR 1.30 95%CI [0.55,3.07] and 0.99; 95%CI [0.40,2,49]).

In sensitivity analyses, the bone phenotype and having two phenotypes (vs. none) were both associated with increased risk of experiencing the composite outcome (bone: OR 1.65; 95% CI 1.04, 2.61; 2 phenotypes: OR 1.87; 95% CI 1.11, 3.16.

Conclusion:

The bone phenotype was associated with increased risk of having both radiographic and pain progression together, or radiographic progression alone, whereas the inflammatory phenotype or meniscus/cartilage phenotype each individually were not associated with either outcome. Phenotypic stratification appears to provide insights into risk for structural or composite structure plus pain progression, and therefore may be useful to consider when selecting patients for inclusion in clinical trials.

References:

[1]Roemer FW, Collins J, Kwoh CK, et al. MRI-based screening for structural definition of eligibility in clinical DMOAD trials: Rapid OsteoArthritis MRI Eligibility Score (ROAMES). Osteoarthritis Cartilage 2020;28(1):71-81

Disclosure of Interests:

Frank Roemer: None declared, Jamie Collins Consultant of: Boston Imaging Core Lab (BICL), LLC., Tuhina Neogi Grant/research support from: Pfizer/Lilly, Consultant of: Pfizer/Lilly, EMD-Merck Serono, Novartis, Michel Crema: None declared, Ali Guermazi Consultant of: AventisGalapagos, Pfizer, Roche, AstraZeneca, Merck Serono, and TissuGene

The effect of weight loss on the progression of meniscal extrusion and size in knee osteoarthritis: a post-hoc analysis of the Intensive Diet and Exercise for Arthritis (IDEA) trial

OBJECTIVE

Weight loss has beneficial effects on clinical outcomes in knee osteoarthritis (OA), but the mechanism is still unclear. Since meniscus extrusion is associated with knee pain, this study assessed whether weight loss by diet and/or exercise is associated with less progression in meniscus extrusion measures over time.

DESIGN

The Intensive Diet and Exercise for Arthritis trial (IDEA) was a prospective, single-blind, randomized-controlled trial including overweight and obese older adults with knee pain and radiographic OA. Participants were randomized to 18-month interventions: exercise only, diet only or diet + exercise. In a random subsample of 105 participants, MRIs were obtained at baseline and follow-up. The medial and lateral menisci were segmented and quantitative position and size measures were obtained, along with semiquantitative extrusion measures. Linear and log-binomial regression were used to examine the association between change in weight and change in meniscus measures. Between-group differences were analyzed using an analysis of covariance.

RESULTS

Weight loss was associated with less progression over time of medial meniscus extrusion as measured by the maximum (β: -24.59 μm, 95%CI: -41.86, -7.33) and mean (β: -19.08 μm, 95%CI: -36.47, -1.70) extrusion distances. No relationships with weight loss were observed for lateral meniscus position, medial or lateral meniscus size or semiquantitative measures. Change in meniscus position and size did not differ significantly between groups.

CONCLUSIONS

Weight loss was associated with beneficial modifications of medial meniscus extrusion over 18 months. This may be one of the mechanisms by which weight loss translates into a clinical benefit.

CLINICAL TRIAL REGISTRATION

NCT00381290.

Qualitative and quantitative measures of prefemoral and quadriceps fat pads are associated with incident radiographic osteoarthritis: data from the Osteoarthritis Initiative

OBJECTIVE

To determine if qualitative and quantitative measures of prefemoral fat pad (PFP) and quadriceps fat pad (QFP) are associated with incident radiographic osteoarthritis (iROA) over 4 years in the Osteoarthritis Initiative (OAI) study.

DESIGN

Participants in this nested case-control study were selected from the OAI study with knees that had Kellgren Lawrence grades (KLG) of 0 or 1 at baseline. Case knees were defined by iROA (KLG≥ 2) over 4 years. Control knees without iROA were matched 1:1 with case knees. Magnetic resonance images (MRIs) were read at P0 (time of onset of iROA), P-1 (1 year prior to P0) and baseline, and used to assess PFP (i.e., prefemoral hyperintensity alteration, patellofemoral hyperintensity alteration, maximum axial area) and QFP (i.e., hyperintensity alteration, mass effect, maximum axial area). Conditional logistic regression analyses were performed to study the associations between PFP/QFP measures and iROA, after adjustment for covariates.

RESULTS

354 case knees with iROA were matched to 354 control knees. 66.9% of the participants were female, with an average age of 60.1 years. PFP prefemoral hyperintensity alteration measured at three time points (OR [95%CI]: 1.46 [1.18-1.82], 1.50 [1.20-1.88], 1.52 [1.22-1.89] respectively), PFP maximum axial area (OR [95%CI]: 1.07 [1.01-1.14], 1.08 [1.01-1.15], 1.08 [1.02-1.15] respectively) and QFP hyperintensity alteration (OR [95%CI]: 1.59 [1.27-2.00], 1.44 [1.13-1.82], 1.38 [1.09-1.73] respectively) were significantly associated with iROA in multivariable conditional logistic analyses. QFP mass effect measured at BL and P-1 (OR [95%CI]: 1.42 [1.11-1.82], 1.33 [1.01-1.73] respectively) were significantly associated with iROA.

CONCLUSIONS

Qualitative and quantitative measures of PFP and QFP are associated with increased iROA over 4 years.

Osteoarthritis year in review 2019: imaging

OBJECTIVE

To provide a narrative review of original articles on osteoarthritis (OA) imaging published between April 1, 2018 and March 30, 2019.

METHODS

All original research articles on OA imaging published in English between April 1, 2018 and March 30, 2019 were identified using a PubMed database search. The search terms of "Osteoarthritis" or "OA" were combined with the search terms "Radiography", "X-Rays", "Magnetic Resonance Imaging", "MRI", "Ultrasound", "US", "Computed Tomography", "Dual Energy X-Ray Absorptiometry", "DXA", "DEXA", "CT", "Nuclear Medicine", "Scintigraphy", "Single-Photon Emission Computed Tomography", "SPECT", "Positron Emission Tomography", "PET", "PET-CT", or "PET-MRI". Articles were reviewed to determine relevance based upon the following criteria: 1) study involved human subjects with OA or risk factors for OA and 2) study involved imaging to evaluate OA disease status or OA treatment response. Relevant articles were ranked according to scientific merit, with the best publications selected for inclusion in the narrative report.

RESULTS

The PubMed search revealed a total of 1257 articles, of which 256 (20.4%) were considered relevant to OA imaging. Two-hundred twenty-six (87.1%) articles involved the knee joint, while 195 (76.2%) articles involved the use of magnetic resonance imaging (MRI). The proportion of published studies involving the use of MRI was higher than previous years. An increasing number of articles were also published on imaging of subjects with joint injury and on deep learning application in OA imaging.

CONCLUSION

MRI and other imaging modalities continue to play an important role in research studies designed to better understand the pathogenesis, progression, and treatment of OA.

Are contrast-enhanced and non-contrast MRI findings reflecting synovial inflammation in knee osteoarthritis: a meta-analysis of observational studies

OBJECTIVE

To determine the correlation between knee synovitis assessed on contrast-enhanced (CE) and non-contrast enhanced (NCE) magnetic resonance imaging (MRI) with histology in patients with knee osteoarthritis.

METHODS

A comprehensive literature search was performed, and related articles published through July 2018 were extracted. Spearman correlation coefficients of MRI-based scores with histology reports were pooled using random effects model. To evaluate presence of publication bias, Egger test was performed.

RESULTS

Of 2377 identified records, eight studies consisting of 246 MRI exams were included. Two studies reported results of dynamic CE (DCE)-MRI examinations (81 knees) and two studies reported results of NCE-MRI. There were moderate positive correlations between CE-MRI scores and macroscopic (r = 0.53 (95% Confidence Interval (CI):0.37-0.66), P < 0.001) as well as microscopic (r = 0.56 (0.39-0.69), P < 0.001) histology. DCE-MRI were strongly correlated (r = 0.71 (0.58-0.80), P-value<0.001), with microscopic histology reports, while the correlation for NCE-MRI was low positive (r = 0.44 (0.20-0.63), P < 0.001). Meta-regression analysis showed that pooled correlation coefficients of DCE-MRI were significantly higher than CE-MRI (Slope = 0.29, SE = 0.13, P-value = 0.02). CE-MRI were also correlated with inflammatory infiltrate (r = 0.42), while the correlations for cell number of synovial lining (r = 0.27) and level of fibrosis (r = 0.29, P < 0.001) were very low.

CONCLUSION

Static and dynamic CE-MRI evaluation of knee synovitis were positively correlated with macroscopic and microscopic features of synovial membrane inflammation. Among the features of synovial tissue inflammation, CE-MRI scores correlated best with the inflammatory infiltrates of synovial tissue. Paucity of current evidence warrants further studies to assess performance of NCE-MRI on determining knee synovitis.

Scrutinizing the cut-off for "pathological" meniscal body extrusion on knee MRI

OBJECTIVES

Medial meniscal body extrusion ≥ 3 mm on MRI is often considered "pathologic." The aims of this study were to (1) assess the adequacy of 3 mm as cut-off for "pathological" extrusion and (2) find an optimal cut-off for meniscal extrusion cross-sectionally associated with radiographic knee osteoarthritis, bone marrow lesions (BMLs), and cartilage damage.

METHODS

Nine hundred fifty-eight persons, aged 50-90 years from Framingham, MA, USA, had readable 1.5 T MRI scans of the right knee for meniscal body extrusion (measured in mm). BMLs and cartilage damage were read using the whole organ magnetic resonance imaging score (WORMS). Knee X-rays were read according to the Kellgren and Lawrence (KL) scale. We evaluated the performance of the 3-mm cut-off with respect to the three outcomes and estimated a new cut-off maximizing the sum of sensitivity and specificity.

RESULTS

The study persons had mean age of 62.2 years, 57.0% were women and the mean body mass index was 28.5 kg/m2. Knees with radiographic osteoarthritis, BMLs, and cartilage damage had overall more meniscal extrusion than knees without. The 3-mm cut-off had moderate sensitivity and low specificity for all three outcomes (sensitivity between 0.68 [95% CI 0.63-0.73] and 0.81 [0.73-0.87], specificity between 0.49 [0.45-0.52] and 0.54 [0.49-0.58]). Using 4 mm maximized the sum of sensitivity and specificity and improved the percentage of correctly classified subjects (from between 54 and 61% to between 64 and 79%).

CONCLUSIONS

The 4-mm cut-off may be used as an alternative cut-off for denoting pathological meniscal extrusion.

KEY POINTS

• Medial meniscal body extrusion is strongly associated with osteoarthritis. • The 3-mm cut-off for medial meniscal body extrusion has high sensitivity but low specificity with respect to bone marrow lesions, cartilage damage, and radiographic osteoarthritis. • The 4-mm cut-off maximizes the sensitivity and specificity with respect to all three osteoarthritis features.

Proposed study designs for approval based on a surrogate endpoint and a post-marketing confirmatory study under FDA's accelerated approval regulations for disease modifying osteoarthritis drugs

In 1992, the Food and Drug Administration (FDA) instituted the accelerated approval regulations that allow drugs or biologics for serious conditions that fill an unmet medical need to be approved on the basis of a surrogate endpoint or an intermediate clinical endpoint. The current definition of a serious condition includes chronic disabling conditions, such as osteoarthritis (OA), and thereby provides expanded opportunities for the use of biomarkers for regulatory approval of drugs for OA. The use of surrogates or intermediate clinical endpoints for initial regulatory approval of a drug or biologic requires confirmation in a post-marketing study of a drug effect on a clinically relevant outcome, such as on how a patient feels, functions or survives. Current FDA guidance requires that the post-marketing approval (PMA) study be ongoing during the time of initial drug approval. This white paper arose out of the need to brainstorm trial designs that might be suitable for PMA of drugs initially approved, on the basis of a surrogate or intermediate clinical endpoint, for treatment of OA to alter disease progression, abnormal function or pathological changes in the morphology of the joint. In this white paper we define the concept and regulations regarding accelerated approval and propose two major study design scenarios for PMA trials in OA. The long-term goal is to discuss and refine these designs in consultation with regulatory agencies in order to facilitate development of drugs to fill the large unmet need in OA.

The association of frontal plane alignment to MRI-defined worsening of patellofemoral osteoarthritis: the MOST study

OBJECTIVE

To determine the sex-specific relation of frontal plane alignment (FPA) to magnetic resonance imaging (MRI)-defined features of patellofemoral osteoarthritis, and also to tibiofemoral osteoarthritis and knee pain.

METHOD

The Multicenter Osteoarthritis Study is cohort study comprised of individuals with or at risk of knee osteoarthritis. We determined the sex-specific dose-response relation of baseline FPA to MRI-defined patellofemoral and tibiofemoral structural worsening, and incident knee pain, over 7 years.

RESULTS

In women only, greater varus alignment was associated with medial patellofemoral osteophytes (risk ratio [RR] 1.7 [95% CI 1.2, 2.6]) and valgus with lateral patellofemoral osteophytes (RR 1.9 [1.0, 3.6]). In men, greater varus increased risk for medial tibiofemoral cartilage worsening (RR 1.7 [1.1, 2.6]), and valgus for lateral tibiofemoral cartilage worsening (RR 1.8 [1.6, 2.2]). In women, findings were similar for tibiofemoral cartilage, but varus also increased risk for medial bone marrow lesions [BMLs] (RR 2.2 [1.6, 3.1]) and medial osteophytes (RR 1.8 [1.3, 2.5]), and valgus for lateral BMLs (RR 3.3 [2.2, 4.5]) and osteophytes (RR 2.0 [1.2, 3.2]). Varus increased risk of incident pain in men (RR 1.7 [1.4, 2.2]) and women (RR 1.3 [1.0, 1.6]), valgus did so in men only (RR 1.5 [1.1, 1.9]).

CONCLUSION

FPA was associated with patellofemoral osteophyte worsening in women, though overall was more strongly associated with tibiofemoral than patellofemoral osteoarthritis feature worsening. FPA in women was more consistently associated with structural worsening, yet men had higher associations with incident pain.

Prediction of incident vertebral fracture using CT-based finite element analysis

Prior studies show vertebral strength from computed tomography-based finite element analysis may be associated with vertebral fracture risk. We found vertebral strength had a strong association with new vertebral fractures, suggesting that vertebral strength measures identify those at risk for vertebral fracture and may be a useful clinical tool.

INTRODUCTION

We aimed to determine the association between vertebral strength by quantitative computed tomography (CT)-based finite element analysis (FEA) and incident vertebral fracture (VF). In addition, we examined sensitivity and specificity of previously proposed diagnostic thresholds for fragile bone strength and low BMD in predicting VF.

METHODS

In a case-control study, 26 incident VF cases (13 men, 13 women) and 62 age- and sex-matched controls aged 50 to 85 years were selected from the Framingham multi-detector computed tomography cohort. Vertebral compressive strength, integral vBMD, trabecular vBMD, CT-based BMC, and CT-based aBMD were measured from CT scans of the lumbar spine.

RESULTS

Lower vertebral strength at baseline was associated with an increased risk of new or worsening VF after adjusting for age, BMI, and prevalent VF status (odds ratio (OR) = 5.2 per 1 SD decrease, 95% CI 1.3-19.8). Area under receiver operating characteristic (ROC) curve comparisons revealed that vertebral strength better predicted incident VF than CT-based aBMD (AUC = 0.804 vs. 0.715, p = 0.05) but was not better than integral vBMD (AUC = 0.815) or CT-based BMC (AUC = 0.794). Additionally, proposed fragile bone strength thresholds trended toward better sensitivity for identifying VF than that of aBMD-classified osteoporosis (0.46 vs. 0.23, p = 0.09).

CONCLUSION

This study shows an association between vertebral strength measures and incident vertebral fracture in men and women. Though limited by a small sample size, our findings also suggest that bone strength estimates by CT-based FEA provide equivalent or better ability to predict incident vertebral fracture compared to CT-based aBMD. Our study confirms that CT-based estimates of vertebral strength from FEA are useful for identifying patients who are at high risk for vertebral fracture.

Diagnostic performance of knee physical exam and participant-reported symptoms for MRI-detected effusion-synovitis among participants with early or late stage knee osteoarthritis: data from the Osteoarthritis Initiative

OBJECTIVE

Evaluate the diagnostic performance of knee physical exam findings and participant-reported symptoms for MRI-detected effusion-synovitis (ES) among knees with early and late-stage osteoarthritis (OA).

DESIGN

The Osteoarthritis Initiative (OAI) is a longitudinal study of participants with or at risk for knee OA. Two samples with MRI readings were available: 344 knees with early OA (312 participants) and 216 with late-stage OA (186 participants). Trained examiners performed bulge sign (BS) and patellar tap (PT) exams, and participants reported on knee swelling and pain with leg straightening. Effusion-synovitis on 3T non-contrast MRI was scored using the MRI Osteoarthritis Knee Score (MOAKS). Diagnostic performance of physical exam findings and symptoms was estimated with bootstrapped confidence intervals.

RESULTS

For the early OA sample, the highest sensitivity for medium/large effusion-synovitis was achieved with a positive finding for any of the physical exam maneuvers and/or participant-reported symptoms (81.0 [95% CI: 70.0, 91.3]). Both knee symptoms in combination had a prevalence of 11.7% and yielded the highest estimated positive predictive value (PPV) (50.0 [95% CI: 34.2, 66.7]) and likelihood ratio positive (LR+) (5.2 [95% CI: 2.9, 9.7]). In late-stage OA knees, exam findings and symptoms provided minimal information beyond the prevalence.

CONCLUSION

Patient report of both symptoms, or at least one positive exam finding and at least one symptom, could be used to identify knees at increased risk of effusion-synovitis in knees with early stage OA, either for screening purposes in clinical evaluation, or for study sample enrichment with an inflammatory phenotype; diagnostic performance was not sufficiently high for clinical diagnostic purposes.

Mitochondrial DNA haplogroups associated with MRI-detected structural damage in early knee osteoarthritis

OBJECTIVE

Magnetic resonance imaging (MRI)-detected structural features are associated with increased risk of radiographic osteoarthritis (ROA). Specific mitochondrial DNA (mtDNA) haplogroups have been associated with incident ROA. Our objective was to compare the presence of MRI-detected structural features across mtDNA haplogroups among knees that developed incident ROA.

DESIGN

Knees from the Osteoarthritis Initiative (OAI) that developed incident ROA during 48 months follow-up were identified from Caucasian participants. mtDNA haplogroups were assigned based on a single base extension assay. MRIs were obtained annually between baseline and 4-year follow-up and scored using the MRI Osteoarthritis Knee Score (MOAKS). The association between mtDNA haplogroups and MRI-detected structural features was estimated using log-binomial regression. Participants who carried haplogroup H served as the reference group.

RESULTS

The sample included 255 participants contributing 277 knees that developed ROA. Haplogroups included H (116, 45%), J (17, 7%), T (26, 10%), Uk (61, 24%), and the remaining less common haplogroups ("others") (35, 14%). Knees of participants with haplogroup J had significantly lower risk of medium/large bone marrow lesions (BMLs) in the medial compartment [3.2%, relative risks (RR) = 0.17; 95%CI: 0.05, 0.64; P = 0.009] compared to knees of participants who carried haplogroup H [16.3%], as did knees from participants within the "others" group [2.8%, RR = 0.20; 95%CI: 0.08, 0.55; P = 0.002], over the 4 year follow-up period.

CONCLUSIONS

mtDNA haplogroup J was associated with lower risk of BMLs in the medial compartment among knees that developed ROA. Our results offer a potential hypothesis to explain the mechanism underlying the previously reported protective association between haplogroup J and ROA.

Assessment of meniscus with adiabatic T1ρ and T2ρ relaxation time in asymptomatic subjects and patients with mild osteoarthritis: a feasibility study

OBJECTIVE

To investigate the ability of magnetic resonance imaging (MRI) adiabatic relaxation times in the rotating frame (adiabatic T_1ρ and T_2ρ) to detect structural alterations in meniscus tissue of mild OA patients and asymptomatic volunteers.

METHOD

MR images of 24 subjects (age range: 50-67 years, 12 male), including 12 patients with mild osteoarthritis (OA) (Kellgren-Lawrence (KL) = 1, 2) and 12 asymptomatic volunteers, were acquired using a 3 T clinical MRI system. Morphological assessment was performed using semiquantitative MRI OA Knee Score (MOAKS). Adiabatic T_1ρ and T_2ρ (AdT_1ρ, AdT_2ρ) relaxation time maps were calculated in regions of interest (ROIs) containing medial and lateral horns of menisci. The median relaxation time values of the ROIs were compared between subjects classified based on radiographic findings and MOAKS evaluations.

RESULTS

MOAKS assessment of patients and volunteers indicated the presence of meniscal and cartilage lesions in both groups. For the combined cohort group, prolonged AdT_1ρ was observed in the posterior horn of the medial meniscus (PHMED) in subjects with MOAKS meniscal tear (P < 0.05). AdT_2ρ was statistically significantly longer in PHMED of subjects with MOAKS full-thickness cartilage loss (P < 0.05). After adjusting for multiple comparisons, differences in medians of observed AdT_1ρ and AdT_2ρ values between mild OA patients and asymptomatic volunteers did not reach statistical significance.

CONCLUSION

AdT_1ρ and AdT_2ρ measurements have the potential to identify changes in structural composition of meniscus tissue associated with meniscal tear and cartilage loss in a cohort group of mild OA patients and asymptomatic volunteers.

Bisphosphonates intake and its association with changes of periarticular bone area and three-dimensional shape: data from the Osteoarthritis Initiative (OAI)

OBJECTIVE

To determine the association between bisphosphonate treatment with the change of periarticular bone area and three-dimensional (3D) shape in participants of the Osteoarthritis Initiative (OAI) study.

DESIGN

Using propensity score (PS) matching method in females, 48 bisphosphonate users and 105 non-users, who were matched for osteoarthritis (OA) and osteoporosis (OP) related factors were included. Baseline and 24-month magnetic resonance imaging (MRI)-based periarticular bone area and 3D shape measurements were used. The association between bisphosphonate intake and 24-month interval changes of the periarticular bone area and 3D shape were evaluated using paired Wilcoxon signed rank test. We used conditional logistic regression models for determining the association between bisphosphonate intake and periarticular bone change, defined using the standard deviation of difference (SDD) and reliable change index (RCI) methods. P-values have been adjusted for multiple comparisons using Benjamini & Hochberg procedure and false discovery rate (FDR)-adjusted P-values were reported.

RESULTS

The 24-month interval increases in the periarticular bone area in medial side of tibia were significantly greater in non-users than users (FDR-adjusted P-value: 0.002). There was an approaching significance trend for lower medial tibial periarticular bone area expansion in bisphosphonate users in comparison with non-users (For 1SDD change, odds ratio 95% confidence interval (OR (95% CI)): 0.514 (0.271-0.975), FDR-adjusted P-value: 0.085) (For 1.96RCI change, OR (95% CI): 0.552 (0.309-0.986), FDR-adjusted P-value: 0.085).

CONCLUSIONS

Bisphosphonate intake was associated with a reduction in the odds (approaching but not achieving significance) of expansion periarticular bone area, specifically in the medial tibial sub-region.