Abstract
BackgroundWe aimed to determine if composite structural measures of knee osteoarthritis (KOA) progression on magnetic resonance (MR) imaging can predict the radiographic onset of accelerated knee osteoarthritis.MethodsWe used data from a nested case-control study among participants from the Osteoarthritis Initiative without radiographic KOA at baseline. Participants were separated into three groups based on radiographic disease progression over 4 years: 1) accelerated (Kellgren-Lawrence grades [KL] 0/1 to 3/4), 2) typical (increase in KL, excluding accelerated osteoarthritis), or 3) no KOA (no change in KL). We assessed tibiofemoral cartilage damage (four regions: medial/lateral tibia/femur), bone marrow lesion (BML) volume (four regions: medial/lateral tibia/femur), and whole knee effusion-synovitis volume on 3 T MR images with semi-automated programs. We calculated two MR-based composite scores. Cumulative damage was the sum of standardized cartilage damage. Disease activity was the sum of standardized volumes of effusion-synovitis and BMLs. We focused on annual images from 2 years before to 2 years after radiographic onset (or a matched time for those without knee osteoarthritis). To determine between group differences in the composite metrics at all time points, we used generalized linear mixed models with group (3 levels) and time (up to 5 levels). For our prognostic analysis, we used multinomial logistic regression models to determine if one-year worsening in each composite metric change associated with future accelerated knee osteoarthritis (odds ratios [OR] based on units of 1 standard deviation of change).ResultsPrior to disease onset, the accelerated KOA group had greater average disease activity compared to the typical and no KOA groups and this persisted up to 2 years after disease onset. During a pre-radiographic disease period, the odds of developing accelerated KOA were greater in people with worsening disease activity [versus typical KOA OR (95% confidence interval [CI]): 1.58 (1.08 to 2.33); versus no KOA: 2.39 (1.55 to 3.71)] or cumulative damage [versus typical KOA: 1.69 (1.14 to 2.51); versus no KOA: 2.11 (1.41 to 3.16)].ConclusionsMR-based disease activity and cumulative damage metrics may be prognostic markers to help identify people at risk for accelerated onset and progression of knee osteoarthritis.
Highlights
We aimed to determine if composite structural measures of knee osteoarthritis (KOA) progression on magnetic resonance (MR) imaging can predict the radiographic onset of accelerated knee osteoarthritis
Starting at 1 year prior and continuing to at least 2 years after the index visit, the accelerated knee osteoarthritis group presented with greater disease activity compared to the typical and no knee osteoarthritis groups (Fig. 3)
The cumulative damage metric offers a parsimonious strategy to conceptualize cartilage damage throughout the joint rather than relying on at least four different regional metrics. While these results provide an overall estimation of cumulative damage throughout the tibiofemoral joint, previous reports have demonstrated that starting at the index visit the people with accelerated knee osteoarthritis had greater cartilage damage in the medial and lateral tibia as well as the medial femur than those with typical or no knee osteoarthritis [8]
Summary
We aimed to determine if composite structural measures of knee osteoarthritis (KOA) progression on magnetic resonance (MR) imaging can predict the radiographic onset of accelerated knee osteoarthritis. Knee osteoarthritis is typically considered a gradually progressive disease that is a leading cause of physical disability [1]. At least 20% of people who develop knee osteoarthritis will experience a more painful, debilitating, and accelerated form of knee osteoarthritis. People prior to the radiographic development of accelerated knee osteoarthritis are more likely to report frequent knee pain and present with decreased physical function (e.g., slower walking and chair-stand pace) compared to those who develop a typical, gradual onset of knee osteoarthritis [2]. People that develop accelerated knee osteoarthritis are more likely to receive pharmacological treatments and knee replacements than people who develop typical knee osteoarthritis [4, 5]. Developing prognostic methods to detect early manifestations of the disease will be key to identifying who is at high-risk for the radiographic development of accelerated knee osteoarthritis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
