Difficulties in Defining a Clinical Score for Acute Flare-Ups in an Osteoarthritic Knee

Abstract

The basic idea of this editorial was to try to propose new techniques and laboratory measurements for future incorporation into a new score for identifying an acutely inflamed osteoarthritic knee joint. In the area of research, defining clinical status was always a hurdle to proper patient recruitment because working on quiet cases of OA with minimal to moderate pain is totally different from working on acute cases of OA with a lot of pain. Hence the problem of defining the clinical status at time of recruitment has become of an utmost importance. To achieve this goal we have navigated through all available methods and tests whether validated or still waiting for validation, to find the most suitable for a new sensitive score. Osteoarthritis of the knee joint points to a clinical syndrome of joint pain associated with varying degrees of functional deterioration and lesser quality of life. It is the most prevalent form of arthritis, and one of the principal causes of pain and disability among the globe. A strong discrepancy has always been demonstrated between the level of radiological deterioration and clinical symptomatology. In other words minimal radiological changes can be associated with a lot of pain during flare-ups in contrast to a severe radiological deterioration with modest reduction in function and a modest level of pain [1]. Several scores and indexes have been created for OA serving many relevant points. A short description of the scores and indexes available will be done. Lequesne‘s algo-functionnal index [2] has dealt with many points as nocturnal pain, walking ability, stiffness and some daily activities. The score gave special emphasis on the distance walked by the patients which is not accomplished by knee only as several body systems contribute to walking. The impression given to users was that the score deals with function more than it does with acuteness of symptoms. For example if the patient has severe nocturnal pain and stiffness but can walk, then the score gets down abrogating the element of pain, an important issue in acute flare-ups.