Abstract
IntroductionTo evaluate the impact of meniscal extrusion (Ext) on knee osteoarthritis (OA) structural progression and on response to strontium ranelate (SrRan) treatment at 36 months in patients with (+) or without (-) Ext, in association (+) or not (-) with bone marrow lesions (BML) in the medial compartment using X-rays (JSW) and qMRI.MethodsPatients from the qMRI substudy of the SEKOIA trial (SrRan 1 g/day, n = 113; SrRan 2 g/day, n = 105; placebo, n = 112) were stratified based on whether meniscal extrusion and/or BML were present or not in the medial compartment.ResultsIn the placebo group, Ext+ patients (n = 26) had more JSW loss (p = 0.002) and cartilage volume loss in the global knee (p = 0.034) and plateau (p = 0.005), and medial compartment (p = 0.0005) than Ext- patients (n = 86). Ext-BML+ patients (n = 18) demonstrated more JSW loss (p = 0.003) and cartilage volume loss in the global (p = 0.020) and medial femur (p = 0.055) than Ext-BML- (n = 68). Compared to Ext+ BML- (n = 14), Ext+ BML+ patients (n = 12) had more cartilage volume loss in the global femur (p = 0.028), with no change in JSW. The JSW loss (p = 0.0004) and cartilage volume loss (global knee, p = 0.033, medial compartment, p = 0.0005) were greater when Ext and BML were simultaneously present in the medial compartment. SrRan 2 g/day treatment demonstrated a reduction in OA knee structural progression with qMRI, but not with JSW, in which less cartilage volume loss was found in the plateaus (p = 0.007) in Ext+ patients (n = 15), and in the medial plateau (p = 0.046) in patients in whom both Ext and BML were co-localized.ConclusionThe findings of this study are novel and could have an impact on future strategies regarding clinical trials. Indeed, data first argue for a combined, cumulative effect of meniscal extrusion and bone marrow lesions on cartilage loss and, secondly, they showed that SrRan may have protective effects in OA patients with meniscal extrusion as well as when both meniscal extrusion and BML are co-localized.
Highlights
To evaluate the impact of meniscal extrusion (Ext) on knee osteoarthritis (OA) structural progression and on response to strontium ranelate (SrRan) treatment at 36 months in patients with (+) or without (-) Ext, in association (+) or not (-) with bone marrow lesions (BML) in the medial compartment using X-rays (JSW) and quantitative magnetic resonance imaging (qMRI)
This question was raised by the findings of recent studies using qMRI, in which patients with severe meniscal extrusion demonstrated more severe cartilage volume loss but were more responsive to such treatment [14], and in a subset of patients from the phase III knee OA trial (SEKOIA) showing that Strontium ranelate (SrRan) (2 g/day) at 36-month follow up significantly decreased cartilage volume loss in the medial plateau in patients with BML in the medial compartment [15]
In addition to previous data showing that SrRan at 2 g/day can reduce cartilage volume loss in the medial plateau in patients with BML [15], data from this study suggest that SrRan may have structural protective effects in patients with both BML and meniscal extrusion, a condition which represents an even higher risk for more rapid structural disease progression [11,12,17,29]
Summary
To evaluate the impact of meniscal extrusion (Ext) on knee osteoarthritis (OA) structural progression and on response to strontium ranelate (SrRan) treatment at 36 months in patients with (+) or without (-) Ext, in association (+) or not (-) with bone marrow lesions (BML) in the medial compartment using X-rays (JSW) and qMRI. In the context of personalized management of OA, another clinically relevant concern is the impact of meniscal extrusion, alone or in conjunction with BML, on the response to putative DMOAD treatment This question was raised by the findings of recent studies using qMRI, in which patients with severe meniscal extrusion demonstrated more severe cartilage volume loss but were more responsive to such treatment [14], and in a subset of patients from the phase III knee OA trial (SEKOIA) showing that Strontium ranelate (SrRan) (2 g/day) at 36-month follow up significantly decreased cartilage volume loss in the medial plateau in patients with BML in the medial compartment [15]. The impact of the simultaneous presence of meniscal extrusion and BML on response to treatment that may modify disease structural progression is at present unknown and is an issue of great clinical interest
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