Abstract
BackgroundTo study the predictive value of baseline radiographs and low-field (0.2T) MRI scans for the symptomatic outcome of clinically significant weight loss in obese patients with knee osteoarthritis.MethodsIn this study we hypothesize that imaging variables assessed with radiographs and MRI scans pre-treatment can predict the symptomatic changes following a recommended clinically significant weight reduction Patients were recruited from the Department of Rheumatology, Frederiksberg Hospital, Denmark. Eligibility criteria were: age >18 years; primary osteoarthritis according to ACR; BMI > 28 kg/m2; motivation for weight loss. Subjects were randomly assigned to either intervention by low-energy diet (LED) for 8 weeks followed by another 24 weeks of dietary instruction or control-group. MRI scans and radiographs were scored for structural changes and these parameters were examined as independent predictors of changes in osteoarthritis symptoms after 32 weeks. The outcome assessor and statistician were blinded to group allocation.ResultsNo significant correlations were found between imaging variables and changes in Western Ontario and McMaster Universities Index of Osteoarthritis (Spearman's test, r < 0.33 and P > 0.07).Only the LED group achieved a weight loss, with a mean difference of 16.3 kg (95%CI: 13.4-19.2;P < 0.0001) compared to the control group. The total WOMAC index showed a significant difference favouring LED, with a group mean difference of - 321.3 mm (95%CI: -577.5 to -65.1 mm; P = 0.01). No significant adverse events were reported.ConclusionStage of joint destruction, assessed on either radiographs or low-field MRI (0.2T), does not preclude a symptoms relief following a clinically relevant weight loss in elderly obese female patients with knee osteoarthritis.
Highlights
To study the predictive value of baseline radiographs and low-field (0.2T) MRI scans for the symptomatic outcome of clinically significant weight loss in obese patients with knee osteoarthritis
The WOMAC disability index showed improvement in the low-energy diet (LED) group when compared with the control group, MD of - 266 mm (95%confidence interval (CI): -468.9 to -63.1; p < 0.01)
We found that Knee osteoarthritis (KOA) related structural changes seen on radiographs and MRI scans, at baseline, did not rule out improvement of symptoms following a clinically significant weight loss and could not predict the symptomatic outcome of the diet intervention in this elderly sample of female obese KOA patients
Summary
To study the predictive value of baseline radiographs and low-field (0.2T) MRI scans for the symptomatic outcome of clinically significant weight loss in obese patients with knee osteoarthritis. Conventional radiography is the simplest and least expensive imaging method for assessing KOA, and the K/L score remains the most widely applied system when diagnosing KOA [11,12] in clinical trials Both low- and high field MRI provides additional information to radiographs, as these modalities have a unique ability to image all knee joint related structures [13]. The MRI modality withholds a possibility for semiquantitative scoring of synovial thickening, joint effusion, bone marrow lesions (BMLs) and cartilage abnormalities These structures are essential because the synovium, joint capsule and subchondral bone are highly innervated and appear to represent some of the main origins of KOA-related pain, whereas the cartilage status is suggested to be more a marker of joint strain and thereby a surrogate marker for KOA symptoms [14]. All of these structural changes have been shown to correlate with clinical symptoms and/or progression of disease [15,16,17,18,19,20], and they seem relevant to examine in this intervention study
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