Change In Joint Space Narrowing Research Articles

Fully automatic software for detecting radiographic joint space narrowing progression in rheumatoid arthritis: phantom study and comparison with visual assessment.

We have developed an in-house software equipped with partial image phase-only correlation (PIPOC) which can automatically quantify radiographic joint space narrowing (JSN) progression. The purpose of this study was to evaluate the software in phantom and clinical assessments. In the phantom assessment, the software's performance on radiographic images was compared to the joint space width (JSW) difference using a micrometer as ground truth. A phantom simulating a finger joint was scanned underwater. In the clinical assessment, 15 RA patients were included. The software measured the radiological progression of the finger joints between baseline and the 52nd week. The cases were also evaluated with the Genant-modified Sharp score (GSS), a conventional visual scoring method. We also quantitatively assessed these joints' synovial vascularity (SV) on power Doppler ultrasonography (0, 8, 20 and 52weeks). In the phantom assessment, the PIPOC software could detect changes in JSN with a smallest detectable difference of 0.044mm at 0.1mm intervals. In the clinical assessment, the JSW change of the joints with GSS progression detected by the software was significantly greater than those without GSS progression (p = 0.004). The JSW change of joints with positive SV at baseline was significantly higher than those with negative SV (p = 0.024). Our in-house software equipped with PIPOC can automatically and quantitatively detect slight radiographic changes of JSW in clinically inactive RA patients.

Validation of Fully Automatic Quantitative Software for Finger Joint Space Narrowing Progression for Rheumatoid Arthritis Patients.

In rheumatoid arthritis (RA), the radiographic progression of joint space narrowing (JSN) is evaluated using visual assessments. However, those methods are complicated and time-consuming. We developed an automatic system that can detect joint locations and compute the joint space difference index (JSDI), which was defined as the chronological change in JSN between two radiographs. The purpose of this study was to establish the validity of the software that automatically evaluates the temporal change of JSN. This study consisted of 39 patients with RA. All patients were treated with tocilizumab and underwent hand radiography (left and right hand separately) at 0, 6, and 12 months. The JSN was evaluated using mTSS (modified Total Sharp Score) by one musculoskeletal radiologist as well as our automatic system. Software measurement showed that JSDI between 0 and 12 months was significantly higher than that between 0 and 6 months (p < 0.01). While, there was no significant difference in mTSS between 0, 6, and 12 months. The group with higher disease activity at 0 months had significantly higher JSDI between 0 and 6 months than that with lower disease activity (p = 0.02). The automatic software can evaluate JSN progression of RA patients in the finger joint on X-ray.

Fully automatic quantitative software for assessment of minute finger joint space narrowing progression on radiographs: evaluation in rheumatoid arthritis patients with long-term sustained clinical low disease activity

Rheumatoid arthritis (RA) causes joint space narrowing (JSN) as a form of joint destruction. We developed an automatic system that can detect joint locations and compute the joint space difference index (JSDI), which was defined as the chronological change in JSN between two radiographs. This study aims to evaluate the application of "machine vision" for radiographic image of the finger joints. Fifteen RA patients with long-term sustained clinical low disease activity were recruited. All patients underwent hand radiography and power Doppler ultrasonography (PDUS). The JSN was evaluated using the Genant-modified Sharp scoring (GSS) method and the automatic system. Synovial vascularity (SV) was assessed quantitatively using ultrasonography. There were no significant differences in the JSDI between the joints with JSN and those without JSN on GSS (p = 0.052). The JSDI of the joints with SV was significantly higher than those without SV (p = 0.043). The JSDI of the no therapeutic response group was significantly higher than those of the response group (p < 0.001). Our software can automatically evaluate temporal changes of JSN, which might free rheumatologists / radiologists from the burden of scoring hand radiography.

Detection of Fine Radiographic Progression in Finger Joint Space Narrowing Beyond Human Eyes: Phantom Experiment and Clinical Study with Rheumatoid Arthritis Patients

The visual assessment of joint space narrowing (JSN) on radiographs of rheumatoid arthritis (RA) patients such as the Genant-modified Sharp score (GSS) is widely accepted but limited by its subjectivity and insufficient sensitivity. We developed a software application which can assess JSN quantitatively using a temporal subtraction technique for radiographs, in which the chronological change in JSN between two radiographs was defined as the joint space difference index (JSDI). The aim of this study is to prove the superiority of the software in terms of detecting fine radiographic progression in finger JSN over human observers. A micrometer measurement apparatus that can adjust arbitrary joint space width (JSW) in a phantom joint was developed to define true JSW. We compared the smallest detectable changes in JSW between the JSDI and visual assessment using phantom images. In a clinical study, 222 finger joints without interval score change on GSS in 15 RA patients were examined. We compared the JSDI between joints with and without synovial vascularity (SV) on power Doppler ultrasonography during the follow-up period. True JSW difference was correlated with JSDI for JSW differences ranging from 0.10 to 1.00 mm at increments of 0.10 mm (R2 = 0.986 and P < 0.001). Rheumatologists were difficult to detect JSW difference of 0.30 mm or less. The JSDI of finger joints with SV was significantly higher than those without SV (P = 0.030). The software can detect fine differences in JSW that are visually unrecognizable.

Medial femur T2 Z-scores predict the probability of knee structural worsening over 4-8 years: Data from the osteoarthritis initiative.

The purpose of this study was to determine the probability of structural worsening of knee cartilage and whole joint degeneration over 4-8 years based on cartilage T2 Z-scores at baseline. Right knees with Kellgren-Lawrence (KL) grades of 0-2 in 587 participants from the Osteoarthritis Initiative were studied. 3T MR images were used to perform baseline cartilage T2 quantification and assess 4-year changes in cartilage morphology (WORMS scoring) in 5 regions. Changes in joint space narrowing (JSN) and KL were assessed over 8 years. T2 Z-scores were based on a reference database of knees without morphologic cartilage degeneration at baseline. Odds ratios for, and predicted probabilities of any worsening in WORMS cartilage, JSN and KL grade were obtained from logistic regression models. A one-unit increase in the baseline medial femur T2 Z-score was associated with cartilage worsening in the same region (OR = 1.59; P < 0.0001) and in any region (OR = 1.37; P < 0.0001), and with worsening JSN (OR = 1.82; P < 0.0001) and KL grades (OR = 1.69; P < 0.0001). Predicted probabilities of worsening in knees with a medial femur T2 Z-score from 2-4 were 38% for medial femur cartilage WORMS, 70% for any cartilage region, 28% for increasing JSN and 31% for increasing KL grade. Knees with elevated cartilage T2 (especially in the medial femur and those that are 2 to 4 SDs above the mean reference values) are significantly more likely to have structural worsening over 4 to 8 years. Knowing cartilage T2 Z-scores may aid in targeting prevention efforts at early stages of osteoarthritis. 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1128-1136.

Prospective Clinical and Radiographic Outcomes After Concomitant Anterior Cruciate Ligament Reconstruction and Meniscal Allograft Transplantation at a Mean 5-Year Follow-up

Background: Concomitant anterior cruciate ligament reconstruction and meniscal allograft transplantation (ACLR/MAT) has demonstrated short-term success in small, retrospective cohort studies. Patient- and disease-specific predictors of success after ACLR/MAT are largely unknown. Purpose: To (1) prospectively evaluate the subjective and objective clinical and radiographic outcomes after ACLR/MAT and (2) conduct a subgroup analysis to identify patient- or disease-related factors that correlate with failure. Study Design: Case series; Level of evidence, 4. Methods: Patient-reported outcomes (PROs) were prospectively collected on 40 patients undergoing concomitant ACLR/MAT. Nineteen athletes responded to return-to-sport data. Clinical data (physical examination including Lachman and pivot-shift testing and KT-1000 arthrometer testing) were obtained on 28 patients who returned for an evaluation, while 24 of those patients additionally had radiographic data (progression of Kellgren-Lawrence [KL] grade and joint-space narrowing) evaluated. Reoperations and failures were documented for all patients at their final follow-up. Results: The overall cohort of 40 patients had a mean age of 30.3 ± 9.6 years (range, 16.0-54.0 years) and a mean body mass index of 27.7 ± 4.2 kg/m2. The mean follow-up time was 5.7 ± 3.2 years (range, 1.7-16.5 years). There were 33 (83%) medial meniscal transplants performed compared with 7 (17%) lateral meniscal transplants. Patients underwent a mean of 2.9 ± 1.9 prior surgical procedures. Nineteen patients underwent concomitant procedures, including, most commonly, 9 hardware removals and 9 osteochondral allografts. There were significant improvements in 11 of 14 PRO measures as well as a 50% return-to-sport rate. Knee stability significantly improved in 28 patients who returned for a physical examination, and KT-1000 arthrometer testing indicated no differences between the affected and unaffected sides at final follow-up (mean, 0.9 ± 1.5 mm [range, –2 to 4 mm] in comparison to contralateral knee at 30 lb of testing; mean, 0.9 ± 1.9 mm [range, –4 to 4 mm] in comparison to contralateral knee at maximum manual strength). Significant improvements were seen in patients with Lachman grade ≥2A at final follow-up (18% vs 97%, respectively; P < .01) and with pivot shift ≥1+ at final follow-up (36% vs 94%, respectively; P < .01) compared with preoperatively. For the 24 patients with radiographic data, no significant joint-space decrease was recorded in the medial compartment for medial MAT–treated patients or the lateral compartment for lateral MAT–treated patients. The mean KL grade increased from 0.7 ± 0.8 to 1.6 ± 0.9 at final follow-up (P < .01). There were no major (0%) and 2 minor (5%) complications, which constituted early postoperative drainage treated successfully with oral antibiotics. While 35% of patients underwent reoperations, the majority of these were simple arthroscopic debridements and occurred after nearly 4 years from the index surgery. The overall survival rate at final follow-up was 80%. Failures occurred at a mean of 7.3 years, and those who converted to arthroplasty did so at a mean of 8.3 years from the time of index ACLR/MAT. Patients with failed grafts were more frequently associated with workers’ compensation claims (38% vs 13%, respectively) and less frequently self-identified as athletes (13% vs 56%, respectively) compared with patients with intact grafts. Conclusion: Concomitant ACLR/MAT can provide significant improvements in clinical outcomes and enhancement in objective knee stability and was associated with an insignificant degree of radiographic joint-space narrowing changes with a 5-year survivorship of more than 80% for those with data available. Athlete status may be a preoperative predictor of midterm survival.

Correlation Between Changes in Global Knee Structures Assessed by Magnetic Resonance Imaging and Radiographic Osteoarthritis Changes Over Ten Years in a Midlife Cohort.

The aim of this study was to describe the correlation between changes in structural abnormalities assessed on magnetic resonance imaging (MRI) and change in radiographic osteoarthritis (OA) over 10 years in a midlife cohort. A total of 211 participants (mean age 45 years [range 26-61 years], 57% female) were studied at baseline, 2 years, and 10 years. Approximately one-half were adult offspring of subjects who had undergone knee replacement for OA and the remainders were randomly selected controls. Joint space narrowing (JSN) and osteophytes were assessed from radiographs, while cartilage volume, cartilage defects, and meniscal tears/extrusion were assessed from MRI. Spearman ranked correlation analysis was used to describe the correlation between structural changes assessed on MRI and radiographs. Only medial tibiofemoral compartment results are presented, as the lateral compartment had limited change. Over 10 years, change in meniscal tears showed a moderate independent correlation with change in both JSN (ρ = +0.37, P < 0.01) and osteophytes (ρ = +0.31, P < 0.01) in the adjusted analysis. Meniscal extrusion (ρ = +0.22, P < 0.01) and cartilage defects (ρ = +0.16, P < 0.04) showed a slightly weaker independent correlation with JSN in the adjusted analysis, whereas cartilage volume loss showed no significant correlation with either of the 2 radiographic outcomes. Change in JSN is correlated with change in meniscal tears and, to a lesser extent, with meniscal extrusion and cartilage defects. In this sample, change in JSN is a composite measure that does not reflect cartilage volume loss, prompting the review of the use of JSN as an outcome measure in chondro-protective drug trials.

Relationship of multi-biomarker disease activity score and other risk factors with radiographic progression in an observational study of patients with rheumatoid arthritis.

Objectives. To evaluate the multi-biomarker disease activity (MBDA) score as a predictor of radiographic progression and compare it with other risk factors among patients with established RA receiving non-biologic DMARDs.Methods. For 163 patients with RA, we assessed 271 visits for MBDA score (scale of 1−100), clinical data and subsequent 1-year radiographic progression (change in Sharp−van der Heijde score [SHS]). Scatter plot and non-parametric quantile regression curves evaluated the relationship between the MBDA score and change in SHS. Changes in joint space narrowing and erosions were compared among MBDA categories with Wilcoxon rank-sum tests. The ability of the MBDA score to independently predict progression was determined by multivariate models and cross-classification of MBDA score with other risk factors. Generalized estimating equation methodology was used in model estimations to adjust for same-patient visits, always ≥1 year apart.Results. Patient characteristics included 67% female, 66%/67% RF+/anti-CCP+; mean age 55 years, MBDA score 43 (moderate = 30−44); median disease duration 4.6 years, SHS 23. Radiographic progression was infrequent for low MBDA scores. Relative risk for progression increased continuously as the MBDA score increased, reaching 17.4 for change in SHS >5 with MBDA scores ≥60. Joint space narrowing and erosion progression were associated with MBDA score. MBDA score was associated with radiographic progression after adjustments for other risk factors. MBDA score significantly differentiated risk for progression when swollen joint count, CRP or DAS28–CRP was low, and among seropositive patients.Conclusion. MBDA score enhanced the ability of conventional risk factors to predict radiographic progression in patients with established RA receiving non-biologic DMARDs.

Hyaluronan molecular weight distribution is associated with the risk of knee osteoarthritis progression

We investigated the relationship between the molecular weight (MW) distribution of hyaluronan (HA) in synovial fluid (SF) and risk of knee osteoarthritis (OA) progression. HA MW was analyzed for 65 baseline knee SFs. At 3-year follow-up, knees were scored for change in joint space narrowing (JSN), osteophyte (OST) progression, or occurrence of total knee arthroplasty (TKA). HA MW distribution was analyzed using agarose gel electrophoresis (AGE), and its relationship to OA progression was evaluated using logistic regression. The association between HA MW and self-reported baseline knee pain was analyzed using Pearson's correlation coefficients. Knee OA was categorized as non-progressing (OST-/JSN-, 26 knees, 40%), or progressing based on OST (OST+/JSN-, 24 knees, 37%), OST and JSN (OST+/JSN+, 7 knees, 11%) or total knee arthroplasty (TKA, 8 knees, 12%). The MW distribution of HA in baseline SFs was significantly associated with the odds of OA progression, particularly for index knees. After adjusting for age, gender, BMI, baseline X-ray grade and pain, each increase of one percentage point in %HA below 1 million significantly increased the odds of JSN (odds ratios (OR)=1.45, 95% CI 1.02-2.07), TKA or JSN (OR=1.24, 95%CI 1.01-1.53) and the odds of any progression (OR=1.16, 95% CI 1.01-1.32). HA MW distribution significantly correlated with pain. These data suggest that the odds of knee OA progression increases as HA MW distribution shifts lower and highlight the value of reporting MW distribution rather than just average MW values for HA.

Comparing the disease modifying effects of alendronate to risedronate in the rat anterior cruciate ligament transection model of osteoarthritis

Comparing the disease modifying effects of alendronate to risedronate in the rat anterior cruciate ligament transection model of osteoarthritis

FRI0066 Meta-analysis of joint structural deterioration over time in minimally treated rheumatoid arthritis patients

BackgroundThe goals of treatment for rheumatoid arthritis (RA) are to reduce disease activity, reduce or arrest the rate of joint damage, and, if possible, achieve remission. The majority of the...

IL-1 receptor antagonist gene as a predictive biomarker of progression of knee osteoarthritis in a population cohort

Within the interleukin-1 (IL-1) cytokine family, IL-1 receptor antagonist (IL1RN) gene variants have been associated with radiological severity of knee osteoarthritis (OA) in cross-sectional studies. The present study tested the relation between IL1RN gene variants and progression of knee OA assessed radiographically by change in Kellgren-Lawrence (KL) score over time. 1153 Caucasian adults (age range: 44-89) from the Johnson County Osteoarthritis Project were evaluated for unequivocal radiographic evidence of knee OA at baseline, defined as KL score ≥2, and were re-examined after 4-11 years for radiographic changes typical of OA progression. IL1RN gene variants were tested for association with OA progression and for potential interaction with body mass index (BMI). Other IL-1 gene variations were tested for association with OA progression as a secondary objective. Of 154 subjects with OA at baseline, 88 showed progression at follow-up. Seven IL1RN single nucleotide polymorphisms (SNPs) and one IL-1 receptor SNP were associated with progression. Four IL1RN haplotypes, each occurring in >5% of this population, showed different relationships with progression, including one (rs315931/rs4251961/rs2637988/rs3181052/rs1794066/rs419598/rs380092/rs579543/rs315952/rs9005/rs315943/rs1374281; ACAGATACTGCC) associated with increased progression [odds ratio (OR) 1.91 (95%CI 1.16-3.15); P=0.012]. Haplotypes associated with progression by KL score were also associated with categorical change in joint space narrowing. BMI was associated with OA progression in subjects carrying a specific IL1RN haplotype, but not in subjects without that haplotype. A significantly greater likelihood of radiological progression of knee OA was associated with a commonly occurring IL1RN haplotype that could be tagged by three IL1RN SNPs (rs419598, rs9005, rs315943). Interactions were also observed between IL1RN gene variants and BMI relative to OA progression. This suggests that IL1RN gene markers may be useful in stratifying patients for medical management and drug development.

A 2-year randomised, double-blind, placebo-controlled, multicentre study of oral selective iNOS inhibitor, cindunistat (SD-6010), in patients with symptomatic osteoarthritis of the knee

ObjectiveTo determine if inhibition of inducible nitric oxide synthase (iNOS) with cindunistat hydrochloride maleate slows progression of osteoarthritis (OA)MethodsThis 2-year, multinational, double-blind, placebo-controlled trial enrolled patients with symptomatic knee OA...

MRI-based extended ordered values more efficiently differentiate cartilage loss in knees with and without joint space narrowing than region-specific approaches using MRI or radiography – data from the OA initiative

The sensitivity to change of quantitative analysis of cartilage in knee osteoarthritis using magnetic resonance imaging (MRI) is compromised by the spatial heterogeneity of cartilage loss. We explore whether extended (medial-lateral) "ordered values" (OVs) are superior to conventional approaches of analyzing subregional cartilage thickness loss and to radiography, in differentiating rates of progression in knees with and without joint space narrowing (JSN). 607 Osteoarthritis Initiative (OAI) participants (308 without and 299 with baseline JSN at baseline) were studied over 12 months. Subregional femorotibial cartilage loss was determined in all knees, and changes in minimum joint space width (mJSW) in a subset of 290 knees. Subregional thickness changes in medial and lateral tibial and femoral cartilages were sorted in ascending order (OV1-16). A Wilcoxon rank-sum test was used to compare rates of change in knees with and without JSN. JSN-knees displayed greater cartilage loss than those without JSN, with minimal P-values of 0.008 for femorotibial subregions, 3.3×10(-4) for medial OV1, and 5.4×10(-7) for extended (medial and lateral) OV1. mJSW measurements (n=290) did not discriminate between longitudinal rates of change in JSN vs no-JSN knees (P=0.386), whereas medial OV1 (P=5.1×10(-4)) and extended OV1 did (P=2.1×10(-5)). Extended OVs showed higher sensitivity to detecting differences in longitudinal rates of cartilage loss in knees with and without baseline JSN than anatomical (sub)regions and radiography. The OV technique also circumvents challenges of selecting particular regions "a priori" in clinical trials and may thus provide a powerful tool in studying risk factors or treatment efficacy in osteoarthritis.

Trabecular morphometry by fractal signature analysis is a novel marker of osteoarthritis progression

To evaluate the effectiveness of using subchondral bone texture observed on a radiograph taken at baseline to predict progression of knee osteoarthritis (OA) over a 3-year period. A total of 138 participants in the Prediction of Osteoarthritis Progression study were evaluated at baseline and after 3 years. Fractal signature analysis (FSA) of the medial subchondral tibial plateau was performed on fixed flexion radiographs of 248 nonreplaced knees, using a commercially available software tool. OA progression was defined as a change in joint space narrowing (JSN) or osteophyte formation of 1 grade according to a standardized knee atlas. Statistical analysis of fractal signatures was performed using a new model based on correlating the overall shape of a fractal dimension curve with radius. Fractal signature of the medial tibial plateau at baseline was predictive of medial knee JSN progression (area under the curve [AUC] 0.75, of a receiver operating characteristic curve) but was not predictive of osteophyte formation or progression of JSN in the lateral compartment. Traditional covariates (age, sex, body mass index, knee pain), general bone mineral content, and joint space width at baseline were no more effective than random variables for predicting OA progression (AUC 0.52-0.58). The predictive model with maximum effectiveness combined fractal signature at baseline, knee alignment, traditional covariates, and bone mineral content (AUC 0.79). We identified a prognostic marker of OA that is readily extracted from a plain radiograph using FSA. Although the method needs to be validated in a second cohort, our results indicate that the global shape approach to analyzing these data is a potentially efficient means of identifying individuals at risk of knee OA progression.

IL1 Polymorphisms May Predispose Distal Interphalangeal Joints of the Hands to Effects of Mechanical Overload

The increasing impact of osteoarthritis (OA) on individuals, families, and society is considerable. For example, the prevalence of OA has increased in the United States to nearly 27 million, the third most prevalent condition causing work disability1. As expected, increasingly sophisticated studies are being undertaken in an effort to better define the etiology and pathogenesis of OA2–4. The overall objectives of such studies are to develop novel strategies for prevention and early treatment of OA. Genotype, age, sex, body mass index (BMI) and joint load are the main known risk factors for the development and progression of primary OA1. Many studies have shown familial aggregation for the occurrence and progression of primary OA after adjusting for age, sex, and BMI. For example, findings in the Genetics, Arthrosis, and Progression study from the Netherlands showed that familial aggregation of OA is most striking in the hand and hip, and that changes in joint space narrowing are significantly correlated between siblings5. The latter studies, however, do not quantify the relative contributions of genetic and environmental factors in family members with OA. The relative contributions of the latter factors have been determined in twin sets after adjustment for the known risk factors. Comparisons of identical and nonidentical twins show that the contribution of genetic factors to radiographic OA of the hand, hip and knee in women is between 39% and 60%6. … Address correspondence to Prof. Cole; E-mail: wcole{at}ualberta.ca

Clinical Implications of Understanding Radiographic Findings in Relation to Clinical Outcomes in Rheumatoid Arthritis

The clinical progression of rheumatoid arthritis (RA) and longterm response to therapy is generally assessed by quantifying changes in joint space narrowing and erosions visible on serial plain radiographs. In patients treated with classic disease modifying antirheumatic drugs, the joint damage seen on radiographic images is usually directly associated with longterm functional disability. However, this relationship is not as clearly defined in patients treated with biologic agents. The apparent dissociation between clinical and radiologic outcomes in patients with RA who are treated with biologic therapies needs to be taken into consideration when evaluating the efficacy of treatment.

Do MRI features at baseline predict radiographic joint space narrowing in the medial compartment of the osteoarthritic knee 2 years later?

PurposeThe purpose of the study was to relate magnetic resonance imaging (MRI) features at baseline with radiographically determined joint space narrowing (JSN) in the medial compartment of the knee after 2 years in a group of patients with symptomatic osteoarthritis at multiple joint sites.Materials and methodsMRI of the knee and standardized radiographs were obtained at baseline and after 2 years in 186 patients (81% female; aged 43–76 years; mean 60 years). MRI was analyzed for bone marrow lesions, cysts, osteophytes, hyaline cartilage defects, joint effusion, and meniscal pathology in the medial compartment. Radiographs were scored semiquantitatively for JSN in the medial tibiofemoral joint using the Osteoarthritis Research Society International (OARSI) atlas. Radiological progression was defined as ≥1 grade increase. Associations between baseline magnetic resonance (MR) parameters and subsequent radiographic JSN changes were assessed using logistic regression. Relative risk (RR) was then calculated.ResultsRadiographic progression of JSN was observed in 17 (9.1%) of 186 patients. Eleven patients had a Kellgren and Lawrence (KL) score of ≥2. A significant association was observed between all patients and meniscal tears (RR 3.57; confidence interval (CI) 1.08–10.0) and meniscal subluxation (RR 2.73; CI 1.20–5.41), between KL < 2 and meniscal subluxation (RR 11.3; CI 2.49–29.49) and KL ≥ 2 and meniscus tears (RR 8.91; CI 1.13–22.84) and radiographic JSN 2 years later. Follow-up MR in 15 of 17 patients with progressive JSN showed only new meniscal abnormalities and no progression of cartilage loss.ConclusionMeniscal pathology (tears and/or meniscal subluxation) was the only MRI parameter to be associated with subsequent radiographic progression of JSN in the medial tibiofemoral compartment on a radiograph 2 years later, as assessed by the OARSI score.

Change in joint space width: Hyaline articular cartilage loss or alteration in meniscus?

To explore the relative contribution of hyaline cartilage morphologic features and the meniscus to the radiographic joint space. The Boston Osteoarthritis of the Knee Study is a natural history study of symptomatic knee osteoarthritis (OA). Baseline and 30-month followup assessments included knee magnetic resonance imaging (MRI) and fluoroscopically positioned weight-bearing knee radiographs. Cartilage and meniscal degeneration were scored on MRI in the medial and lateral tibiofemoral joints using a semiquantitative grading system. Meniscal position was measured to the nearest millimeter. The dependent variable was joint space narrowing (JSN) on the plain radiograph (possible range 0-3). The predictor variables were MRI cartilage score, meniscal degeneration, and meniscal position measures. We first conducted a cross-sectional analysis using multivariate regression to determine the relative contribution of meniscal factors and cartilage morphologic features to JSN, adjusting for body mass index (BMI), age, and sex. The same approach was used for change in JSN and change in predictor variables. We evaluated 264 study participants with knee OA (mean age 66.7 years, 59% men, mean BMI 31.4 kg/m(2)). The results from the models demonstrated that meniscal position and meniscal degeneration each contributed to prediction of JSN, in addition to the contribution by cartilage morphologic features. For change in medial joint space, both change in meniscal position and change in articular cartilage score contributed substantially to narrowing of the joint space. The meniscus (both its position and degeneration) accounts for a substantial proportion of the variance explained in JSN, and the change in meniscal position accounts for a substantial proportion of change in JSN.

Reading radiographs in pairs or in chronological order influences radiological progression in osteoarthritis

To determine the influence of the order in which a series of radiographs were read on the sensitivity to change over a 2-yr follow-up period in patients with osteoarthritis (OA) at multiple sites. Radiographs of 20 patients with OA in at least two joint sites were obtained at baseline and after 2 yr, and scored according to the consensus of two readers. Joint space narrowing (JSN) and osteophytes were graded (0-3) in the hand, hip and tibiofemoral joints. The cervical (C2-7) and lumbar spine disc spaces (L1-S1) were graded (0-3) for disc space narrowing (DSN) and anterior osteophytes. Films were read by two different procedures: in pairs, with an unknown time sequence and in chronological order. Radiological progression was defined as an increase of at least one grade in JSN, DSN or osteophyte total scores. The two procedures were compared using standardized response means (SRM). The SRM for changes in JSN or DSN progression scores in the hands, hips, knees and spine were, respectively, 0.00, 0.00, 0.32, 0.13 and 0.38, 0.32, 0.56, 0.18 for the paired and chronological readings. The SRM for changes in osteophyte progression scores in the hands, hips, knees and spine were, respectively, 0.39, 0.20, 0.32, 0.38 and 0.41, 0.37, 0.56, 0.66 for the paired and chronological readings. When assessing radiological progression in OA, reading a series of radiographs in chronological order tended to be more sensitive to change over a 2-yr follow-up period than reading in pairs with an unknown time sequence.