Classification Criteria For Knee Osteoarthritis Research Articles

Prevalence and progression of arterial calcifications on computed tomography in humans with knee osteoarthritis.

Ectopic bone deposition plays an important role in osteoarthritis (OA) and in arterial wall disease. We aimed to investigate the prevalence and progression of arterial calcifications on whole-body computed tomography (CT) in persons with knee OA. We included 118 (36 male) participants who satisfied the clinical American College of Rheumatology classification criteria for knee OA. Baseline investigations included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kellgren-Lawrence grading. At baseline and after two years, a whole-body CT was performed using the same scanner and protocol. Calcifications were quantified in the carotid, brachiocephalic, coronary, thoracic aortic, abdominal aortic, iliac, femoropopliteal and crural arteries. Multivariable linear and logistic regression modeling was used for analyses. At baseline males were 66.9 ± 7.7 and females were 68.0 ± 5.6 years old. Calcifications were common, all participants except two females had some calcification, and prevalence ranged between 41.8% and 94.4% for various arterial beds. Baseline femoropopliteal calcifications were associated with a higher Kellgren-Lawrence grade (more severe knee OA). Median annual progression rate was 13.1% in males and 15.7% in females. Structural OA severity was not associated with progression, but a five points lower (worse) WOMAC was associated with 1% faster progression of arterial calcifications (p= 0.008). Around age 70 nearly all persons with knee OA have arterial calcifications, which progress substantially. For further investigation into shared causality intervention studies are needed.

Magnetic resonance imaging as a structural refinement to the American College of Rheumathology clinical classification criteria for knee osteoarthritis

To evaluate if fulfilment of the definition of osteoarthritis (OA) based on the American College of Rheumatology (ACR) clinical criteria corresponds to pathological knee findings evaluated by magnetic resonance imaging (MRI). To evaluate if any such criteria is associated with a specific MRI pattern. Forty-six consecutive patients aged 50 years or more referred by their general practitioners (GPs) to a radiology department because of non-traumatic knee pain underwent MRI using a dedicated low field (0.2 T) machine. MRI results were compared against the ACR criteria for knee OA. Patients with knee pain fulfilling the ACR criteria showed more severe synovial fluid effusion (OR 6.2, 95% CI 2.02 to 19.1), cartilage lesions in the medial area (OR 2.4, 95% CI 1.2 to 5) and higher mean number of osteophytes (OR 2.3, 95% CI 1.1 to 4.5). The association between single criteria and MRI features was more difficult to establish. Nonetheless, crepitus at joint movement was associated with synovial fluid effusion (p=0.02); bone enlargement was more frequent in patients with lesions of the posterior cruciate ligament (p=0.0001); no palpable warmth was associated with cartilage lesions (p=0.02), and morning stiffness shorter than 30 minutes was associated with the surface of bone edema (p=0.02). The ACR clinical criteria identify patients showing the most important features of OA. The association between individual clinical ACR criteria and OA pathology depicted by MRI may be difficult to explain on the basis of anatomical changes and needs further evaluation.

THE CONSTRUCT VALIDITY OF DIFFERENT KNEE OSTEOARTHRITIS CLASSIFICATION CRITERIA IN THE ELSA-BRASIL MUSCULOSKELETAL STUDY

Purpose: The existence of different knee osteoarthritis (OA) classification criteria makes it difficult to investigate risk factors and clinical manifestations associated with knee OA (KOA). We evaluated the construct validity of different knee OA classification criteria by assessing the association between these criteria and body mass index (BMI), current pain, and subjective and objective functionality.

Assessment of Serum Magnesium Concentration in Patients with Knee Osteoarthritis

Background: Magnesium, which is an essential trace element in bone metabolism, has been paid to great attention in recent years due to its osteogenic effect and critical role in bone mineralization process. Objective: Detection of the association between serum Mg concentration and clinical and radio-graphical findings in patients with knee OA and in apparently healthy controls. Subjects and method: A cross-sectional study conducted on 100 female patients with primary knee osteoarthritis (OA) diagnosed according to the American College of Rheumatology (ACR) clinical and radiological classification criteria for knee OA. In addition, 100 apparently healthy volunteers with no features of OA matched for age and sex worked as control group. All the study populations underwent bilateral weight bearing anteroposterior x-ray of the knee which was assessed according to the Kellgren and Lawrence (KL) grading system. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analogue Scale (VAS) were used to assess pain severity and functional limitation. Blood samples had been collected for assessing serum Mg concentration by colorimetric method. Results: The mean serum Mg level in the OA group was 1.97 ± 0.17 mg/dl and the mean level of Mg in the control group was 2.09 ± 0.15 mg/dl with high statistically significant difference between the two groups (p < 0.001). Conclusion: Serum Mg concentration may have an inverse relationship with radiographic knee OA. Therefore, high level of Mg could possibly exert a protective role in the control of knee OA and can be used in its management.

Lack of agreement in experts’ classification of patients with early-stage knee osteoarthritis

Purpose: Current classification criteria for knee osteoarthritis (OA) typically define patients at a relatively late disease stage with substantial structural changes and biomechanical derangement. Earlier identification of patients may be more suitable to test interventions that potentially slow down structural disease progression and improve patient outcomes. However, there is a lack of consensus on classification of patients with symptomatic early-stage knee OA (EsKOA). The use of such classification criteria would also allow more efficient future meta-analyses and other comparisons of results across studies.

Towards classification criteria for early-stage knee osteoarthritis: A population-based study to enrich for progressors

ObjectiveTo facilitate a greater likelihood of favorable response to new disease-modifying therapies, recruitment of patients at an earlier stage of their disease into clinical trials may be an attractive strategy. Hence, there is a need to develop widely accepted classification criteria for early-stage knee osteoarthritis (OA). We have proposed a set of classification criteria for early-stage knee OA (2018 classification criteria) now being further refined. Here, we test the draft criteria for enrichment for clinical and structural progression. DesignPerformance of the 2018 classification criteria for early stage knee OA was tested using data from the Osteoarthritis Initiative (OAI). The OAI comprises data of 4796 men and women aged 45–79 years with or at risk for knee OA at baseline. Based on the 2018 classification criteria, a knee with Kellgren & Lawrence (K&L) grade of 0-I, two out of four Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales equal or less than 85, and presence of at least one of joint line tenderness or crepitus, was considered as early-stage knee OA. Knees with K&L grade 0-I that did not fulfill the 2018 criteria, were considered as controls. Logistic regression analysis was used to evaluate the predictive performance of the criteria set for structural as well as clinical progression. We further explored the discriminatory capability of criteria by including the average KOOS4 score, and relevant clinical examination findings such as the presence of effusion and/or Heberden's nodes. ResultsWe identified 1315 (27%) knees from OAI fulfilling the 2018 early-stage knee OA classification criteria. The female to male ratio was higher in the early knee OA group compared to controls. The early-stage knee OA group were on average slightly younger and had higher body mass index vs controls (mean [SD] age: 59.2 [8.9] years vs. 60.2 [9.1] and mean [SD] BMI 28.3 [7.0] vs. 26.8 [6.0]). By applying the 2018 criteria, there was a substantial enrichment compared to controls at 48 and 96 months for both structural (OR=1.1–1.4, and AUC=0.72–0.74) and clinical progressors (OR=2.1–2.5, 95% and AUC=0.66). Expanding the clinical examination findings by including joint effusion and/or Heberden's nodes improved the enrichment for both structural and clinical progressors (OR=4.2, 95% confidence interval=3.2–5.5 and OR=3.3, 95% confidence interval=2.8–3.5, respectively). Replacing scoring of the 4 separate KOOS domains by a KOOS4 score performed comparably. ConclusionsThe proposed 2018 early-stage knee OA classification criteria showed encouraging performance characteristics with regard to an enrichment for structural and clinical progression using longitudinal OAI data. Our results indicate that the addition of clinical findings improves the performance of previous criteria to define early-stage disease and risk for progression.

Comparison of intra articular autologous platelet-rich plasma with steroids in osteoarthritis knee: Experience from a North Indian tertiary care center

Background: Intra-articular (IA) platelet-rich plasma (PRP) is a promising treatment option for knee osteoarthritis (OA). It accelerates the process of healing, ligament repair, cartilage regeneration, and bone formation when given in supraphysiological doses. The aim of this study was to compare the efficacy of IA PRP versus IA methylprednisolone acetate (MPA) in patients with knee OA. Methods: Open labeled prospective observational study was conducted on 60 patients with Kellgren-Lawrence Grade 2 and 3 OA knee, who fulfilled the ACR classification criteria for knee OA. Thirty patients were given IA PRP (6 ml) and 30 received IA methyl prednisolone (80 mg) at baseline line, which was repeated at 12 weeks. The primary endpoint was an improvement in Western Ontario and McMaster Universities Index (WOMAC) and 100 mm Visual Analog Scale (VAS) pain at 24 weeks postinjections. Results: The mean change in VAS pain and total WOMAC score from baseline to 24 weeks was 32.9 ± 12.1, 31.8 ± 14.7 for PRP group, and 12.9 ± 5.9, 7.5 ± 5.5 for MPA group, which was statistically significant (P Conclusions: Treatment with IA PRP showed sustained improvements in WOMAC and VAS scores compared to IA steroids. PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis.

Comparison of three sets of clinical classification criteria for knee osteoarthritis: a cross-sectional study of 13,459 patients treated in primary care

To determine and compare the proportion of patients treated in a primary care setting that have knee osteoarthritis (OA) according to the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), and the National Institute for Health and Care Excellence (NICE) clinical classification criteria. A cross-sectional analysis of baseline data from 13,459 patients with knee symptoms or functional limitations associated with OA participating in the Good Life with osteoArthritis in Denmark (GLA:D®) treatment program. The prevalence of knee OA according to the EULAR, ACR and NICE criteria were calculated in all participants and in the subgroup of patients with self-reported radiographic changes associated with knee OA (n=10,651 or 79%). Mean age (SD) was 65.3 (9.8) years, median (IQR) duration of symptoms 12 (6-36) months and mean pain intensity (0-100; SD) 46.5 (22.1) mm. 39% fulfilled all three sets of criteria. 48%, 52% and 89% fulfilled the EULAR, ACR, and NICE criteria for having knee OA, respectively. In the subgroup with self-reported radiographic changes, the corresponding numbers were 49%, 54% and 90%. While the EULAR and ACR criteria only identified around half of those, with or without self-reported radiographic knee OA, that were treated because of symptoms or functional limitations associated with knee OA, the NICE criteria identified most patients. The results indicate that the NICE criteria are relevant and appropriate to identify individuals treated for knee OA in primary care.

Development of an Impulse Response Method for Assessing Knee Osteoarthritis at the Femorotibial Joint: Comparison Between Healthy Young Adults and Older Women with Clinical Knee Osteoarthritis

Because in patients with knee osteoarthritis (OA), the knee joint properties such as cartilage, meniscus, soft tissue and bone formation are assumed to degeneration change, the shock absorb might also decrease. The transmission of impulse from femur and tibia is thought to change in the knee joint. The purpose of the present study was to determine the differences between young healthy women and elderly women with knee OA using the impulse response method. Twenty-six older women with clinically diagnosed knee OA (OA group, age: 69 ± 6 years) and 26 young women without knee OA (young control [YC] group, age: 21 ± 1 years) participated in the study. The OA group fulfilled the knee OA classification criteria based on clinical findings. An input device provided an impulse to the subject while standing. The output value was measured using a single-axis accelerometer. The outcome measures were the input–output ratio and power spectrum. The input–output ratio did not significantly differ between the groups. The power spectrum at 21–30 Hz was significantly greater (p = 0.036) in the OA group than in the control group. Additionally, the power spectrum at 21–30 Hz correlated with knee pain (r = 0.39, p = 0.049). At 21–30 Hz, transmission of impulse from femur and tibia in the knee joint was lower in the OA group than in the control group. The IR method used in the present study could detect the transmission of impulse in early knee OA.

How much gloom is in groans? Depression and its determinants in Nigerian patients with knee osteoarthritis: a multi-center cross-sectional study.

To determine the prevalence of depression and its determinants among Nigerian patients with knee osteoarthritis (OA). Two hundred and fifty patients satisfying the American College of Rheumatology classification criteria for knee OA were recruited from five centers. Pain was assessed using Western Ontario and McMaster Universities Index (WOMAC) pain subscale, functional status was determined by Steinbrokers criteria, radiographic knee OA was graded using Kellgren-Lawrence criteria, depression was determined using the Patient Health Questionnaire (PHQ-9), sleep quality by the Pittsburgh Sleep Quality Index (PSQI), and family functioning by Family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve). Factors associated with depression in KOA following bivariate analyses were adopted as independent variables in logistic regression analysis to determine the predictors of depression in KOA. The study was approved by the Ethical Review Committee of each of the study centers. The mean age of patients was 59.90 ± 10.62years and 209 (83.6%) were females. Their mean PHQ-9 score was 4.68 ± 4.19 with 105 (42%) having depression (PHQ-9 ≥ 5). Eighty-four (80%) of patients with depression had poor sleep quality (PSQI≥5.0). Depression was significantly associated with poor sleep, WOMAC pain scores, medial compartment KOA, lateral compartment KOA, and patellofemoral OA. Poor sleep quality was the best predictor of depression (OR 4.555, CI (2.241-9.257), p < 0.001) followed by moderate to severe pain (OR 2.490, CI (1.119-5.542), p < 0.025). Depression is common among patients with knee OA, and depression can be predicted by poor sleep quality and moderate to severe pain.

Performance of distinct knee osteoarthritis classification criteria in the ELSA-Brasil musculoskeletal study.

To compare the performance of different knee osteoarthritis (OA) classification criteria in a subsample of subjects of ELSA-Brasil Musculoskeletal cohort (ELSA-Brasil MSK) in comparison with the clinical-radiographic evaluation of an experienced rheumatologist. A cross-sectional study of the diagnostic accuracy of different knee OA classification criteria: radiographic OA, symptomatic OA, clinical and clinical-radiographic criteria of the American College of Rheumatology (ACR), and the definition proposed by the National Institute for Health and Care Excellence (NICE), UK. The study also evaluated some alternative definitions of OA including a combination of criteria. In total, 250 subjects participated. Only one knee per subject was included. When both or none of the knees were affected, one knee was randomly selected for analysis. OA prevalence, sensitivity, specificity, positive and negative predictive values, and accuracy were presented (CI 95%; α= 5%). The mean age was 56.1years (SD = 8.7), 48.8% female, and 39.2% presented knee OA according to the rheumatologist. The sensitivity and the specificity of radiographic OA were 51% and 96.7%, respectively, while the NICE definition showed 57.0% and 76.3%, respectively. The other OA criteria showed good levels of specificity, but the levels of sensitivity were below 30%. Considering NICE and/or X-ray result in combination, the sensitivity increased (73.4%), while the specificity reduced slightly (73.0%) in relation to the original NICE definition. Radiographic OA showed the best performance, followed by NICE definition, especially in combination with X-ray results.

Neuropathic pain among patients with primary knee osteoarthritis: Results of a cross-sectional study from a tertiary care center in Southern India

Background: Pain in knee osteoarthritis (OA) may have a neuropathic component. We used the Douleur Neuropathique in 4 questions (DN4) questionnaire to assess neuropathic pain in knee OA and to identify factors associated with neuropathic pain. Methods: A total of 161 patients with knee OA satisfying the American College of Rheumatology 1986 classification criteria for knee OA were prospectively studied. DN4 questionnaire was administered; a score of ≥4/10 was classified as diagnostic for neuropathic pain. The Indian version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness, and physical function. Factors associated with neuropathic pain were explored. Results: Mean age was 55.7 ± 8.8 years. The mean total Indian WOMAC was 75.07 ± 13.8 and WOMAC pain score was 16.1 ± 3.6. Seventy-nine patients of 161 (49%) had DN4 score ≥4 (neuropathic pain present). When diabetics were excluded (n = 58), the proportion of patients with DN4 score ≥4 reduced to 45.6%. The most frequently described pain characteristic was sensation of electric shock (58.4%). Mean total WOMAC and physical function subscale were significantly higher in neuropathic pain group when compared to the group without neuropathic pain (DN4 ≤3), 77.5 ± 11.5 versus 72.6 ± 15.5, P = 0.024 and 54.3 ± 8.8 and 49.8 ± 12.6, respectively, P = 0.008. Conclusions: Neuropathic pain (DN4 ≥4) was seen in up to 49% patients with knee OA. Centrally acting drugs such as tricyclic antidepressants or duloxetine can be used to improve the quality of life and physical function of knee OA patients with neuropathic pain.

Adiponectin associates with markers of cartilage degradation in osteoarthritis and induces production of proinflammatory and catabolic factors through mitogen-activated protein kinase pathways

IntroductionAdiponectin is an adipokine that regulates energy metabolism and insulin sensitivity, but recent studies have pointed also to a role in inflammation and arthritis. The purpose of the present study was to investigate the association and effects of adiponectin on inflammation and cartilage destruction in osteoarthritis (OA).MethodsCartilage and blood samples were collected from 35 male OA patients undergoing total knee replacement surgery. Preoperative radiographs were evaluated using Ahlbäck classification criteria for knee OA. Circulating concentrations of adiponectin and biomarkers of OA, that is, cartilage oligomeric matrix protein (COMP) and matrix metalloproteinase 3 (MMP-3), were measured. Cartilage samples obtained at the time of surgery were cultured ex vivo, and the levels of adiponectin, nitric oxide (NO), IL-6, MMP-1 and MMP-3 were determined in the culture media. In addition, the effects of adiponectin on the production of NO, IL-6, MMP-1 and MMP-3 were studied in cartilage and in primary chondrocyte cultures.ResultsPlasma adiponectin levels and adiponectin released from OA cartilage were higher in patients with the radiologically most severe OA (Ahlbäck grades 4 and 5) than in patients with less severe disease (Ahlbäck grades 1 to 3). Plasma adiponectin concentrations correlated positively with biomarkers of OA, that is, COMP (r = 0.55, P = 0.001) and MMP-3 (r = 0.34, P = 0.046). Adiponectin was released by OA cartilage ex vivo, and it correlated positively with production of NO (r = 0.43, P = 0.012), IL-6 (r = 0.42, P = 0.018) and MMP-3 (r = 0.34, P = 0.051). Furthermore, adiponectin enhanced production of NO, IL-6, MMP-1 and MMP-3 in OA cartilage and in primary chondrocytes in vitro in a mitogen-activated protein kinase (MAPK)-dependent manner.ConclusionsThe findings of this study show that adiponectin is associated with, and possibly mediates, cartilage destruction in OA.