Classification Criteria For Osteoarthritis Research Articles

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.

Erosive hand osteoarthritis: latest findings and outlook.

Osteoarthritis (OA) most commonly affects knee joints, and the next most commonly affected sites are the hands and hips. Three distinct hand OA phenotypes have been described: erosive hand OA (EHOA), nodal hand OA - also known as non-erosive hand OA (non-EHOA) - and first carpometacarpal joint OA. EHOA predominantly affects women and is the most aggressive form of hand OA, characterized by a severe clinical onset and progression, leading to joint damage, disability and reduction of quality of life. Clinical signs of inflammation associated with EHOA include the acute onset of pain, swelling and redness. Moreover, EHOA is characterized by radiographic features such as central erosion, saw-tooth and gull-wing lesions and, rarely, ankylosis. The aim of this Review is to report the latest findings on epidemiology, clinical features, pathology and aetiopathogenesis, biomarkers, imaging modalities and treatments for EHOA. The ongoing development of new hand OA classification criteria should facilitate standardization between 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.

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.

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.

Health and Lifestyles Factors Associated With Osteoarthritis among Older Adults in Portugal

This study aimed to identify independent associations of sociodemographic, functionality, physical activity, physical and mental health, and osteoarthritis (OA), among older adults. A sample of 1,645 older adults (50+ years) observed by rheumatologists, from EpiReumaPt, a population-based study was analyzed. A structured interview included sociodemographic data, chronic non-communicable disease, and physical activity. Functional ability was assessed by the Health Assessment Questionnaire Disability Index; depression and anxiety were assessed by Hospital Anxiety and Depression Scale. OA (knee OA and/or hip OA and/or hand OA) was defined after medical evaluation by rheumatologists according to expert opinion combined with the fulfillment of the American College of Rheumatology classification criteria. 1,059 participants (64.9%) met the OA classification criteria. Statistically significant differences were found between persons with and without OA in all sociodemographic variables, non-communicable diseases, functional status, physical activity, depression, and anxiety. In the unadjusted logistic regression models, all variables were associated with OA. The final adjusted model explained 32% of the variance. Those who are female with higher age, have more than five comorbidities, and lower levels of function and physical activity were more likely to meet the criteria for a diagnosis of OA. We have analyzed data from a population-based study and found that a diagnosis of OA was independently associated with age, female gender, higher number of comorbidities, physical disability, and low levels of physical activity. These results reinforce the usefulness of the development of a multidimensional assessment to design and test effective interventions for this population.

Association of body mass index and community mobility among older adults with osteoarthritis knee

Background:Obesity is common among physically inactive older adults with osteoarthritis (OA) knee. Obesity has been shown to affect the joint mechanics as increased body mass can increase the mechanical stress on joints, causing disarrangements or abnormalities. In addition, obesity may increase disability in OAdue to a decrease in lower-extremity performance. Adequate mobility and balance are needed in order to ambulate independently in the community. Mobility limitations (reduced ability to ambulate in indoors and community) in older adults with knee OA found to increase risk for falls. Studies investigating the relationship between BMI andmobility have focused on individuals with severe obesity, and few studies have examined the relationship between BMI and community mobility among older adults with OA knee. Purpose: To examine the association between BMI and community mobility among older adults with OA knee. Methods: Participants were a sample of convenience of 75 older adults diagnosed with OA knee who were receiving out-patient physiotherapy from a tertiary care hospital. Before enrolment, written informed consent was obtained from all the participants. Participants diagnosed according to the American College of Rheumatology Clinical ClassificationCriteria forOsteoarthritis of the kneewere included in the study (N= 75,mean age 57.8± 5.4, 61 females).Wecollected demographic information and baseline measures including disease severity using includingKellegren and Lawrence system for classification of osteoarthritis of knee by radiographic examination (grade I (N= 28), grade II (N= 33), grade III (N= 14)), pain intensity at rest (mean score 2.2± 1.1) and duringwalking using numerical pain rating scale (mean score 4.8± 1.8), and fall history in past one year using self report. BMI was calculated using standardized height and weight measurements. Communitymobility was examined using the community balance and mobility scale, a performance measure composed of 13 challenging tasks used to detect ‘high level’ balance and mobility deficits based on tasks that are commonly encountered in community environments. Community balance and mobility scale is a standardized and validatedmeasure of communitymobility andbalance among elderly adults with OA knee. We compared the mean scores of community balance and mobility scale scores across BMI classifications using oneway ANOVA. Results:Communitymobility and balance is significantly different across various BMI classifications (p= 0.000). Participants with severe obesity (n= 6, mean18.3± 4.93), moderately obese (n= 24, mean21.7± 6.64), and overweight (n= 31, mean34.9± 12.29), had the lowest levels of balance and mobility score when compared to participants with normal weight (n= 14, mean68.5± 7.26). In addition we also found that participants who had a history of fall in the past year had lower scores (21.1± 8.2) than those with no history of fall (41.5± 19.3). Conclusion(s): In older adults with OA knee, obesity is associated with increased balance and mobility deficits related to community environment.We believe that clinicians should consider incorporating education program that communicates patients about the likelihood of increased risk of fall associated with obesity in older adults with OA knee. Implications: Results of this research could lead to more efforts directed towardsmeasuring risk of fall and developing fall prevention interventions among obese elderly adults with OA knee.

SAT0445 Risk of Cardiovascular Disease in Patients with Osteoarthritis: Results from the Must-Heart Study

BackgroundControversies exist regarding whether patients with osteoarthritis (OA) have an increased risk of cardiovascular (CV) disease.ObjectivesOur aim was to evaluate the CV risk in a population-based OA cohort.MethodsThe Musculoskeletal pain...

Bildgebung bei der Arthrose peripherer Gelenke

Pain and loss of function are the clinical signs of osteoarthritis (OA). Conventional x-rays confirm the diagnosis or provide important hints for differential diagnosis. In the natural course of OA, x-rays are performed at longer intervals when pain increases or therapy is without effect, especially if more invasive therapies, or even surgery, becomes necessary. The advantages of x-rays are worldwide availability, cost effectiveness, very long experience with this imaging method and the possibility of storing the images for long periods of time. The typical findings of OA can be detected only roughly by quantitative methods. In many patients, grading of OA does not correlate well with the clinical symptoms. X-ray changes are part of the American College of Rheumatology (ACR) classification criteria for OA of the hand, hip and knee. Ordinary s-rays can depicting bone with a higher local resolution than any other imaging technique. Soft tissues and cartilage can be visualized only indirectly. In OA, ultrasound is the method to depict intra-articular effusion at an early stage. Osteophytes or the degree of synovitis are also visible. Concomitant changes in tendons, bursae or cartilage, such as structures in the hip, shoulder and knee, can be evaluated. MRI is an appropriate tool for describing changes in cartilage volume and concomitant soft-tissue alterations. For qualitative cartilage imaging, MRI has, to date, not been fully validated. Bone scans (bone scintigraphy) allow the differentiation of inflammatory from degenerative joint affections and may add information on the activity of the subchondral bone, which may develop to a prognostic marker of OA. This survey represents recommendations of the Commission "Imaging Techniques" of the German Rheumatology Society regarding the technical and individual conditions, indications, practical guidance and the typical findings of imaging in OA.

Joint exercises in elderly persons with symptomatic osteoarthritis of the hip or knee. Performance patterns, medical support patterns, and the relationship between exercising and medical care.

A total of 110 community-living elderly persons with chronic hip and/or knee pain, all of whom met American College of Rheumatology classification criteria for osteoarthritis (OA), were interviewed to obtain information about their performance of therapeutic joint exercises and exercise-related medical care. Although exercises are considered standard treatment for OA and 96% of subjects had seen a physician for the problem, fewer than half had received medical advice to exercise and very few had received thorough exercise-related teaching and monitoring. Arthritis specialists provided significantly more support for exercising than primary care physicians. Forty percent of the total sample and 63% of those advised by a physician to exercise were making some attempt to do so; however, only 10% were exercising in a manner that might be expected to achieve maximum therapeutic benefit. Supportive medical care was highly related to frequency of exercising.

Arthroscopic and synovial correlates of pain in osteoarthritis

PATIENTS AND METHODS D EFINITION OF DISEASE complicates the correlation of pain with other features of knee joint osteoarthritis (OA). Patient selection for clinical trials is limited by the fact that joint pain is often present before joint destruction is demonstrated by radiographs.“* Direct inspection of the joint by knee arthroscopy can detect cartilage degeneration and hence confirm the diagnosis of OA before radiographic changes occur.3 Thus, patients presumed to have an early stage of OA also may be selected for screening of disease. Recently, the American College of Rheumatology (ACR; formerly the American Rheumatism Association) published criteria for classification of OA of the knee.’ These criteria can be tested by arthroscopy. Abnormal cartilage per se may not explain pain in OA because cartilage lacks innervation. However, joint pain in OA could be caused by a pathological process in the synovial membrane. There is controversy regarding the presence or absence of synovitis in OA4*’ based on diverging results in previous studies.“‘* The question has been addressed by a recent arthroscopic study using immunohistologic stains of the synovium.” An intense inflammation was demonstrated in synovium areas near OA cartilage, whereas the remainder of the joint interior remained without inflammation. Biopsies of involved synovium guided by direct visualization microscopically displayed highly inflammatory changes comparable to the synovial changes in rheumatoid arthritis. In contrast, tissues sampled from apparently noninflamed areas lacked immunohistopathologic signs of synovitis. Thus, microscopic examination verified the arthroscopic findings of local synovitis.13 Among the patients referred to the Department of Rheumatology, Huddinge University Hospital, for investigation of knee joint pain, five patients were studied who fulfilled the ACR clinical criteria for classification of OA’ and lacked other signs of a specific form of arthritis. They had given informed consent for the study. Patients were evaluated for the six sets of ACR criteria. Synovial fluid was not available in one of the five patients. No signs of disease in joints other than the knee were apparent at clinical examination. Arthroscopy of the knee joints was performed under local anesthesia. The pressure of irrigating solution was kept below the capillary blood pressure to avoid interference with the synovial circulation. The optics and biopsy forceps were introduced through the joint capsule at different points to enable biopsy sampling under direct vision, as previously described.“.‘4 The synovial biopsy specimens were snapfrozen at 70°C, and frozen sections were examined ,by immunohistochemical single and double stainings with monoclonal antibodies to T lymphocytes, macrophages, HLA-DR antigens, and immunoglobulins, as in earlier studies.‘3,‘4