Early Symptomatic Knee Osteoarthritis Research Articles

Comparison of three treatment protocols with intra-articular low or intermediate molecular weight hyaluronic acid in early symptomatic knee osteoarthritis.

Introduction:Viscosupplementation with hyaluronic acid (HA) is indicated for non-responders to non-pharmacological therapy, to analgesics or when non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. The aim of this study is to compare the efficacy, safety and costs of three different HA treatments (Sinovial® Forte, sinovial one and hyalgan).Patients and methods:Ninety patients with grade I/II Kellgren–Lawrence knee osteoarthritis were included in three groups, the first was treated with hyalgan (weekly for 5 weeks), the second with Sinovial® Forte (weekly for 3 weeks) and the third group with a single injection of sinovial one.Results:All three treatments were effective, with an average reduction in the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score of 18.9 points for hyalgan, 18.04 points for Sinovial® Forte and 17.92 points for sinovial one. The comparison of the three groups did not show any statistical difference in terms of efficacy. National health system (NHS) and social costs are, respectively, €419.12 and €853.43 for hyalgan, €338.64 and €599.22 for Sinovial® Forte, €221.56 and €308.42 for sinovial one.Conclusion:All three treatments were equally effective with no statistically significant differences; thus, the treatment with sinovial one may be considered as clinically effective as the other two regimens, but with a very efficient cost profile in early symptomatic knee osteoarthritis.

Efficacy of Avosoya®300 (Avocado/Soybean Unsaponifiables) on Cartilage Catabolic Biomarkers among Egyptian Patients with Early Symptomatic Knee Osteoarthritis

Biochemical catabolic biomarkers receive increasing attention in early stage of osteoarthritis (OA), due to superior sensitivity and objectivity in comparison to conventional endpoints. While previous studies with biochemical biomarkers in OA have focused primarily on structural changes, this study focused on early OA stage associated knee pain. Early determination would allow progressing personalized treatment choices and leading to better management of patients with OA.

Establishing outcome measures in early knee osteoarthritis.

The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.

Characteristics associated with joint replacement in early symptomatic knee or hip osteoarthritis: 6-year results from a nationwide prospective cohort study (CHECK).

Many patients with osteoarthritis (OA) of the knee and/or hip undergo total joint replacement (TJR) because of severely progressed symptoms. To determine patient and disease characteristics associated with undergoing TJR in participants with recent-onset knee and/or hip OA. Participants with hip or knee pain from the nationwide prospective Cohort Hip and Cohort Knee (CHECK) study were included. The outcome measure was total hip arthroplasty (THA) or total knee arthroplasty (TKA) during 6 years of follow-up. Joint-dependent characteristics were compared using generalised estimating equations (GEE). Multivariable models were built for both subgroups. Differences in symptomatic and radiographic progression were determined between baseline and 2-year follow-up (T2). The knee subgroup included 751 participants (1502 knees), and there were 538 participants in the hip subgroup (1076 hips). Nineteen participants (22 knees) underwent TKA and 53 participants (62 hips) THA. Participants who underwent TKA had higher baseline body mass index, painful knee flexion, and higher Kellgren and Lawrence scores. Participants who underwent THA had painful internal hip rotation and showed more severe radiographic OA features. Participants who underwent TKA or THA showed more rapid symptomatic and radiographic OA progression at T2. In patients with recent-onset knee or hip pain, radiographic OA features already exist and a substantial number of patients fulfil existing criteria for knee and hip OA. A trend was observed in rapid progression of radiographic and symptomatic OA severity among patients with TKA and THA. Early detection of OA by the GP is important in managing knee and hip OA.

Erratum to: The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology.

Erratum to: The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology.

The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology.

The aim of this study was to establish consensus for potential early symptomatic knee osteoarthritis (ESKOA) clinical definition and referral criteria from primary care to rheumatologists, based on available data from literature and a qualitative approach, in order to perform studies on patients fulfilling such criteria and to validate the obtained ESKOA definition. A complex methodological approach was followed including: (1) three focus groups (FG), including expert clinicians, researchers and patients; (2) a systematic literature review (SLR); (3) two discussion groups followed by a Delphi survey. FG and SLR were performed in parallel to inform discussion groups in order to identify relevant constructs to be included in the modified Delphi survey. ESKOA is defined in the presence of: (a) two mandatory symptoms (knee pain in the absence of any recent trauma or injury and very short joint stiffness, lasting for less than 10min, when starting movement) even in the absence of risk factors, or (b) knee pain, and 1 or 2 risk factors or (c) three or more risk factors in the presence of at least one mandatory symptom, with symptoms lasting less than 6 months. These criteria are applicable in the absence of active inflammatory arthritis, generalized pain, Kellgren-Lawrence grade >0, any recent knee trauma or injury, and age lower than 40years. Knee pain in the absence of any recent trauma lasting for less than 6months was considered as the referral criterion to the rheumatologist for the suspicion of ESKOA. This consensus process has identified provisional clinical definition of ESKOA and defined potential referral criterion to rheumatologist, in order to test ESKOA obtained definition in prospective validation studies.

Exploring Fatigue Trajectories in Early Symptomatic Knee and Hip Osteoarthritis: 6-year Results from the CHECK Study.

To examine whether different groups of fatigue trajectories can be identified among patients with early symptomatic osteoarthritis (OA) of the knee or hip, to describe the level of fatigue severity within each of these fatigue groups, and to investigate the involvement of age, sex, use of medication, comorbidity, and OA severity in relation to group membership. Six years of followup data on fatigue (Medical Outcomes Study Short Form-36 Vitality scale) came from the Cohort Hip and Cohort Knee (CHECK) cohort. Growth mixture modeling was applied to identify distinct fatigue trajectories as well as to take into account the effects of the patient characteristics. Three fatigue trajectories were identified: low fatigue, low-to-high fatigue, and high fatigue. Latter trajectories showed considerable overlap from years 2 to 6, but differed in some patient characteristics in comparison with each other and in comparison with the low fatigue group. Comorbidity, medication use, and sex were significantly associated with the identified trajectories. Women, individuals with a comorbid disease, and those who used medication were more likely to follow a high fatigue trajectory. These findings suggest heterogeneous development of fatigue in the early OA population associated with varying patient characteristics. Further, this study shows that a considerable number of patients with OA already experience elevated levels of fatigue at an early stage of OA. While these findings need to be replicated, the identification of these trajectories with differing patient characteristics may warrant tailored psychosocial interventions for patients with elevated levels of fatigue.

Knee joint proprioception mediates the association between erythrocyte sedimentation rate and muscle strength in patients with early symptomatic knee osteoarthritis: results from the check cohort

Knee joint proprioception mediates the association between erythrocyte sedimentation rate and muscle strength in patients with early symptomatic knee osteoarthritis: results from the check cohort

Defining knee pain trajectories in early symptomatic knee osteoarthritis in primary care: 5-year results from a nationwide prospective cohort study (CHECK).

GPs have high consultation rates for symptoms related to knee osteoarthritis (OA). Many risk factors for symptomatic knee OA progression remain unknown. To define distinct knee pain trajectories in individuals with early symptomatic knee OA and determine the risk factors for these pain trajectories. Data were obtained from the multicentre prospective Cohort Hip and Cohort Knee study in the Netherlands. Participants with knee OA, according to the clinical criteria of the American College of Rheumatology, and a completed 5-year follow-up were included. Baseline demographic, anamnestic, and physical examination characteristics were assessed. Outcome was annually assessed by the Numeric Rating Scale for pain. Pain trajectories were retrieved by latent class growth analysis. Multinomial logistic regression was used to calculate relative risk ratios. In total, 705 participants were included. Six distinct pain trajectories were identified with favourable and unfavourable courses. Statistically significant differences were found in baseline characteristics, including body mass index (BMI), symptom severity, and pain coping strategies between the different trajectories. Higher BMI, lower level of education, greater comorbidity, higher activity limitation scores, and joint space tenderness were more often associated with trajectories characterised by more pain at first presentation and pain progression--compared with the reference group with a mild pain trajectory. No association was found for baseline radiographic features. These results can help differentiate those patients who require more specific monitoring in the management of early symptomatic knee OA from those for whom a 'wait-and-see' policy seems justifiable. Radiography provided no additional benefit over clinical diagnosis of early symptomatic knee OA in general practice.

Short-term effect of the combination of hyaluronic acid, chondroitin sulfate, and keratin matrix on early symptomatic knee osteoarthritis

In the last years, symptomatic slow-acting drugs for osteoarthritis (SYSADOA) have been vastly studied and have generated considerable interest among clinicians. SYSADOA are generally used as a ground therapy with the main rationale to reduce the consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) and thus limit the related adverse events. In this study, we evaluated the short-term effect of an oral combination of hyaluronic acid, chondroitin sulfate, and keratin matrix on early symptomatic knee osteoarthritis. Forty patients were treated for 1 month and were allowed to assume analgesics or NSAIDs if necessary. At 2 months, the mean reduction of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was 36% (p<0.001), and the mean reduction of the WOMAC pains score was 40% (p<0.001). Only two patients reported a sporadic need to assume analgesics; no patient reported any side effect during the study period. This data demonstrates that the oral combination of hyaluronic acid, chondroitin sulfate, and keratin matrix is safe, well tolerated, and shows a rapid action reducing pain and improving joint function and stiffness in early symptomatic knee osteoarthritis.

Identifying Trajectories of Pain Severity in Early Symptomatic Knee Osteoarthritis: A 5-year Followup of the Cohort Hip and Cohort Knee (CHECK) Study

To identify subgroups of pain trajectories in patients with symptomatic knee osteoarthritis (OA), and to explain these different trajectories by patient characteristics, lifestyle, and coping factors, as well as radiographic features. Longitudinal data of pain severity (0-10) from 5 years of followup of the CHECK (Cohort Hip and Cohort Knee) study was used. Latent class growth analysis identified homogeneous subgroups with distinct trajectories of pain. Multinomial regression analysis was used to examine different lifestyle and coping characteristics between the trajectories. In longitudinal pain data of 5 years of followup in 705 participants, 3 pain trajectories were identified: marginal, mild, and moderate pain trajectories. Compared with the marginal pain trajectory, the mild and moderate pain trajectories can be characterized by the following baseline variables: body mass index (BMI) > 25, additional hip pain, low education level, using the coping strategy "worrying," and having ≥ 3 comorbidities. Moderate pain trajectory can be supplemented with the Kellgren-Lawrence grading scale grade ≥ 2 radiological change. Three trajectories of pain were identified. Participants with a BMI > 25, secondary school as highest education level, having at least 3 comorbidities, additional hip pain, and/or whose coping style is worrying are more likely to develop a moderate or mild pain trajectory compared with those without these characteristics. In the management of knee pain in people with early symptomatic OA, attention should also be given to additional factors such as hip pain, other comorbidities, passive coping strategy, and obesity.

Predictors and outcome of pain-related avoidance of activities in persons with early symptomatic knee osteoarthritis: a five-year followup study.

It has been hypothesized that pain and low vitality lead to an increase in avoidance of activities in persons with early symptomatic knee osteoarthritis (OA), and that avoidance of activities leads to an increase in activity limitations. The present study aimed to evaluate these hypotheses. Baseline, 2-year, and 5-year followup data of 828 participants from the Cohort Hip and Cohort Knee Study with early symptomatic knee OA were used. Autoregressive generalized estimating equations and linear regression models were used to analyze the longitudinal and cross-sectional associations between self-reported knee pain, vitality, pain-related avoidance of activities, and activity limitations. The models were adjusted for the covariates age, sex, education level, body mass index, comorbidity, radiographic severity, and hip pain. In longitudinal analyses, knee pain and vitality predicted a subsequent increase in avoidance of activities. Pain-related avoidance of activities predicted a subsequent increase in activity limitations; however, this relationship lost statistical significance (P = 0.089) after adjustment for covariates. Cross-sectional analyses showed strong relationships between knee pain, low vitality, pain-related avoidance of activities, and activity limitations at all time points. In persons with early symptomatic knee OA, knee pain and low vitality lead to a subsequent increase in avoidance of activities. Pain-related avoidance of activities is related to activity limitations at inception of symptoms, but also years later. Therefore, it can be recommended to monitor and target avoidance of activities at various stages of the disease.

Intermittent and constant pain and physical function or performance in men and women with knee osteoarthritis: data from the osteoarthritis initiative.

Severe constant and intermittent knee pain are associated with "unacceptable" symptoms in older adults with osteoarthritis (OA) [22]. We hypothesized that constant and intermittent pain would be independently related to physical function, with intermittent knee pain being a better predictor of future declines in physical function in early symptomatic knee OA. This study included men (n = 189) and women (n = 133) with radiographic, unilateral knee OA, observed using data from the Osteoarthritis Initiative (OAI). Pain types were measured using the Intermittent and Constant Osteoarthritis Pain (ICOAP) scale. Physical function was measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC-PF) and Knee Injury and Osteoarthritis Outcome Score (KOOS-FSR) and physical performance tests. High baseline intermittent (B = 0.277; p = 0.001) and constant (B = 0.252; p = 0.001) knee pain were related to poor WOMAC-PF. Increased constant (B = 0.484; p = 0.001) and intermittent (B = 0.104; p = 0.040) pain were related to 2-year decreased WOMAC-PF. High baseline intermittent knee pain predicted poor KOOS-FSR at year 2 (B = -0.357; p = 0.016). Increased constant pain was related to decreased chair stand test performance over 2 years in women (B = 0.077; p = 0.001). High baseline intermittent pain was related to poor performance on repeated chair stands (B = 0.035; p = 0.021), while baseline constant pain was related to poor 400-m walk performance in women (B = 0.636; p = 0.047). Intermittent and constant knee pain were independent factors in self-perceived physical function and were important predictors of future limitations in physical function. Identifying intermittent and constant pain in early symptomatic OA may allow patients to adopt strategies to prevent worsening pain and future declines in physical function.

Decrease of Muscle Strength Is Associated With Increase of Activity Limitations in Early Knee Osteoarthritis: 3-Year Results From the Cohort Hip and Cohort Knee Study

ObjectiveTo determine whether a decrease in muscle strength over 3 years is associated with an increase in activity limitations in persons with early symptomatic knee osteoarthritis (OA), and to examine whether the longitudinal association between muscle strength and activity limitations is moderated by knee joint proprioception and laxity. DesignA longitudinal cohort study with 3-year follow-up. Measurements were performed at the second (t0) and fifth (t1) year of the Cohort Hip and Cohort Knee (CHECK) study. Statistical analyses included paired t tests, chi-square tests, and regression analyses. In regression analyses, the association between muscle strength and activity limitations was adjusted for confounders. SettingA rehabilitation and rheumatology center. ParticipantsSubjects (N=146) with early symptomatic knee OA from the CHECK study. InterventionsNot applicable. Main Outcome MeasuresMuscle strength, proprioception, and laxity were assessed using specifically designed measurement devices. Self-reported and performance-based activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index, the Get Up and Go test, the walk test, and the stair-climb test. ResultsA total of 116 women (79.5%) and 30 men (20.5%), with a mean age ± SD of 58.4±4.9 years and a mean body mass index ± SD of 25.5±3.6, were included in the study. Overall, small 3-year changes in muscle strength and activity limitations were observed. At the group level, the average muscle strength increased by 10% (1.0±0.3 to 1.1±0.3Nm/kg) over the 3 years. The 3-year decrease in muscle strength was independently associated with an increase in performance-based activity limitations on all 3 measures (B=−1.12, B=−5.83, and B=−1.25, respectively). Proprioception and laxity did not moderate this association. ConclusionsIn patients with early knee OA, decreased muscle strength is associated with an increase in activity limitations. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations in knee OA. Further well-designed experimental studies are indicated to establish the causal role of muscle weakness in activity limitations.

OP0132-HPR Predictors and Outcome of Avoidance of Activities in Persons with Early Symptomatic Knee Osteoarthritis: A 5-Year Follow-Up Study in the CHECK Cohort

BackgroundIt has been hypothesized (i) that pain and low vitality lead to an increase in avoidance of activities in persons with early symptomatic knee osteoarthritis (OA), and (ii) that avoidance...

SAT0430 Association between Serum 25-Hydroxy (OH) Vitamin D Level and Muscle Strength in Patients with Knee Osteoarthritis: Results of the AMS-OA Cohort

BackgroundMuscle weakness is frequent in patients with knee osteoarthritis (OA) and is an important contributor to pain and activity limitations1. Determinants of muscle weakness in knee OA include pain, disuse,...

AB0788 Decrease of Muscle Strength is Associated with Increase of Activity Limitations in Early Knee Osteoarthritis: 3-Year Results from the CHECK Study

BackgroundMuscle weakness has been hypothesized as being an important factor in the development of activity limitations in knee osteoarthritis (OA). Longitudinal evidence to support this hypothesis is scarce in early...

Relationship between knee extensor torque and physical function in men with early knee osteoarthritis

Relationship between knee extensor torque and physical function in men with early knee osteoarthritis

AB1340 Associations between proprioception, laxity, muscle strength and activity limitations in early symptomatic knee osteoarthritis: Results from the check cohort

BackgroundOsteoarthritis (OA) of the knee is a leading cause of activity limitations (e.g. stair-climbing, walking) in Western countries (1), and an important physical determinant of activity limitations is muscle strength...

Three trajectories of activity limitations in early symptomatic knee osteoarthritis: a 5-year follow-up study

ObjectivesKnee osteoarthritis (OA) is a leading cause of activity limitations. The knee OA population is likely to consist of subgroups. The aim of the present study was to identify homogeneous...