MRI Osteoarthritis Research Articles

Association of biochemical markers with bone marrow lesion changes on imaging—data from the Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium

BackgroundTo assess the prognostic value of short-term change in biochemical markers as it relates to bone marrow lesions (BMLs) on MRI in knee osteoarthritis (OA) over 24 months and, furthermore, to assess the relationship between biochemical markers involved with tissue turnover and inflammation and BMLs on MRI.MethodsData from the Foundation for the National Institutes of Health OA Biomarkers Consortium within the Osteoarthritis Initiative (n = 600) was analyzed. BMLs were measured according to the MRI Osteoarthritis Knee Score (MOAKS) system (0–3), in 15 knee subregions. Serum and urinary biochemical markers assessed were as follows: serum C-terminal crosslinked telopeptide of type I collagen (CTX-I), serum crosslinked N-telopeptide of type I collagen (NTX-I), urinary CTX-Iα and CTX-Iβ, urinary NTX-I, urinary C-terminal cross-linked telopeptide of type II collagen (CTX-II), serum matrix metalloproteinase (MMP)-degraded type I, II, and III collagen (C1M, C2M, C3M), serum high sensitivity propeptide of type IIb collagen (hsPRO-C2), and matrix metalloproteinase-generated neoepitope of C-reactive protein (CRPM). The association between change in biochemical markers over 12 months and BMLs over 24 months was examined using regression models adjusted for covariates. The relationship between C1M, C2M, C3M, hsPRO-C2, and CRPM and BMLs at baseline and over 24 months was examined.ResultsIncreases in serum CTX-I and urinary CTX-Iβ over 12 months were associated with increased odds of changes in the number of subregions affected by any BML at 24 months. Increase in hsPRO-C2 was associated with decreased odds of worsening in the number of subregions affected by any BML over 24 months. C1M and C3M were associated with BMLs affected at baseline.ConclusionsShort-term changes in serum CTX-I, hsPRO-C2, and urinary CTX-Iβ hold the potential to be prognostic of BML progression on MRI. The association of C1M and C3M with baseline BMLs on MRI warrants further investigation.

Unveiling MRI-based structural phenotypes in temporomandibular joint osteoarthritis: implications for clinical practice and research.

Osteoarthritis (OA) is a progressive degenerative disease characterized by the gradual degradation of cartilage, remodeling of subchondral bone, synovitis, and chronic pain. This condition impacts various large and small joints, including the temporomandibular joint (TMJ). However, addressing OA, particularly in impeding or reducing disease progression, is challenging due to its clinical and imaging heterogeneity. Authors are increasingly suggesting that this heterogeneity involves different phenotypes or subpopulations, discernible by variations in the disease's pathophysiology and structural manifestations. Even within the TMJ, these phenotypes may display distinct clinical features, laboratory parameters, biochemical markers, and imaging criteria. Recent research has proposed MRI as a reference standard for TMJ OA, highlighting its substantial agreement with histopathological changes. MRI-based phenotypes offer a promising avenue for understanding disease progression and treatment response, potentially providing valuable insights for prognosis and treatment planning. This article introduces the ROAMES-TMJ (Rapid OsteoArthritis MRI Eligibility Score for TMJ) to assess the structural eligibility of individuals for inclusion in TMJ OA clinical trials.

A PRECISION HEALTH APPROACH FOR OSTEOARTHRITIS: PREDICTION OF RAPID KNEE OSTEOARTHRITIS PROGRESSION USING AUTOMATED MACHINE LEARNING

AbstractIntroductionPrecision health aims to develop personalised and proactive strategies for predicting, preventing, and treating complex diseases such as osteoarthritis (OA), a degenerative joint disease affecting over 300 million people worldwide. Due to OA heterogeneity, which makes developing effective treatments challenging, identifying patients at risk for accelerated disease progression is essential for efficient clinical trial design and new treatment target discovery and development.ObjectivesThis study aims to create a trustworthy and interpretable precision health tool that predicts rapid knee OA progression based on baseline patient characteristics using an advanced automated machine learning (autoML) framework, “Autoprognosis 2.0”.MethodsAll available 2-year follow-up periods of 600 patients from the FNIH OA Biomarker Consortium were analysed using “Autoprognosis 2.0” in two separate approaches, with distinct definitions of clinical outcomes: multi-class predictions (categorising patients into non-progressors, pain-only progressors, radiographic-only progressors, and both pain and radiographic progressors) and binary predictions (categorising patients into non-progressors and progressors). Models were developed using a training set of 1352 instances and all available variables (including clinical, X-ray, MRI, and biochemical features), and validated through both stratified 10-fold cross-validation and hold-out validation on a testing set of 339 instances. Model performance was assessed using multiple evaluation metrics, such as AUC-ROC, AUC-PRC, F1-score, precision, and recall. Additionally, interpretability analyses were carried out to identify important predictors of rapid disease progression.ResultsOur final models yielded high accuracy scores for both multi-class predictions (AUC-ROC: 0.858, 95% CI: 0.856–0.860; AUC-PRC: 0.675, 95% CI: 0.671–0.679; F1-score: 0.560, 95% CI: 0.554–0.566) and binary predictions (AUC-ROC: 0.717, 95% CI: 0.712–0.722; AUC-PRC: 0.620, 95% CI: 0.616–0.624; F1-score: 0.676, 95% CI: 0.673–0679). Important predictors of rapid disease progression included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and MRI features. Our models were further successfully validated using a hold-out dataset, which was previously omitted from model development and training (AUC-ROC: 0.877 for multi-class predictions; AUC-ROC: 0.746 for binary predictions). Additionally, accurate ML models were developed for predicting OA progression in a subgroup of patients aged 65 or younger (AUC-ROC: 0.862, 95% CI: 0.861–0.863 for multi-class predictions; AUC-ROC: 0.736, 95% CI: 0.734–0.738 for binary predictions).ConclusionsThis study presents a reliable and interpretable precision health tool for predicting rapid knee OA progression using “Autoprognosis 2.0”. Our models provide accurate predictions and offer insights into important predictors of rapid disease progression. Furthermore, the transparency and interpretability of our methods may facilitate their acceptance by clinicians and patients, enabling effective utilisation in clinical practice. Future work should focus on refining these models by increasing the sample size, integrating additional features, and using independent datasets for external validation.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Structural tissue damage and 24-month progression of semi-quantitative MRI biomarkers of knee osteoarthritis in the IMI-APPROACH cohort

BackgroundThe IMI-APPROACH cohort is an exploratory, 5-centre, 2-year prospective follow-up study of knee osteoarthritis (OA). Aim was to describe baseline multi-tissue semiquantitative MRI evaluation of index knees and to describe change for different MRI features based on number of subregion-approaches and change in maximum grades over a 24-month period.MethodsMRIs were acquired using 1.5 T or 3 T MRI systems and assessed using the semi-quantitative MRI OA Knee Scoring (MOAKS) system. MRIs were read at baseline and 24-months for cartilage damage, bone marrow lesions (BML), osteophytes, meniscal damage and extrusion, and Hoffa- and effusion-synovitis. In descriptive fashion, the frequencies of MRI features at baseline and change in these imaging biomarkers over time are presented for the entire sample in a subregional and maximum score approach for most features. Differences between knees without and with structural radiographic (R) OA are analyzed in addition.ResultsTwo hundred eighty-nine participants had readable baseline MRI examinations. Mean age was 66.6 ± 7.1 years and participants had a mean BMI of 28.1 ± 5.3 kg/m2. The majority (55.3%) of included knees had radiographic OA. Any change in total cartilage MOAKS score was observed in 53.1% considering full-grade changes only, and in 73.9% including full-grade and within-grade changes. Any medial cartilage progression was seen in 23.9% and any lateral progression on 22.1%. While for the medial and lateral compartments numbers of subregions with improvement and worsening of BMLs were very similar, for the PFJ more improvement was observed compared to worsening (15.5% vs. 9.0%). Including within grade changes, the number of knees showing BML worsening increased from 42.2% to 55.6%. While for some features 24-months change was rare, frequency of change was much more common in knees with vs. without ROA (e.g. worsening of total MOAKS score cartilage in 68.4% of ROA knees vs. 36.7% of no-ROA knees, and 60.7% vs. 21.8% for an increase in maximum BML score per knee).ConclusionsA wide range of MRI-detected structural pathologies was present in the IMI-APPROACH cohort. Baseline prevalence and change of features was substantially more common in the ROA subgroup compared to the knees without ROA.Trial RegistrationClinicaltrials.gov identification: NCT03883568.

The Osteoarthritis Natural Progress and Changes in Intraosseous Pressure of the Guinea Pig Model in Different Degeneration Stages.

Articular cartilage and subchondral bone changes during the pathological progress of knee osteoarthritis (KOA) is a key event marking the development of the disease. The age varying alteration patterns within entire osteochondral unit remains poorly understood. The purpose of this study was to find a reasonable age range of the Dunkin-Hartley guinea pig model for the studying of KOA pathological process, and to investigate Intraosseous pressure (IOP) in the process during different degeneration stages of KOA. Male Dunkin-Hartley guinea pigs were selected and divided into groups of 3, 6, 9, 12, 18months old by age, 10 in each group. All knees underwent imaging examination including X-ray, Micro-CT and MRI. Observed the imaging findings with the use of Kellgren-Lawrence (K-L) classification and knee osteoarthritis MRI scores. Measured the IOP of distal femur (DF) and proximal tibia (PT) in each group, and observed the differences of bilateral tibiofemoral articular cartilage in histological and immunohistochemistry, staining results were evaluated by using Mankin's score. Analysis of variance (ANOVA) and t-tests were used to compare the differences indicators between groups. With the increase of age, changes in X-ray, Micro-CT and MRI imaging findings and pathological staining results of articular cartilage in all stages were consistent with the changing of degenerative KOA process. The IOP of DF and PT increased gradually with age, and reached its peak in 12-month age group, and then gradually decreased, there was a statistically significant difference of IOP between each group. The IOP of DF was slightly higher than that of PT, but the difference was not statistically significant. Dunkin-Hartley guinea pigs can be used as an animal model to study different pathological stages of KOA. There might be a correlation between the changes of IOP and the pathological progress of articular cartilage and subchondral bone in DF and PT.

Role of MRI and T2 mapping in osteoarthritis of knee joint

Introduction: osteoarthritis is the most common joint disease and the leading cause of long-term disability, placing tremendous financial burdens at the individual and societal levels. Indeed, the onset of biochemical changes leading to irreversible cartilage loss. Objective: to clarify the role of conventional MRI anT2 mapping in patients with osteoarthritis of knee joint. Materials and methods: This prospective study was conducted between June 2019 and July 2021, on 40 cases; 30 patients clinically presented with knee pain and 10 healthy volunteers as a control group. They were referred from outpatient clinics and orthopedic surgery department to Radio-diagnosis and Medical Imaging Department of Tanta university hospitals for assessment by MRI. This study was approved by the ethics committee of Tanta University. Results: The mean and standard deviation for T2 values of cartilage that measured at 4 compartments of the knee joint were elevated in patients clinically suspected to have osteoarthritic changes than healthy volunteers with statistically significant P values (<0.001) at 4 compartments. Conclusions: MRI is a powerful non-invasive tool for both diagnosis and characterization of cartilage degeneration.

Patterns of progression differ between Kellgren-Lawrence 2 and 3 knees fulfilling different definitions of a cartilage-meniscus phenotype in the Foundation for National Institutes of Health Osteoarthritis Biomarkers study (FNIH)

ObjectiveAim was to describe three definitions for an MRI-defined cartilage-meniscus phenotype and to report phenotypic progression in Kellgren-Lawrence (KL) 2 and 3 knees over 48 months. MethodsThe study sample was a nested case-control study with knees showing either 1) radiographic and pain progression (“composite” case), 2) radiographic progression only, 3) pain progression only, and 4) no progression. MRI was performed on 3T systems. MRIs were read according to the MOAKS system. Knees were classified as having the cartilage-meniscus phenotype according to three modified ROAMES (Rapid OsteoArthritis MRI Eligibility Score) definitions (D): 1) ​≤ ​2.2 (10–75% of the region of cartilage surface area with 10–75% affected by full thickness loss), i.e. ‘D1’ 2) ≤ 2.1 (10–75% of the region of cartilage surface area with <10% affected by full thickness loss), i.e. ‘D2’ and 3) ≤ 2.0 (10–75% of the region of cartilage surface area without full thickness loss), i.e. ‘D3’. The odds of being a composite case for those with vs. without each definition was determined using logistic regression. Results485 knees were included. For KL2 knees 191 (64%) knees fulfilled D1 criteria, 183 (62%) D2 and 167 (56%) D3. For KL3 these numbers were 164 (87%), 103 (55%) and 77 (41%). Odds for being a composite case for KL2 knees were 2.52 (95% CI 1.40,4.54) for D1, 1.93 (95% CI 1.11,3.35) for D2 and 1.92 (95% CI 1.13,3.28) for D3. For KL3 knees odds were 0.32 (95% CI 0.13,0.78) for D1, 0.56 (95% CI 0.31,1.01) for D2 and 0.49 (95% CI 0.26,0.91) for D3. ConclusionIncreased odds for progression are seen for KL2 knees for all definitions, while this was not observed for KL3 knees. KL3 knees exceeding the maximum damage thresholds and not fulfilling the phenotypic definitions are still likely to experience further progression.

KELLGREN-LAWRENCE 2 AND 3 KNEES WITH A CARTILAGE-MENISCUS PHENOTYPE SHOW DIFFERENT PATTERNS OF STRUCTRAL PROGRESSION

Purpose: Imaging plays an important role in defining structural disease severity and potential suitability of patients recruited to disease-modifying osteoarthritis drug (DMOAD) trials. Three main structural phenotypes in knee OA have been proposed based on MRI, i.e., inflammation, cartilage-meniscus and subchondral bone. Recently, Rapid OsteoArthritis MRI Eligibility Score (ROAMES1) system has been introduced that allows structural phenotypic stratification based on abbreviated MRI assessment and thus, may potentially be applicable in screening efforts for inclusion into clinical DMOAD trials.

MRI-BASED STRUCTURAL PHENOTYPES AND INCIDENCE OF RADIOGRAPHIC OSTEOARTHRITIS:DATA FROM OSTEOARTHRITIS INITIATIVE

Purpose: Recently, the Rapid OsteoArthritis MRI Eligibility Score (ROAMES), a tri-compartmental anatomic approach characterizing structural knee OA phenotypes based on underlying pathophysiologic changes, was proposed to simplify OA grading with MRI for screening for large-scale drug trials. We applied deep learning and survival analysis to investigate the association between time to incident radiographic osteoarthritis (OA) and ROAMES structural phenotypes.

Transcutaneous vagus nerve stimulation in erosive hand osteoarthritis: protocol for the randomised, double-blind, sham-controlled ESTIVAL trial

IntroductionPatients with erosive hand osteoarthritis (EHOA) experience pain and inflammation, two features that can be targeted by vagus nerve stimulation using electrical auricular transcutaneous vagus nerve stimulation (tVNS). A pilot...

Intelligent Algorithm-Based Magnetic Resonance for Evaluating the Effect of Platelet-Rich Plasma in the Treatment of Intractable Pain of Knee Arthritis.

The application of intelligent algorithms in the treatment of intractable pain of patients with platelet-rich plasma (PRP) knee osteoarthritis by magnetic resonance was investigated. The automatic diagnosis of magnetic resonance knee osteoarthritis was established with multiple intelligent algorithms, including gray projection algorithm, adaptive binarization algorithm, and active shape model (ASM). The difference between automatic magnetic resonance detection indexes of the patients with knee osteoarthritis and artificial measurement results was analyzed. The included patients received PRP treatment. Knee osteoarthritis MRI osteoarthritis knee scores (KOA MOAKS) and Western Ontario and McMaster Universities arthritis index (WOMAC) before and after treatment were compared. The results showed that the results of knee osteoarthritis scores, inferior angle of femur, superior angle of tibia, and tibiofemoral angle (TFA) by automatic magnetic resonance diagnostic model were entirely consistent with artificial detection results. After the treatment, the total scores of knee lateral area, interior area, central area, and patellar area were all remarkably lower than those before the treatment (P < 0.05). After the treatment, knee KOA MOAKS scores and WOMAC scores were both lower than those before the treatment (P < 0.05). Visual analogue scale (VAS) scores 1 week, 2 weeks, and 3 weeks after the treatment were decreased compared with those before the treatment (P < 0.05). Relevant studies indicated that intelligent algorithm-based automatic magnetic resonance diagnostic knee osteoarthritis model showed good utilization values, which could provide the reference and basis for the treatment of the patients with knee osteoarthritis.

A whole-joint, unidimensional, irreversible, and fine-grained MRI knee osteoarthritis severity score, based on cartilage, osteophytes and meniscus (OA-COM).

ObjectiveTo develop a whole-joint, unidimensional, irreversible, and fine-grained MRI knee osteoarthritis (OA) severity score, based on cartilage, osteophytes and meniscus (OA-COM), and to predict progression across different severity states using OA-COM as outcome and clinical variables as predictors.MethodsPopulation-based knee pain cohort aged 40–79 was assessed at baseline and 7-year follow-up. OA-COM score was defined as the sum of MRI scores for cartilage, osteophytes and menisci, measured at 6, 8 and 6 sites, total score 0–54. To anchor severity levels, we fit cross-sectional logistic models using OA-COM to predict Kellgren-Lawrence (KL) grades in subsets at or one point below each grade. OA-COM threshold scores were selected on sensitivity, specificity, positive and negative predictive value. We developed longitudinal logistic models for OA-COM progression over each threshold over 7 years. Potential predictors included age, sex, BMI, malalignment, physical exam effusion, quadriceps weakness, and crepitus, selected on area under the receiver operating characteristic curve (AUC) and Akaike’s Information Criterion (AIC).ResultsOptimal OA-COM thresholds were 12, 18, 24 and 30, for KL grades 1 to 4. Significant predictors of progression (depending on threshold) included physical exam effusion, malalignment and female sex, with other selected predictors age, BMI and crepitus.ConclusionOA-COM (0–54 range) is a whole-joint, unidimensional, irreversible, and fine-grained MRI OA severity score reflecting cartilage, osteophytes and menisci. OA-COM scores 12, 18, 24 and 30 are equivalent to KL grades 1 to 4, while offering fine-grained differentiation of states between KL grades, and within pre-radiographic disease (KL = 0) or late-stage disease (KL = 4). In modeling, several clinical variables predicted progression across different states over 7 years.

Preoperative T2 mapping MRI of articular cartilage values predicts postoperative osteoarthritis progression following rotational acetabular osteotomy.

Rotational acetabular osteotomy (RAO) has been reported to be effective in improving symptoms and preventing osteoarthritis (OA) progression in patients with mild to severe develomental dysplasia of the hip (DDH). However, some patients develop secondary OA even when the preoperative joint space is normal; determining who will progress to OA is difficult. We evaluated whether the preoperative cartilage condition may predict OA progression following surgery using T2 mapping MRI. We reviewed 61 hips with early-stage OA in 61 patients who underwent RAO for DDH. They underwent preoperative and five-year postoperative radiological analysis of the hip. Those with a joint space narrowing of more than 1 mm were considered to have 'OA progression'. Preoperative assessment of articular cartilage was also performed using 3T MRI with the T2 mapping technique. The region of interest was defined as the weightbearing portion of the acetabulum and femoral head. There were 16 patients with postoperative OA progression. The T2 values of the centre to the anterolateral region of the acetabulum and femoral head in the OA progression cases were significantly higher than those in patients without OA progression. The preoperative T2 values in those regions were positively correlated with the narrowed joint space width. The receiver operating characteristic analysis revealed that the T2 value of the central portion in the acetabulum provided excellent discrimination, with OA progression patients having an area under the curve of 0.858. Furthermore, logistic regression analysis showed T2 values of the centre to the acetabulum's anterolateral portion as independent predictors of subsequent OA progression (p < 0.001). This was the first study to evaluate the relationship between intra-articular degeneration using T2 mapping MRI and postoperative OA progression. Our findings suggest that preoperative T2 values of the hip can be better prognostic factors for OA progression than radiological measures following RAO. Cite this article: Bone Joint J2021;103-B(9):1472-1478.

Influence of knee and ankle rotator strengthening in improving the cartilage volume detected by MRI in knee osteoarthritis

Knee osteoarthritis (KOA) is one among the major degenerative and inflammatory disease that affects a large number of people worldwide especially the female population. As no proper remedy or treatment is available on date, people prefer non-invasive treatments to overcome this malady. Physiotherapy approaches have been recognized as beneficial to the affected. Though the current intervention packages offer satisfactory results, a better treatment modality is proposed in this report. A study with 100 KOA affected subjects who received knee isometrics and ankle rotator strengthening exercises for 4 weeks showed a significant improvement in their condition. The relief status has been assessed by measuring the cartilage volume by MRI scan.

Association of subchondral bone marrow lesion localization with weight-bearing pain in people with knee osteoarthritis: data from the Osteoarthritis Initiative

BackgroundSubchondral bone marrow lesions (BMLs) detected on MRI in knee osteoarthritis (OA) are associated with knee pain. The prevalence and progression of subchondral BMLs are increased by mechanical knee load. However, associations of subchondral BML location with weight-bearing knee pain are currently unknown. In this study, we aim to demonstrate associations of subchondral BML location and size with weight-bearing knee pain in knee OA.MethodsWe analyzed 1412 and 582 varus knees from cross-sectional and longitudinal Osteoarthritis Initiative datasets, respectively. BML scores were semi-quantitatively analyzed with the MRI Osteoarthritis Knee Score for 4 subchondral regions (median and lateral femorotibial, medial and lateral patellofemoral) and subspinous region. Weight-bearing and non-weight-bearing pain scores were derived from WOMAC pain items. Correlation and negative binomial regression models were used for analysis of associations between the BML scores and pain at baseline and changes in the BML scores and changes in pain after 24-month follow-up.ResultsGreater BML scores at medial femorotibial and lateral patellofemoral compartments were associated with greater weight-bearing pain scores, and statistical significance was retained after adjusting for BML scores at the other 4 joint compartments and other OA features, as well as for non-weight-bearing pain, age, sex, and body mass index (BMI) (medial femorotibial; B = 0.08, p = 0.02. patellofemoral; B = 0.13, p = 0.01). Subanalysis revealed that greater medial femorotibial BML scores were associated with greater pain on walking and standing (B = 0.11, p = 0.01, and B = 0.10, p = 0.04, respectively). Lateral patellofemoral BML scores were associated with pain on climbing, respectively (B = 0.14, p = 0.02). Increases or decreases over 24 months in BML score in the medial femorotibial compartment were significantly associated with increases or decreases in weight-bearing pain severity after adjusting for non-weight-bearing pain, age, sex, baseline weight-bearing pain, BMI, and BML at the other 4 joint compartments (B = 0.10, p = 0.01).ConclusionsSubchondral BML size at the medial femorotibial joint compartment was specifically associated with the severity and the change in weight-bearing pain, independent of non-weight-bearing pain, in knee OA. Specific associations of weight-bearing pain with subchondral BMLs in weight-bearing compartments of the knee indicate that BMLs in subchondral bone contribute to biomechanically induced OA pain.

The impact of a significant weight loss on inflammation assessed on dynamic contrast-enhanced mri and static mri in knee osteoarthritis: a prospective cohort study

Purpose: Obesity is a worldwide health issue and one of the most important risk factors for development of osteoarthritis (OA). The beneficial clinical effect of weight loss is well documented and weight loss is recommended (where appropriate) as core treatment in OA. However, the exact mechanisms causing this effect are not well understood. Inflammation has been proposed as a possible link between OA and overweight and studies have found that weight loss lowers biomarkers of inflammation.

Bilateral osteophytes are associated with more severe knee pain in women from an open population

Purpose: Pain is a personal response that is influenced by several factors, for example genetic predisposition, experience and expectations, coping strategies, and sociocultural environment. Therefore, it is difficult to directly link structural osteoarthritis (OA) lesions to pain. Several studies showed that bone marrow lesions (BML) and effusion (inflammation) are associated with pain. Different types of pain have been distinguished within people with osteoarthritis (OA). With the modified painDetect questionnaire (mPD) nociceptive pain, mixed pain and neuropathic-like pain (or predominantly central sensitization) can be distinguished. Little is known about the association between the different types of pain and structural lesions seen on MRI. Therefore, our aim was to explore if there is a difference in structural lesions in the knee in women with different pain types. Methods: In the sub-cohort of 700 women of the Rotterdam Study measurements were performed, including a knee specific questionnaire and MRI of both knees. The knee specific questionnaire included the mPD for knee pain. All MRIs were scored with the MRI OA knee score (MOAKS). The knee was divided in patella and tibiofemoral region. Osteophytes were scored based on size. We defined the presence of a definite osteophytes as a score of 2 or higher. A cartilage lesion was defined as the presence of a cartilage lesion with a score of 1 or higher. Bone marrow lesions (BML) were defined as present if there was a score based on size of 1 or higher. Effusion was defined as present when there was more than a physical amount of fluid seen on the MRI. For each woman we defined if they had no, unilateral of bilateral lesions. The total score of the mPD was calculated and each woman was categorized as no pain (a score of 0), predominantly nociceptive pain (a score <12 on the mPD), mixed pain (a score between 12 and 18 on the mPD), or predominantly central sensitization (a score >18 on the mPD). The number and percentages of unilateral and bilateral osteophytes, cartilage lesions, BML and effusion were calculated. Univariate and multivariate generalized linear models were used to calculated the association between uni- or bilateral MRI features and the categories of the mPD. Results: Of the 700 women, 409 women (59.6%) had no knee pain, 231 women (33.7%) had predominantly nociceptive pain, 40 women (5.7%) had mixed pain, and only six women (0.9%) of this open population had predominantly central sensitization. Due to the low number of women with predominantly central sensitization, we summed the two highest categories of the mPD for further analysis. In table 1 the numbers and percentages of the MRI features are shown per group of women defined by their mPD score. No differences were seen for age per group, while a slightly increasing BMI was seen with each category of the mPD. Bilateral lesions were more likely seen in women with a higher score on the mPD. In table 2 the association between the presence of uni- and bilateral MRI features and the mPD score are shown. Due to high correlation between osteophytes in the patella and osteophytes in the TF joint (r=0.715), and between BML and cartilage lesions in the patella (r=0.664), we discarded the osteophytes and BMLs of the patella from the analysis. Multivariate analysis showed that the presence of osteophytes in the TF (unilateral (OR=1.80 (95%CI 1.1-3.0) p=0.026) and bilateral (OR=3.18 (95% CI 1.7-5.9) p<0.001)) were significantly associated to a higher score on the mPD, independent from age and BMI and the other MRI features. Bilateral effusion (OR=1.63 (95% CI 1.0-2.7) p=0.062) was borderline significantly associated with a higher score on the mPD. A higher BMI (1.055 (1.0-1.1) p=0.009) was also significantly associated to a higher score on the mPD. Conclusions: Women with more OA features seen on MRI, especially those with osteophytes in both knees, are more likely to have mixed pain and predominantly central sensitization (a higher score on the mPD) than women with less OA features. Furthermore, women with mixed pain and predominantly central sensitization had a higher BMI than women with predominantly nociceptive pain and women without pain. Further analysis will be needed to show if women with mixed pain and predominantly central sensitization also have more severe OA features seen on MRI, than women with predominantly nociceptive pain.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Radiographic hand osteoarthritis and worsening of mri-based tibiofemoral osteoarthritis-related structural damage, data from the OAI study

Purpose: To determine whether the presence of hand osteoarthritis (OA) is associated with radiographic knee OA progression (over 48-months) and MRI-based knee OA structural damage worsening (over 24-months). Methods: 600 subjects from the Foundation for the National Institute of Health (FNIH) project which is an IRB approved HIPAA compliant study were included (one index knee and hand in each subject). Baseline hand radiography of all subjects was measured for the presence of hand OA. PA radiographs of the dominant hand or the left hand (in case of ambidexterity) of included subjects were assessed by a musculoskeletal radiologist in a blinded fashion. Distal interphalangeal (DIP), proximal interphalangeal (PIP), interphalangeal (IP), metacarpophalangeal (MCP), and the first carpometacarpal (CMC) joints were assessed for the presence of OA (modified Kellgren and Lawrence (mKL) grade >=2) in each hand joint. Baseline and follow-up knee radiographic measurements and MRI OA Knee Score (MOAKS) variables for cartilage damage, bone marrow lesions, osteophytes, effusion, and Hoffa-synovitis as well as MRI-based knee periarticular bone area measurements were extracted. The association between the presence of hand OA (presence vs. absence of hand OA in each hand joint) and 48-months radiographic knee OA progression (defined as >0.7mm reduction in medial tibiofemoral joint space width) as well as 24-months change in knee MOAKS and periarticular bone measurements were analyzed using regression model (adjusted for age and sex). Results: Presence of any carpometacarpal (CMC) OA (OR 95%CI: 1.58(0.96-2.62)) and overall hand OA (prsence of any mKL>=2 in all hand joints) (OR 95%CI: 1.44(0.97-2.07)) was associated increased odds for being a radiographic or composite progressor (approached but not reached significance). In comparison with controls, subjects with hand OA showed higher odds of worsening tibial/femoral cartilage damage (OR 95%CI: 1.38(0.95-2.01) and 1.79(1.24-2.58)) and femoral periarticular bone area expansion (Beta 95%CI: 10.54(1.40-19.69)) over 24-months. CMC OA and 24-months worsening of MRI-based tibiofemoral cartilage damage and periarticular bone area expansion were also showed approached significant associations. Conclusions: Presence of hand OA, especially in CMC joint, is associated with longitudinal MRI-based knee OA-related structural damage worsening including tibial/femoral cartilage damage and periarticular bone area expansion.

The impact of a significant weight loss on inflammation assessed on DCE-MRI and static MRI in knee osteoarthritis: a prospective cohort study

To study the impact of weight loss on inflammation in individuals with overweight and knee osteoarthritis (OA) using both static- and dynamic contrast-enhanced (DCE)-MRI and assess the association of these changes to pain. Individuals with overweight (BMI>27) and knee OA were examined before and after a >5% weight loss over 8 weeks (ClinicalTrials.gov NCT02905864). Using 3-T MRI, inflammation was quantified from non-contrast enhanced static-MRI according to MOAKS and contrast enhanced static MRI according to BLOKS and 11-point whole-knee synovitis score. DCE-MRI was used to assess the inflammation in the infra patellar fat pad (IPFP). Pain was assessed using KOOS. Complete data were available in 117 participants with a mean age of 60 years, BMI of 35kg/m2 and KOOS pain score of 64. Mean weight loss was 12kg and KOOS pain was improved by 13 points at follow-up. Change in inflammation was not associated with weight loss in static MRI. None of the MRI variables correlated with the change in KOOS pain. Weight loss did not induce a significant change in inflammation in individuals with overweight and OA. The significant clinical beneficial effect of weight loss on knee pain in individuals with overweight and knee OA seems uncoupled to changes in imaging markers of synovitis.

Altered gait mechanics are associated with severity of chondropathy after hip arthroscopy for femoroacetabular impingement syndrome

BackgroundSuboptimal patient-reported function and movement impairments often persist after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Individuals with FAIS with preoperative cartilage pathology (ie. chondropathy) demonstrate distinct movement patterns and have worse post-operative outcomes. It is unknown whether the presence of chondropathy after surgery negatively affects movement and function. Research questionDo sagittal plane gait mechanics differ based on chondropathy severity following arthroscopy for FAIS? MethodsA cross-sectional walking gait analysis was performed for 25 participants post-arthroscopy (2.48 ± 1.38y) and 12 healthy controls (HCs). Peak total support moment (TSM) and relative contributions of the hip, knee, and ankle were calculated during loading response. The Hip Osteoarthritis MRI Scoring System was used to categorize the FAIS group into no-mild or moderate-severe chondropathy groups based on 3 T magnetic resonance imaging of their surgical hip. The interactions of group by limb were evaluated for kinetic variables, covaried by gait speed. ResultsGroups did not differ based on age, BMI and sex distribution (P ≥ 0.14). 13 participants with FAIS presented with moderate-severe chondropathy and 12 presented with no-mild chondropathy. Participants with moderate-severe chondropathy walked significantly slower than both other groups (P = 0.006) and demonstrated lower peak TSM than those with no-mild chondropathy (P = 0.002). Participants with no-mild chondropathy demonstrated lower hip (61.5 %) and greater ankle (17.7 %) contributions to the TSM on the involved limb compared to the moderate-severe group (hip:73.4 %, P = 0.07; ankle:10.5 %, P = 0.007). SignificanceSlower gait speed alone did not explain the lower TSM strategy in participants with moderate-severe chondropathy. Interestingly, the joint contribution strategy of this group was not different than HCs. Participants with no-mild chondropathy demonstrated a TSM strategy that shifted the demand away from their hip and toward their ankle. Given the small sample size, and large variability in joint strategies, future work needs to examine whether these alterations in gait strategy, with or without advanced chondropathy, impact patient function.