Osteophytes Research Articles

Biomarkers and longitudinal changes in lumbar spine degeneration and low back pain: the Johnston County Osteoarthritis Project

To determine if baseline biomarkers are associated with longitudinal changes in the worsening of disc space narrowing (DSN), vertebral osteophytes (OST), and low back pain (LBP). Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for severity of DSN and OST. LBP severity was self-reported. Concentrations of analytes (cytokines, proteoglycans, and neuropeptides) were quantified by immunoassay. Pressure-pain threshold (PPT), a marker of sensitivity to pressure pain, was measured with a standard dolorimeter. Binary logistic regression models were used to estimate odd ratios (OR) and 95% confidence intervals (CI) of biomarker levels with DSN, OST, or LBP. Interactions were tested between biomarker levels and the number of affected lumbar spine levels or LBP. We included participants (n=723) with biospecimens, PPT, and paired lumbar spine radiographic data. Baseline Lumican, a proteoglycan reflective of extracellular matrix changes, was associated with longitudinal changes in DSN worsening (OR=3.19 [95% CI 1.22, 8.01]). Baseline brain-derived neuropathic factor, a neuropeptide, (OR=1.80 [95% CI 1.03, 3.16]) was associated with longitudinal changes in OST worsening, which may reflect osteoclast genesis. Baseline hyaluronic acid (OR=1.31 [95% CI 1.01, 1.71]), indicative of systemic inflammation, and PPT (OR=1.56 [95% CI 1.02, 2.31]) were associated with longitudinal increases in LBP severity. These findings suggest that baseline biomarkers are associated with longitudinal changes occurring in structures of the lumbar spine (DSN vs OST). Markers of inflammation and perceived pressure pain sensitivity were associated with longitudinal worsening of LBP.

MRI underestimates presence and size of knee osteophytes using CT as a reference standard

To explore the diagnostic performance of routine magnetic resonance imaging (MRI) for the cross-sectional assessment of osteophytes (OPs) in all three knee compartments using computed tomography (CT) as a reference standard. The Strontium Ranelate Efficacy in Knee Osteoarthritis (SEKOIA) trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. OPs were scored for the baseline visit only using a modified MRI Osteoarthritis Knee Score (MOAKS) scoring system in the patellofemoral (PFJ), the medial tibiofemoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Sensitivity, specificity, positive predictive value and negative predictive value as well as area under the curve (AUC) measures of diagnostic performance were employed using CT as the reference standard. Included were 74 patients with available MRI and CT data. Mean age was 62.9±7.5 years. Altogether 1,332 locations were evaluated. For the PFJ, MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52-0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51-0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50-0.66]). MRI underestimates presence of osteophytes in all three knee compartments. CT may be helpful particularly regarding assessment of small osteophytes particularly in early disease.

Association of Traumatic Knee Injury With Radiographic Evidence of Knee Osteoarthritis in Military Officers.

The association between knee injury and knee osteoarthritis (OA) is understudied relative to its importance, particularly in younger populations. This study was undertaken to examine the association of knee injury with radiographic features of knee OA in military officers, who have a physically demanding profession and high rates of knee injury. Participants were recruited in 2015-2017 from an existing program that enrolled 6,452 military officers during 2004-2009. Officers with a history of knee ligament or meniscal injuries (n=117 via medical record review) were compared to officers with no history of knee injury (n=143). Bilateral posteroanterior knee radiographs were obtained using a standardized fixed-flexion positioning frame. All images were read for Kellgren/Lawrence (K/L) grade, osteophyte (OST), and joint space narrowing (JSN) scores. Data were analyzed using linear-risk regression models with generalized estimating equations. Injured and noninjured participants were similar (mean age 28 years, mean body mass index 25 kg/m2 , ~40% female). The mean time from first knee injury to imaging among injured participants was 9.2 years. Compared with noninjured knees, greater prevalence of radiographic OA (K/L grade ≥ 2), OST (grade ≥ 1), and JSN (grade ≥ 1) was observed among injured knees, with prevalence differences of +16% (95% confidence interval [95% CI] 10%, 22%), +29% (95% CI 20%, 38%), and + 17% (95% CI 10%, 24%), respectively. Approximately 1 in 6 officers with prior knee injury progressed to radiographic OA by age 30 years. At the midpoint of a projected 20-year military career, officers with a history of traumatic knee injury have a markedly increased prevalence of knee radiographic OA compared to officers without injury.

Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project.

To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self-reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09-2.98]), spine OA (HR 1.56 [95% CI 1.01-2.41]), FOA (HR 4.99 [95% CI 1.46-17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02-3.43]), and LBP (HR 1.75 [95% CI 1.19-2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09-2.09]) and LBP (HR 1.51 [95% CI 1.12-2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44-12.2]). Spine OA (HR 1.80 [95% CI 1.24-2.63]) and OST (HR 1.85 [95% CI 1.02-3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04-1.85]) and OST (HR 1.58 [95% CI 1.00-2.49]) were predictors of LBP worsening. Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.

Novel elemental grading system for radiographic lumbar spondylosis in a population based-cohort study of a Japanese mountain village.

PurposeLumbar radiography is a primary screening tool for lumbar spondylosis (LS). Kellgren-Lawrence (KL) classification is widely used to evaluate LS; however, it cannot individually evaluate each radiographic feature. The purpose of this study was to 1) evaluate radiographic LS using a novel elemental grading system and 2) investigate the relationship between the grades of radiographic LS and low back pain (LBP) in a population-based cohort study.MethodsA total of 260 (75 men, 185 women; mean age, 71.5 ± 8.7 years) participants were included in this study. Participants were divided into two groups according to the presence of LBP (LBP- and LBP+ groups). Radiographic features, including osteophyte (OP), disc height narrowing (DHN), vertebral sclerosis (VS), and spondylolisthesis (SL), were classified between grades of 0–2 grades according to the extent of radiographic changes. The sum of grades at each intervertebral level was designated as the intervertebral grade (IG).ResultsIntra- and inter-observer reliability (kappa coefficient) of OP, DHN, VS, and SL were 0.82–0.92. OP, DHN, VS, and IG grades were significantly higher in the LBP+ group than in the LBP- group. There were no significant differences in KL grades between the LBP- and LBP+ groups. Logistic regression analysis demonstrated that VS grade was a significant independent factor associated with LBP.ConclusionThe novel elemental grading system of LS would reflect LBP more accurately than the KL classification by individually evaluating each radiographic feature.

Identification of Radiographic Foot Osteoarthritis: Sensitivity of Views and Features Using the La Trobe Radiographic Atlas.

To compare the sensitivity of alternative case finding approaches for the identification of foot osteoarthritis (OA) based on the La Trobe radiographic atlas. This was a cross-sectional study of 533 adults age ≥50 years with foot pain in the past year. Weightbearing dorsoplantar (DP) and lateral radiographs were taken of both feet. The La Trobe radiographic atlas was used to document the presence of osteophytes (OPs) and joint space narrowing (JSN). The prevalence of OA in each joint was documented using both views and features in combination (as recommended in the original atlas), and by using a single view (DP or lateral only) and a single feature (OP or JSN only). Compared to the recommended case definition based on OPs and JSN using both views, a DP-only view identified between 15% and 77% of OA cases, while a lateral-only view identified between 28% and 97% of OA cases. Compared to the recommended case definition of using both features, using only OPs identified between 46% and 94% of OA cases, while using only JSN identified between 19% and 76% of OA cases. Applying the La Trobe radiographic atlas but using only 1 radiograph view (DP or lateral) or 1 feature (OP or JSN) in isolation misses a substantial number of OA cases, and the sensitivity of these approaches varies considerably between different foot joints. These findings indicate that, where possible, the atlas should be administered according to the original description to avoid under-ascertainment of radiographic foot OA.

MRI UNDERESTIMATES PRESENCE AND SIZE OF KNEE OSTEOPHYTES USING CT AS A REFERENCE STANDARD

Purpose: The radiographic diagnosis of knee osteoarthritis (OA) is based on the presence of a definite osteophyte (OP) on the a.p. or p.a. radiograph. OPs represent fibrocartilaginous and skeletal outgrowths that are frequently localized at the joint margins, but central osteophytes may also be observed, especially at the femoral notch. Epidemiologic studies and clinical trials commonly employ MRI using standard clinical sequences and OP assessment is one of the features included in whole organ ordinal OA grading.

AUTOMATIC DETECTION OF OSTEOPHYTES FROM CONTRAST ENHANCED μCT-IMAGED RAT TIBIAS USING STATISTICAL SHAPE MODELS

Purpose: Osteophyte (OsP) formation is an important feature of osteoarthritis (OA). Better tools to study OsP formation in detail can yield important insight into OA progression and aid in phenotyping the disease more accurately. Identifying OsPs, as well as their precursors, in pre-clinical OA models is especially important when studying early OA and disease modifying treatments using animal models. OsPs may develop prior to articular cartilage degeneration and their development can be especially rapid in experimental OA models with artificially induced OA.

A prospective cohort study on cam morphology and its role in progression of osteoarthritis.

BackgroundCam morphology contributes to the development of hip osteoarthritis (OA) but is less studied in the general population. This study describes its associations with clinical and imaging features of hip OA.MethodsAnteroposterior hip radiographs of 1019 participants from the Tasmanian Older Adult Cohort (TASOAC) were scored at baseline for α angle (cam morphology) in both hips. Using the Altman's atlas, radiographic hip OA (ROA) was assessed at baseline. Hip pain and right hip structural changes were assessed on a subset of 245 magnetic resonance images (MRI) at 5 years. Joint registry data for total hip replacement (THR) was acquired 14 years from baseline.ResultsOf 1906 images, cam morphology was assessed in 1016 right and 890 left hips. Cross‐sectionally, cam morphology modestly associated with age (prevalence ratio [PR]: 1.02 P = .03) and body mass index (BMI) (PR: 1.03‐1.07, P = .03) and strongly related to male gender (PR: 2.96, P < .001). Radiographically, cam morphology was prevalent in those with decreased joint space (PR: 1.30 P = .03) and osteophytes (PR: 1.47, P = .03). Longitudinally, participants with right cam and high BMI had more hip pain (PR: 17.9, P = .02). At the end of 5 years of follow‐up these participants were also more likely to have structural changes such as bone marrow lesions (BMLs) (PR: 1.90 P = .04), cartilage defects (PR: 1.26, P = .04) and effusion‐synovitis at multiple sites (PR: 1.25 P = .02). Cam morphology at baseline in either hip predicted up to threefold risk of THR (PR: 3.19, P = .003) at the end of 14 years.ConclusionAt baseline, cam morphology was linked with age, higher weight, male gender, early signs of radiographic OA such as joint space narrowing (JSN) and osteophytes (OST). At follow‐up, cam predicted development of hip BMLs, hip effusion‐synovitis, cartilage damage and THR. These findings suggest that cam morphology plays a significant role in early OA and can be a precursor or contribute to hip OA in later life.

PREDICTION OF OSTEOPHYTE PROGESSION FROM CLINICAL DATA AND MRI-BASED 3D KNEE MORPHOLOGY

Osteophytes (OSTs) are one of the most prominent radiographical features of knee OA progression. They are strongly associated with presence of pain and often with other symptoms. However, clinical picture of OSTs in OA and their pathophysiology are not well understood. Prior research on predicting OA progression, particularly from the imaging data, has considered TKR, change in KLG, or JSN as the surrogate outcomes. Thus, the feasibility of using individual radiographic features, such as OSTs, as a potential surrogate endpoint has not been investigated. 1) To investigate the predictive power of the commonly available demographic and radiographic variables in prediction of osteophyte progression over 4 years. 2) To develop an MRI-based (3D tissue morphology) end-to-end model for the same task and evaluate its performance and added value. We used the data from the baseline of the OAI. Progression criterion was based on radiographic OARSI grade for OSTs [0-3]. Knees with an increase in OARSI grade in any compartment at the 4-year follow-up were set as progressors – the rest – as non-progressors. We excluded the knees with OARSI grade 3 in all regions, the non-progressors that dropped out before the last visit, and the samples with missing data. Final sample had 4600 knees (2476 subjects), with 2218 progressed and 2382 non-progressed knees. The baseline models were based on Logistic Regression and the following variables: age, sex, BMI, KLG, and OARSI OST grades. The latter were available for FL, FM, TL, and TM. For MRI-based model, we used the validated automatic segmentations by Tack et al. 2021 (Zuse Institute, Berlin, Germany) derived from 3D DESS MRI. The data included the masks for femur, tibia, corresponding cartilage tissues, and menisci. The ROIs were cropped from the images and resampled to resolution of 95x192x140 (pixel spacing 1.1x0.73x0.73mm^3). The model was based on 3D ResNet-10 CNN and trained in two experiments – from bone masks only, and from all the listed tissues. Eventually, the MRI models were also fused with the baseline ones. Here, the predicted probabilities of the MRI model were used as an additional variable for the baseline model. To develop the predictive models, we used 5-fold cross-validation. For model evaluation, we used a hold-out set of 920 knees (443 progressors and 477 non-progressors). Performance of the models were assessed using area under the ROC curve (AUC), and average precision (AP). Over 4 years, OARSI OST grade changes of (1, 2, and 3) were observed, for (20.22, 2.85, 0.37) percent of knees in TM, (12.54, 2.13, 0.24) in TL, (12.82, 1.48, 0.30) in FL, and (17.28, 3.56, 0.76) in FM, respectively. The age, sex, BMI model yielded AUC=0.60[0.56-0.63], AP=0.56[0.51-0.61]. Adding KLG resulted in similar performance as with added OARSI OST grade. The baseline model with both grades was the best -AUC=0.68[0.65-0.71] and AP=0.67[0.62-0.71]. The MRI (CNN) models showed AUC=0.55[0.51-0.58], AP=0.53[0.48-0.57] (bones-only) and AUC=0.58[0.54-0.61], AP=0.55[0.50-0.60] (all tissues). Fusion of the best baseline and MRI models did not further improve the performance. The model based on the clinical data including KLG and OARSI OST grade showed the highest performance in predicting OST progression in 4 years. The imaging biomarkers, automatically extracted from 3D bone, cartilage, and menisci morphology, showed only limited predictive power and did not improve the final performance. Interestingly, the imaging model including cartilage- and menisci-based biomarkers showed higher metrics than bone-only, which may suggest contribution of soft tissue morphology to the progression of OSTs. Supported by the Academy of Finland (334771 & 334773), under the frame of ERA PerMed. Alexander Tack and ZIB for providing the data. CORRESPONDENCE ADDRESS: mitra.daneshmand@oulu.fi

SIZE OF KNEE OSTEOPHYTES is under‐estimated as Assessed by MRI USING CT AS A REFERENCE STANDARD

The radiographic diagnosis of knee osteoarthritis (OA) is based on the presence of a definite osteophyte (OP). Epidemiologic studies and clinical trials commonly employ MRI using standard clinical sequences and OP assessment is one of the features included. Commonly used sequence protocols in such studies are based on triplanar fat suppressed T2- or proton density-weighted sequences with bony features as well as fibrous and lipomatous tissues appearing hypointense. This may potentially result in underestimation of such features including osteophyte assessment. Computed tomography (CT) is considered as the modality of choice for the analysis of OPs and may therefore be considered a reference standard. To explore the diagnostic performance of routine MRI as used in observational studies and clinical trials of knee OA for the assessment of OPs in all three knee compartments and the femoral notch using CT as a reference standard. The Strontium Ranelate Efficacy in Knee Osteoarthritis Trial (SEKOIA) clinical trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. All patients included in the current study participated in the CT sub-study of SEKOIA. In the current investigation, baseline data from three different centers were used. OPs were scored using a modified MOAKS scoring system in the patellofemoral (PFJ), the medial tibio-femoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Finally, sensitivity, specificity, positive predictive value and negative predictive value as well as AUC measures of diagnostic performance were employed using CT as the reference standard. Mean age of the randomized patients was 62.9 ±7.5 years with a majority of women (70%). Body mass index was 29.9±5.0 kg/m 2 . The target knee JSW was 3.50±0.84 mm at baseline, patients were Kellgren and Lawrence grade 2 (62%) or 3 (38%). Included were 74 patients with available MRI and CT data. Altogether 1332 locations were evaluated. For the PFJ MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52-0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51-0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50-0.66]). Regarding disagreement, for the PFJ MRI underestimated OP size in 94 cases (21%) and over-estimated in 27 cases (6%). For the medial TFJ these numbers were 90 (20%) and 29 (7%), and for the lateral TFJ 67 (15%) and 15 (3%). Details of the diagnostic performance analysis are presented in Table 1 . MRI underestimates presence and size of osteophytes in all 3 knee compartments. However, the sensitivity of >0.9 for OP detection in the medial compartment, which is commonly the compartment of relevance in clinical DMOAD trials, reflects that MRI is adequately able to detect osteophytes that commonly define structural disease. CT may be helpful particularly reading assessment of small osteophytes particularly in early disease. No funding was received for this sub-analysis of the SEKOIA Study AG has received consultancies, speaking fees, and/or honoraria from Pfizer, Novartis, AstraZeneca, Merck Serono, and TissueGene and is President and shareholder of Boston Imaging Core Lab (BICL), LLC a company providing image assessment services. FWR is Chief Medical Officer and shareholder of BICL, LLC. and has received consultancies, speaking fees, and/or honoraria from Calibr –California Institute of Biomedical Research and Grünenthal, GmbH CORRESPONDENCE ADDRESS: frank.roemer@uk-erlangen.de .

Zoledronic acid does not slow spinal radiographic progression of osteoarthritis in postmenopausal women with osteoporosis and radiographic osteoarthritis.

Introduction:Post hoc analyses of osteoporosis trials have suggested that alendronate and strontium ranelate may be associated with a reduction in the progression of spinal radiographic osteoarthritis (OA). We performed an analysis on a subgroup of participants in the horizon PFT trial (a 3-year randomized controlled trial (RCT) of yearly zoledronic acid (ZA) in postmenopausal women with osteoporosis), to evaluate the effect of ZA on the structural progression of spinal osteophytes (OPh) and disk space narrowing (DN).Methods:Paired lateral spinal X-rays (baseline and 36 months) were selected from the horizon PFT trial records restricted to those with radiographic OA at baseline. The X-rays were analyzed by two readers blinded to the treatment allocation. OPh and DN were scored separately using the Lane atlas (0–3 for increasing severity at each vertebral level) at all evaluable levels from T4–12 and L1–5.Results:A total of 504 sets of paired radiographs were included in the analysis, 245 in the ZA group and 259 in the placebo group. Overall, the rates of change of OPh and DN scores were low, and they were not statistically different between the groups (change in the whole spine OPh ZA 1.0 ± 1.6, placebo 0.8 ± 1.3, p = 0.1; DN ZA 0.3 ± 1.0, placebo 0.3 ± 0.8, p = 0.7).Conclusion:Yearly ZA for 3 years was not associated with a slowing of progression of OPh or DN in the thoracolumbar spine in patients with pre-existing radiographic OA.

Dorso-ventral osteophytes of interphalangeal joints correlate with cartilage damage and synovial inflammation in hand osteoarthritis: a histological/radiographical study

ObjectiveTo detect dorsally located osteophytes (OP) on lateral x-ray views and to correlate their presence with the extent of structural joint damage, determined by histologic grading (cartilage damage and synovial inflammation) and radiographic scoring in hand osteoarthritis (HOA).MethodsDistal interphalangeal (DIP) and proximal interphalangeal (PIP) joints were obtained from post mortem specimens (n = 40). Multiplanar plain x-rays were taken (dorso/palmar (dp) and lateral views). Radiographic OA was determined by the Kellgren and Lawrence classification. Joint samples were prepared for histological analysis and cartilage damage was graded according to the Mankin scoring system. Inflammatory changes of the synovial membrane were scored using the general synovitis score (GSS). Spearman’s correlation was applied to examine the relationship between histological and radiographical changes. Differences between groups were determined by Mann-Whitney test.ResultsBony proliferations that were only detectable on lateral views but reminiscent of OPs on dp images were termed dorso-ventral osteophytes (dvOPs). All joints displaying dvOPs were classified as OA and the presence of dvOPs in DIP and PIP joints correlated with the extent of histological and radiographic joint damage, as well as with patient age. Joint damage in osteoarthritic DIP and PIP joints without any dvOPs was less severe compared to joints with dvOPs. Synovial inflammation was mainly present in joints displaying dvOPs and correlated with joint damage.ConclusiondvOPs are associated with increasing structural alterations in DIP and PIP joints and can be seen as markers of advanced joint damage. Detecting dvOPs can facilitate the diagnosis process and improve damage estimation in HOA.

Thoracolumbar flexion dysfunction and thoracolumbar compression fracture in postmenopausal women: a single-center retrospective study

ObjectiveTo investigate whether thoracolumbar flexion dysfunctions increase the risk of thoracolumbar compression fractures in postmenopausal women.MethodsThe records of postmenopausal women with thoracolumbar vertebral compression fractures and without vertebral compression fractures were surveyed. Demographic data, clinical data, and quantitative computed tomography (QCT) findings were compared between the groups. Chi-squared tests, unpaired t-tests, Spearman, and Mann–Whitney U were used to assess the group characteristics and proportions. The relationship between the risk of fracture and the difference of Cobb’s angle of thoracolumbar segment (DCTL) was evaluated by logistic regression. DCTL was calculated by subtracting thoracolumbar Cobb’s angles (TLCobb’s) from thoracolumbar hyperflexion Cobb’s angles (TLHCobb’s). Quantitative computed tomography (QCT) values and spinal osteoarthritis (OA) of postmenopausal women in the two groups were compared.Results102 of 312 were enrolled to the study group of postmenopausal women with the fracture, and 210 of 312 were enrolled to the control group of postmenopausal women without the fracture. There were significant differences in QCT values and spinal OA including disc narrowing (DSN) and osteophytes (OPH) between the two groups (p < 0.001 for all four). The risk of thoracolumbar compression fractures in the postmenopausal women with DCTL ≤ 8.7° was 9.95 times higher (95% CI 5.31–18.64) than that with > 8.7° after adjusting for age, BMI, and QCT values.ConclusionLow DCTL may be a risk factor of thoracolumbar compression fractures in postmenopausal women, and a DCTL ≤ 8.7° can be a threshold value of thoracolumbar compression fractures.

Comparison of standard radiography and magnetic resonance imaging in hand osteoarthritis

Standard radiography in direct projection is the “gold standard” in the diagnosis of hand osteoarthritis (HOA). However, the currently clinically most severe “erosive” or “inflammatory” phenotype of HOA is characterized by the presence of inflammatory symptoms such as bone marrow lession (BML), synovitis and tenosinovitis, which are not visible on the radiograph by the nature of the study due to the low optical density. In addition, X-ray examination is planar and has no possibility of multiplanar visualization. This dictated the need to search for a more informative visualization technique in HOA.Aim – to compare the sensitivity and specificity of standard radiography and magnetic resonance imaging (MRI) techniques in determining the symptoms of osteoarthritis (OA) of the distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the right hand; to determine the indications for the appointment of MRI in patients with HOA.Materials and methods. The study included 64 women with clinically verified diagnosis of HOA according to ask criteria. For the first time, X-rays of the joints of the right hand in the anterior-posterior projection and MRI were performed for each of them. Each patient completed the AUSCAN questionnaire. X-rays were described according to the Kellgren and Lawrence systems, magnetic resonance imaging was analyzed according to the modified OHOA system. The sensitivity and specificity of the methods were compared based on the detection of 4 symptoms detected by radiography and MRI: joint space narrowing (JSN), osteophytes (OP), erosions and subluxations. The average age of the patients was 65.28±6.82 years, the age of onset was 48.81±7.73 years, the duration of the disease was 15.0 (10.0–19.5) years.Results. Both methods showed approximately equal identification JSN symptom in DIP and PIP, 95% definition JSN in MCP. OP were detected in 88% of patients in DIP according to radiography and in 95% – using MRI (p&gt;0.05). In PIP OP were observed in 70% of patients on radiographs and in 86% on magnetic resonance imaging, in MCP – in 45% and 66% of cases, respectively. Erosion in DIP were found in 41% of patients according to MRI and 34% as a result of X-ray examination, in PIP – in 27% and 13% of cases, in MCP – in 60% and 8% of cases, respectively. Subluxations were determined in DIP 23% on radiographs in 31% of cases by MRI, in PIP – in 8% and 6% (p&gt;0.05), in MCP subluxations almost never met – in 3% of cases by conventional radiography.Conclusions. MRI in HOA can be used in the detection of erosive process, differential diagnosis with other diseases of the joints, determination of inflammatory changes in the hands and assessment of their severity, but has no significant advantages over standard radiography in determining the symptoms of degenerative-dystrophic nature (JSN and OP). Subluxations of the MCP joints are not typical for the HOA.

18F]NaF PET-MRI provides direct in-vivo evidence of the association between bone metabolic activity and adjacent synovitis in knee osteoarthritis: a cross-sectional study

Synovitis is hypothesized to play a role in the development and growth of osteophytes. Our objectives were to use hybrid positron emission tomography-magnetic resonance imaging (PET-MRI) to (1) determine whether synovitis adjacent to peripheral bone subregions with increased metabolic activity is greater than adjacent to regions without increased metabolic activity and (2) assess the association between subregional bone metabolic activity and adjacent synovitis. We recruited 11 participants (22 knees) with a diagnosis of OA in at least one knee. Simultaneous bilateral knee PET-MRI was performed. We quantified bone metabolic activity using the radiotracer [18F]sodium fluoride ([18F]NaF) with calculation of maximum standardized uptake values (SUVmax). Synovitis was quantified using dynamic contrast-enhanced MRI with calculation of Ktrans. Bone subregions were coded as osteophyte (OP), focal increased [18F]NaF uptake without osteophyte (FIU), or normal (no osteophyte or FIU). We used robust linear mixed effects models to assess differences in adjacent Ktrans between different subregion types and to assess association between Ktrans and adjacent SUVmax. 94 OPs were detected (59 MOAKS grade 1, 30 grade 2, 5 grade 3), along with 28 FIU and 18 normal subregions. Ktrans was higher adjacent to FIU (adjusted mean [95% CI]=0.06 [0.03,0.09]) and OPs (0.08 [0.05,0.11]) when compared to normal bone subregions (0.03 [0.00,0.09]). PET SUVmax was positively associated with adjacent Ktrans (β[95% CI]=0.018 [0.008,0.027]). Synovitis is more intense adjacent to peripheral bone regions with increased metabolic activity than those without, although there is some overlap. Subregional bone metabolic activity is positively associated with intensity of adjacent synovitis.

A deep-learning-based technique for the quantitative analysis of femorotibial osteophyte and bone volumes -data from the osteoarthritis initiative

Purpose: Osteophytes (OPs) are prominent features in knee osteoarthritis (OA) and an important criterion for defining radiographic knee OA. They have also been suggested to be associated with pain and subsequent knee replacement. Currently, most studies investigating the role of osteophytes rely on semi-quantitative scoring from 2D X-rays or 3D MRI. A quantitative analysis of osteophytes from MRI may provide greater sensitivity to change than scoring-based methodologies, but requires segmentation, which is quite time-consuming when performed manually.

Identification and characterization of two consistent osteoarthritis subtypes by transcriptome and clinical data integration

ObjectiveTo identify OA subtypes based on cartilage transcriptomic data in cartilage tissue and characterize their underlying pathophysiological processes and/or clinically relevant characteristics.MethodsThis study includes n = 66 primary OA patients (41 knees and 25 hips), who underwent a joint replacement surgery, from which macroscopically unaffected (preserved, n = 56) and lesioned (n = 45) OA articular cartilage were collected [Research Arthritis and Articular Cartilage (RAAK) study]. Unsupervised hierarchical clustering analysis on preserved cartilage transcriptome followed by clinical data integration was performed. Protein–protein interaction (PPI) followed by pathway enrichment analysis were done for genes significant differentially expressed between subgroups with interactions in the PPI network.ResultsAnalysis of preserved samples (n = 56) resulted in two OA subtypes with n = 41 (cluster A) and n = 15 (cluster B) patients. The transcriptomic profile of cluster B cartilage, relative to cluster A (DE-AB genes) showed among others a pronounced upregulation of multiple genes involved in chemokine pathways. Nevertheless, upon investigating the OA pathophysiology in cluster B patients as reflected by differentially expressed genes between preserved and lesioned OA cartilage (DE-OA-B genes), the chemokine genes were significantly downregulated with OA pathophysiology. Upon integrating radiographic OA data, we showed that the OA phenotype among cluster B patients, relative to cluster A, may be characterized by higher joint space narrowing (JSN) scores and low osteophyte (OP) scores.ConclusionBased on whole-transcriptome profiling, we identified two robust OA subtypes characterized by unique OA, pathophysiological processes in cartilage as well as a clinical phenotype. We advocate that further characterization, confirmation and clinical data integration is a prerequisite to allow for development of treatments towards personalized care with concurrently more effective treatment response.

Natural History of Radiographic First Metatarsophalangeal Joint Osteoarthritis: A Nineteen-Year Population-Based Cohort Study.

ObjectiveTo assess the long‐term prevalence, natural history, progression, and incidence of radiographic first metatarsophalangeal (MTP) joint osteoarthritis (OA).MethodsA longitudinal cohort design was used in which radiographic OA at the first MTP joint was investigated in participants from the Chingford 1,000 Women Study at year 6 (1995) and year 23 (2013–2015). Radiographic features of osteophytes (OPs) and/or joint space narrowing (JSN) at the first MTP joint were scored according to a validated foot atlas. Natural history was determined by the change in prevalence, incidence, progression, and worsening of OA in the first MTP joint.ResultsComplete case‐matched foot radiographic data were available for 193 of the women currently enrolled in the study (mean ± SD age 75.7 ± 5.2 years [range 69–90 years]). At the level of the first MTP joint, prevalence of OA at year 6 was 21.76% in the left and 24.35% in the right; at year 23, it was 23.83% in the left and 32.64% in the right. Over the 19‐year period, 13.5% of the women developed incident OA in the right first MTP joint and 8.3% in the left. Both progression and worsening of OA were more evident for OPs and in the right first MTP joints.ConclusionIn this study of the natural history of radiographic first MTP joint OA, which to our knowledge is the longest study to date, the prevalence and incidence of first MTP joint OA increased over a 19‐year period. Progression and/or worsening of OA at the first MTP joint over time appears to be driven by OP development rather than JSN, which suggests a biomechanical cause.

High prevalence of patellofemoral osteoarthritis in China: a multi-center population-based osteoarthritis study.

To describe the prevalence and risk factors of patellofemoral osteoarthritis (PFOA) among Chinese residents. A multi-center population-based osteoarthritis study was conducted in 2014. Residents aged ≥ 50years old were recruited using a cluster sampling method. Subjects completed a home interview and physical examination and had skyline view of radiographs at patellofemoral (PF) joints. Radiographs were read by two trained musculoskeletal researchers, and discordance of a subject's PFOA status between two readers was adjudicated with a third musculoskeletal researcher present. Radiographic OA at PF joint was defined if osteophytes (OST) score was ≥ 2 or if joint space narrowing (JSN) score was ≥ 2 with concurrent grade 1 OST in the PF joint. Of 3446 subjects (63.0% women) included in this analysis, the prevalence of radiographic PFOA was 23.9% (20.5% men vs. 25.8% women). Prevalence of lateral radiographic OA was higher than medial radiographic OA at PF joint. Grades of both osteophytes and joint space narrowing in the lateral patellofemoral compartment were higher than those in the medial patellofemoral compartment (all P values < 0.001). Women, older age, higher BMI, and fewer years of education were significantly associated with higher prevalence of radiographic PFOA, osteophytes, and joint space narrowing. Prevalence of radiographic PFOA was high among Chinese population. Key Points • The multi-center population-based osteoarthritis study shows the prevalence of radiographic PFOA was high among Chinese population. • Older age, female gender, obesity, and few years of education were associated with a high risk of PFOA. • Prevalence of lateral radiographic OA was higher than medial radiographic OA at PF joint.