Radiological Knee Osteoarthritis Research Articles

Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?

Background and purpose — Several randomized controlled trials have not shown any added benefit of arthroscopy over placebo surgery or physiotherapy in middle-aged patients with knee symptoms without trauma. We studied the characteristics of the knee arthroscopies performed in southern Sweden.Patients and methods — From the orthopedic surgical records from 2007–2009 in the Skåne region of Sweden (with a population of 1.2 million), we retrieved ICD-10 diagnostic codes and selected all 4,096 arthroscopies that were diagnosed peroperatively with code M23.2 (derangement of meniscus due to old tear or injury) or code M17 (knee osteoarthritis). We extracted information on cartilage and meniscus status at arthroscopy, and we also randomly sampled 502 of these patients from the regional archive of radiology and analyzed the preoperative prevalence of radiographic or magnetic resonance imaging (MRI)-defined osteoarthritis.Results — 2,165 (53%) of the 4,096 arthroscopies had the diagnostic code M23.2 or M17. In this subgroup, 1,375 cases (64%) had typical findings consistent with degenerative meniscal tear (i.e. that correspond to a degenerative meniscal tear in at least a third of all arthroscopies). Of the randomly sampled patients, the preoperative prevalence of radiological knee osteoarthritis was 46%.Interpretation — There is a discrepancy between evidence-based medicine treatment guidelines and clinical practice regarding the amount of knee arthroscopies performed in patients with symptoms of degenerative knee disease.

Serum and synovial fluid levels of CCL18 are correlated with radiographic grading of knee osteoarthritis.

BackgroundChemokines are involved in the pathogenesis of osteoarthritis (OA). CCL18, a member of the chemokines family, is observed in synovial fluid (SF) of OA patients. The aim of this study was to determine the association between CCL18 levels in serum and SF with radiographic knee OA.Material/MethodsThis study was conducted in a population of 308 patients with knee OA. The radiological knee OA was graded by the Kellgren-Lawrence grading system.ResultsSerum levels of CCL18 in knee OA patients were markedly higher than those in healthy controls. Serum and SF levels of CCL18 increased with the severity of KL grades and were correlated with disease severity.ConclusionsThe CCL18 levels in serum and SF are correlated with the severity of OA.

Finger Length Pattern as a Biomarker for Osteoarthritis and Chronic Joint Pain: A Population‐Based Study and Meta‐Analysis After Systematic Review

Type 3 finger length pattern (longer fourth digit than second digit) is influenced by prenatal androgens and has been studied previously as a biomarker for sexually dimorphic traits. Because osteoarthritis (OA) and chronic pain are known to be sexually dimorphic traits, we evaluated the association between finger length pattern and OA and chronic joint pain. This study was part of the Rotterdam Study, a prospective population-based cohort study. We examined 4,784 participants. Associations between type 3 finger length and radiologic knee, hip, and hand OA and chronic joint pain were analyzed using a logistic regression model. Our results for OA were combined with previously published data in a meta-analysis. Participants with type 3 finger length pattern had an odds ratio of 1.64 for hand OA (P = 1.06 × 10(-7)). No associations with radiologic knee or hip OA were observed in the Rotterdam Study. The meta-analysis of previously published data and our novel data showed a significant association between type 3 finger length pattern and clinical symptomatic knee OA, but no association was found with radiologic knee OA. In addition, within the Rotterdam Study, we observed an odds ratio of 1.41 for individuals having joint pain at multiple sites (P = 1.4 × 10(-3)). Type 3 finger length pattern, as an indicator of prenatal androgen exposure, was associated with having symptomatic knee OA, chronic pain, and hand OA. Therefore, it may be applicable as an easy measurable biomarker to identify susceptible subjects for these traits.

Usefulness of urinary CTX-II and NTX-I in evaluating radiological knee osteoarthritis : the Matsudai knee osteoarthritis survey

BackgroundTo assess the usefulness of the urinary crosslinked C-telopeptide of type II collagen (uCTX-II) or crosslinked N-telopeptide of type I collagen (uNTX-I) for evaluating radiological knee osteoarthritis (OA), a crosssectional study was conducted in the cohorts of the Matsudai knee osteoarthritis survey performed in Niigata, Japan. MethodsUrine specimens and standing knee AP X-rays were obtained from 1040 subjects who provided informed consent. The relationship between these markers and gender, age (patients aged 40-59 or 60-79 years), use of bisphosphonates, and OA grades (K–L classification) were analyzed. The diagnostic ability of uCTX-II to detect radiological knee OA was confirmed in the over 60-year-old subjects using a ROC curve. ResultsThe over 60-year-old men with OA grade 3,4 group had significantly higher uCTX-II levels than the other OA grade groups. In the over 60-year-old women, the uCTX-II levels significantly increased according to the progression of the knee OA grade. No significant difference was observed between the uNTX-I levels in the different OA grade groups. From the standpoint of biomarkers, the higher quartiles of the uCTX-II and uNTX-I levels gradually included higher numbers of grade ≥2 OA subjects in the over 60 year-old women. The area under the curve (AUC) in ROC analysis of uCTX-II exhibited a significant association with the diagnosis of knee OA in women (AUC 0.63), although the accuracy was evaluated to be low in the single measurement of our health checkup-based analysis. ConclusionsThis population-based study indicates that the uCTX-II level is strongly correlated with the knee OA grade in women over age 60. A further analysis is needed to clarify its predictive accuracy.

The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: a cross-sectional study from a Korean population in women.

BackgroundThe relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women.Methods One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship.ResultsThere was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade.ConclusionsThe radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward's triangle).

AB1005 Non-monetary health care resources utilization in knee and hip osteoarthritis and associated factors. A national study

ObjectivesTo analyze knee and hip osteoarthritis (OA) healthcare resources utilization and associated factors in Spain.MethodsConsecutive patients aged 50 or older with symptomatic and radiological knee and/or hip OA, who were...

(18F)Fluoro-deoxy-D-glucose uptake of knee joints in the aspect of age-related osteoarthritis: a case-control study

BackgroundThis study investigated 18F-fluorodeoxyglucose (18F-FDG) uptake at knee joints for determination of metabolic alteration in association with the advance of age and joint degeneration such as osteoarthritis (OA).MethodsA total of 166 knees from 83 healthy persons who presented for routine health examination and positron emission tomography-computed tomography (PET/CT) were enrolled in this study. History of knee OA and joint symptoms and signs were reviewed. The maximum standardized uptake values (SUVmax) of cartilage and mean SUV (SUVmean) between the epiphyseal plates of femur and tibia were evaluated at knee joints. Assessment of radiological bony changes was performed using the Kallgren-Lawrence (K/L) grading system with reconstructed CT images of the knee. The joint symptoms and signs were counted and used for diagnosis of clinical and radiological OA of the knee.ResultsThe SUVmean of the knee joints showed a remarkable increase with aging in females (r = 0.503, p < 0.01). Remarkable changes of SUVmean were observed with history of OA (p < 0.01). The SUVmean of joint and the intra-articular SUVmax showed higher values in clinical and radiological OA than in normal joints (p < 0.01). Joint-SUVmean showed significant correlation with OA severity graded according to K/L score (p < 0.05). The intra-articular SUVmax showed a significant increase in symptomatic joints, indicating OA in correlation with the joint-SUVmean (p = 0.01).ConclusionsThe increasing 18F-FDG uptakes of knee joints showed agreement with aging in females and clinical and radiological knee OA, indicating that the metabolic alterations were consistent with diagnosis and demographic aspect of OA as a surrogate marker for degeneration of the knee in association with aging.

Fibulin 3 peptides Fib3‐1 and Fib3‐2 are potential biomarkers of osteoarthritis

This study was undertaken to identify new biomarkers of osteoarthritis (OA) by proteomics analysis and to develop specific immunoassays to detect and quantify them. Proteomics analysis was performed in urine samples from 10 women (mean±SD age 76.0±5.0 years) undergoing knee replacement surgery due to severe OA and 5 healthy women (mean±SD age 25.6±2.6 years). Protein content was analyzed by 2-dimensional differential gel electrophoresis. Protein spots that exhibited an OA:control abundance ratio of ≥1.5 were identified by mass spectrometry. Specific enzyme-linked immunosorbent assays were developed and validated in serum obtained from 236 healthy subjects ages 20-64 years and from 76 patients with severe radiologic knee OA (mean±SD age 68.8±11.9 years). Immunohistochemical analysis was performed on articular cartilage from tibial plateaus. Thirteen proteins within spots that were significantly modified between groups were identified. Two peptides of fibulin 3, named Fib3-1 and Fib3-2, were of particular interest. Two antisera directed against these peptides were used to develop immunoassays. Compared with age-matched healthy subjects, median levels of serum Fib3-1 and Fib3-2 were elevated in OA patients (54.6 pM versus 85.1 pM [P<0.0001] and 144.4 pM versus 191.4 pM [P<0.0001], respectively). Using area under the receiver operating characteristic curve analysis, we demonstrated that Fib3-1 and Fib3-2 levels discriminate between OA and normal populations. Immunostaining revealed the presence of Fib3-1 and Fib3-2 in chondrocytes and in the extracellular matrix of the superficial layer of the fibrillated cartilage. Our findings indicate that Fib3-1 and Fib3-2 are potential biochemical markers for the diagnosis of OA.

Prevention of knee osteoarthritis in overweight females; the first preventive randomized controlled trial

Prevention of knee osteoarthritis in overweight females; the first preventive randomized controlled trial

Relationship between accelerometer‐based measures of physical activity and the Yale Physical Activity Survey in adults with arthritis

To evaluate the correlation between the Yale Physical Activity Survey (YPAS) scores and objective accelerometer measures of time spent in light intensity physical activities, moderate to vigorous intensity physical activities, and moderate to vigorous activities in bouts lasting at least 10 minutes. This study analyzed baseline data from 171 persons with rheumatoid arthritis (RA) and 139 persons with osteoarthritis (OA) in a randomized clinical trial (Increasing Motivation for Physical Activity in Arthritis Clinical Trial). Persons fulfilling the 1987 American College of Rheumatology criteria for RA and persons with symptomatic radiologic knee OA (Kellgren/Lawrence class ≥2) wore an accelerometer for 7 days, then responded to the YPAS questionnaire and questions regarding demographics (age, sex, and race) and health factors (body mass index, disease status [Health Assessment Questionnaire/Western Ontario and McMaster Universities Osteoarthritis Index], comorbidities, pain, and function). Spearman's correlation coefficients were estimated between each YPAS summary measure and accelerometer measures. In the RA participants, the strongest correlation was between the YPAS activity dimensions summary index (Y-ADSI) and average daily minutes of bouted moderate/vigorous activity (r = 0.51). Additionally, the Y-ADSI correlated significantly with both objectively measured average daily accelerometer counts (r = 0.45) and average daily minutes of moderate/vigorous activity (r = 0.43). For OA participants, a similar pattern emerged: the Y-ADSI had significant correlations with average daily minutes of bouted moderate/vigorous activity (r = 0.36), average daily minutes of moderate/vigorous activity (r = 0.31), and average daily counts (r = 0.24). For both the RA and OA groups, the Y-ADSI had the strongest significant correlations with objectively measured physical activity, which supports Y-ADSI use as a tool for clinical applications and in rheumatology research.

Development of radiological knee osteoarthritis in patients with knee complaints

ObjectivesIt is currently impossible to identify which patients with knee complaints presenting to the general practitioner will develop knee osteoarthritis (OA) pathology at a later stage. This study examines the...

Relationship between radiological severity and clinical and psychological factors in knee osteoarthritis

This study was designed to investigate the relationship between radiological severity and clinical and psychological factors in patients with knee osteoarthritis (OA). Patients with knee OA (n = 100) were included in the study. Radiographic staging was done using Kellgren-Lawrence (KL) radiological rating scale. Stage 1-2 changes according to KL were grouped as 'early' and stage 3-4 as 'late' radiological OA. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used for self-reported disability. Performance-based functional assessments were measured as time needed to walk 15m and time needed to climb ten steps. Health-related quality of life was assessed by Nottingham Health Profile (NHP). Beck Depression Inventory (BDI) was used to assess the presence and severity of depression. Social isolation was assessed by a related NHP subscale. Significantly higher scores were found in the late stage group for NHP pain, physical mobility and social isolation subscales and all WOMAC subscales. Mean BDI score was significantly higher (p = 0.001) and performance-based functional score was significantly worse (p < 0.001) in the late stage group compared to the early stage. In logistic regression analysis, NHP social isolation subscore was found to be associated with WOMAC pain subscore (p = 0.013, odds ratio [OR] = 1.163; 95% confidence interval [CI], 1.032-1.309) and radiological severity (p = 0.018, OR = 2.924; 95% CI, 1.198-7.136). Radiological severity is an important indicative factor for pain, disability, depression and social isolation. We believe that assessment of psychological involvement in addition to pain and disability might provide benefit in the management of patients with advanced radiological knee OA.

Influence of blinding sequence of radiographs on the reproducibility and sensitivity to change of joint space width measurement in knee osteoarthritis

To investigate whether knowledge of the sequence of radiographs impacts inter- and intraobserver reproducibility and sensitivity to change for measuring joint space width (JSW) in patients with knee osteoarthritis (OA). A cohort of 70 postmenopausal women with radiologic knee OA was assessed through the measurement of knee radiographs acquired in the semiflexed posteroanterior view, using a positioning frame and fluoroscopy, at baseline and 48 months later. Paired readings of radiographs were made using landmarks at baseline by 2 independent observers unblinded to sequence and blinded to sequence. Intra- and interobserver reproducibility was assessed on JSW measurements at baseline and 4 years later and on the longitudinal difference (joint space narrowing [JSN]), using intraclass correlation coefficient (ICC) and Bland and Altman methods. The sensitivity to change was assessed through standardized response means (SRMs). For JSW and JSN and with both methods, ICCs were high for the intra- and interobserver reproducibility (0.90-0.99 for JSW and 0.77-0.89 for JSN). For the Bland-Altman method, the mean difference was close to 0, with no bias for both observers and methods. The SRMs ranged from 0.38 to 0.48. All of the results were numerically in favor of measuring with knowledge of time sequence, but without a statistically significant difference between the methods. Intra- and interobserver reproducibility was high with or without blinding of the radiograph sequence. Reading with knowledge of time sequence using baseline landmarks tended to improve sensitivity. Therefore, in longitudinal studies of OA radiographs can be read unblinded to sequence.

Relationship between radiological knee osteoarthritis and biochemical markers of cartilage and bone degradation (urine CTX-II and NTX-I): the Matsudai Knee Osteoarthritis Survey

Biochemical markers of cartilage and bone degradation are becoming increasingly important in the evaluation of knee osteoarthritis (OA). To clarify the correlation between radiological knee OA and urine CTX-II (C-terminal crosslinking telopeptide of collagen type II) or urine NTX-I (N-terminal crosslinking telopeptide of type I collagen), we conducted a cross-sectional study in the cohorts of the epidemiological knee survey at the Matsudai district in Niigata Prefecture, Japan. Urine specimens were collected from 296 subjects, and CTX-II and NTX-I were measured using ELISA. Standing knee AP X-rays were obtained and graded according to the Kellgren-Lawrence classification. The subjects were then divided by gender, age (40- to 59-year-old group and 60- to 79-year-old group), and the X-ray grade (Grade 0, 1, Grade 2, and Grade 3, 4). In non-OA (Grade 0, 1) subjects, the 60- to 79-year-old group had significantly higher CTX-II values than the younger group only in females. The subjects of both genders aged over 60 years of age with OA Grade 3, 4 had significantly higher CTX-II values than the Grade 0, 1 group or the Grade 2 group. For NTX-I, there were no significant differences between each OA grade although the Grade 3, 4 group females from 60 to 79 years of age had higher values than the Grade 2 group. In addition, in the 60- to 79-year-old subjects of both genders, a positive correlation was observed between the urine CTX-II and urine NTX-I. For the subjects ranging from 60 to 79 years of age in both genders, the urine CTX-II values indicate the progression of OA. In addition, the weak but positive correlation between urine CTX-II and urine NTX-I in the subjects ranging from 60 to 79 years of age in both genders suggests that bone resorption and cartilage degradation appear to develop in parallel.

Economic burden of knee and hip osteoarthritis in spain

To estimate the direct and indirect osteoarthritis (OA)-attributable costs and predictors of costs of knee and hip OA in Spain. This study included consecutive patients age > or = 50 years with symptomatic and radiologic knee and/or hip OA who were seen at primary care centers in all provinces of Spain. Information on demographics, health status (Short Form 12 Health Survey), comorbidities (Charlson Index), clinical (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and radiologic OA severity (Kellgren/Lawrence [K/L] scale), data related to OA health resources utilization (medical and nonmedical), and subjects' and caregivers' expenses and time lost in the previous 6 months were collected in 2 separate, structured, and detailed interviews. Costs in euros were assigned using market prices and official sources if available, and were annualized (to 2007). The predictors of costs were assessed in multivariate regression models. Costs were log-transformed before being modeled. A total of 1,071 subjects were analyzed (74% women, mean +/- SD age 71 +/- 9 years). Average total annual costs were euro1,502 per patient. Direct costs accounted for 86% of the total cost. We estimated a national cost of euro4,738 million, representing 0.5% of the gross national product. Higher total costs were associated with comorbidity (Charlson Index odds ratio [OR] 1.27, 95% confidence interval [95% CI] 1.03-1.58), poorer health status (P < 0.050), worse WOMAC scores (OR 1.05, 95% CI 1.03-1.08), and grade 4 K/L scores (OR 1.76, 95% CI 1.15-2.69). The economic burden of knee and hip OA is substantial. Costs increased with comorbidity, poorer health status, and clinical and radiologic OA severity.

Intervertebral disc is an alternate tissue source of circulating C-telopeptide of type II collagen after menopause or ovariectomy: Comment on the article by Sondergaard et al

To the Editor: We write to caution against the now routine presumption, recently repeated in this journal by Sondergaard and coworkers (1), that circulating levels of C-telopeptide of type II collagen (CTX-II) represent a direct surrogate measure of articular cartilage degradation, particularly after menopause or ovariectomy. A growing body of research suggests that intervertebral discs (IVDs) also represent a likely source of CTX-II following either natural or surgical menopause. The evidence for this is as follows. First, articular cartilage is but one tissue pool of type II collagen in the body. One canine dissection study estimated that articular cartilage and IVD represent 0.06% and 0.10% of dry body weight, respectively, both of which were dwarfed by other extraarticular cartilage pools (2). Second, IVD is an estrogen-responsive tissue. Human IVD cells express estrogen receptor β and respond to exogenous estradiol in vitro (3). Third, several studies have demonstrated narrowing of IVD height in postmenopausal women compared with premenopausal or hormone-treated women (4, 5), and that this narrowing is rapidly progressive in the period immediately following menopause (5), suggestive of rapid tissue remodeling, if not frank IVD degeneration. Fourth, animal studies confirm IVD changes following surgical ovariectomy, notably in rats, which show a significant (2–3-fold) increase in lumbar disc pathology, apoptosis of nucleus pulposus cells, and up-regulation of the pathological mediator inducible nitric oxide synthase following ovariectomy (6, 7). Our own research group has also demonstrated altered IVD biomechanical function in ovariectomized ewes 6 months after ovariectomy (Cake M et al: unpublished observations). Furthermore, a link between elevated CTX-II levels and IVD disease has been directly demonstrated by Garnero et al (8), who showed by multivariate analysis that the contribution of lumbar disc space narrowing to circulating CTX-II levels was similar to, and independent of, the contribution of radiologic knee osteoarthritis or clinical hand osteoarthritis. This finding, combined with the above evidence from both human and animal studies of IVD narrowing, remodeling, and/or degeneration following menopause or ovariectomy, indicates that IVD is indeed a potential source of circulating CTX-II in these conditions, and that, as indeed the above-cited work (1) has done, additional sources of evidence for articular cartilage degradation should support claims based on measurement of serum or urinary CTX-II.

Serum cartilage oligomeric matrix protein (COMP) levels in knee osteoarthritis in a Brazilian population: clinical and radiological correlation

Objectives: In this study we present data on serum cartilage oligomeric matrix protein (COMP) levels in a Brazilian population with isolated knee osteoarthritis (OA) compared to healthy controls. Clinical and radiological correlations with COMP levels were also evaluated.Methods: Two hundred and seventy‐two patients seen at the Rheumatology Division of the Federal University of São Paulo (UNIFESP) with a symptom of ‘pain in the knees’ for at least 3 months were invited to participate in this study. History and clinical examination were performed in all patients. Eighty‐six patients with clinical isolated knee OA according to the American College of Rheumatology (ACR) criteria and without other causes of pain in the knee were included. Fifty‐eight healthy individuals were selected, matched for age and sex, and used as controls. OA evaluation included Lequesne and Western Ontario and MacMaster Universities osteoarthritis index (WOMAC) questionnaires, visual analogue scale (VAS) for pain and standard knee X‐rays. Blood samples were taken from all participants and serum COMP levels were measured by enzyme‐linked immunosorbent assay (ELISA). OA radiological analysis was performed using the Kellgren and Lawrence (K/L) grading scale.Results: Patients with symptomatic knee OA presented significantly higher serum COMP levels compared to healthy controls and to those with non‐symptomatic narrowing of the articular space (p<0.001). Patients with clinical evidence of knee OA and without radiological abnormalities (K/L grade 0 or 1) had intermediate serum COMP levels, significantly higher than those observed in healthy controls (p<0.03).Conclusions: We observed increased serum COMP levels in patients with symptomatic radiological knee OA. High serum COMP levels may also indicate cartilage damage in selected symptomatic patients without significant radiological abnormalities.

Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: Data from the longitudinal Melbourne Women's Midlife Health Project

The prevalence of osteoarthritis (OA) is greater in women then men. Weight, a factor strongly associated with osteoarthritis, is significantly increased over the menopausal transition. Despite the high prevalence of osteoarthritis, a disabling disease with limited treatment options, there is a paucity of studies in women. The longitudinal phase of the Melbourne Women's Midlife Health Project, is a population-based prospective study of 438 Australian born women who have been followed annually over 11 years. 257 (59%) of these women remained in longitudinal assessment at 11th year of follow-up and 224 of these women agreed to undergo X-rays of their knees and hands. In this study, X-rays were scored for evidence of osteoarthritis using a validated scale, by two investigators who were blinded to questionnaire results. Information on hormone therapy use, physical activity, smoking, BMI and age were obtained by both self-administered and face-to-face questionnaires. Results showed that one hundred and twenty-eight women (56%) had evidence of radiological OA. Forty-nine (21.6%) had evidence of radiological knee OA. One hundred and one (44.5%) had evidence of radiological hand OA. Compared to baseline, at 11th year of follow-up participants had put on weight (4 kg range −14 to 25 kg) and a larger proportion (25% vs. 40%) reported exercising frequently (P = 0.005). Physical activity and BMI were associated with higher prevalence of osteoarthritis in the final year of follow-up. Smoking was associated with a lower prevalence of radiological knee OA. The prevalence was 61% among never smokers compared to only 39% among those who smoked (P < 0.05). Total OA was associated with never having used hormone therapy (odds ratio 2.7; CI 1.1–6.9). There was a trend for increasing level of physical activity at ages 20–29 to be associated with an increased risk of knee OA (P value 0.03 for trend). In conclusion increasing age, BMI and history of more frequent physical activity in younger years were risk factors for radiological knee OA. In contrast, smoking appeared to be associated with less knee OA. Never having used hormone therapy was a risk factor for radiological hand and knee OA. Further work will be needed to determine whether modification of these factors can prevent the development of OA.

Association between spine disc degeneration and type II collagen degradation in postmenopausal women: the OFELY study.

To investigate whether radiologic spine disc degeneration is associated with increased type II collagen (CII) degradation products in the urine of postmenopausal women, independently of radiologic knee osteoarthritis (OA) and clinical hand OA. The study group comprised 324 postmenopausal women ages 58-94 years who had no treatment or disease that could alter bone metabolism. Lateral radiographs of the thoracic and lumbar spine were obtained in each woman and scored for disc space narrowing (DSN) and osteophytes. Fixed-flexion posteroanterior radiographs of the knee were obtained to assess femorotibial knee OA. In all women, hand OA was assessed by clinical examination, and the level of urinary C-terminal crosslinking telopeptide of CII (CTX-II), a biologic marker of CII degradation, was measured. The prevalences of radiographic lumbar and thoracic spine disc degeneration, knee OA, and clinical hand OA were 84%, 88%, 35%, and 58%, respectively. After adjustment for age and body mass index (BMI), patients with lumbar spine DSN grade > or = 1 had, on average, 34% higher CTX-II levels compared with the other women (P = 0.0005), whereas no association was observed with lumbar spine osteophytes. No significant association between thoracic spine DSN or osteophytes and urinary CTX-II levels was observed. Multivariate analysis of variance showed that, after adjustment for age and BMI, lumbar spine DSN (P = 0.0049), knee OA (P = 0.0055), and clinical hand OA (P = 0.0060) were, independently of each other, associated with CTX-II levels. Thus, patients with lumbar spine DSN, knee OA, and clinical hand OA had CTX-II levels 80% higher (P < 0.0001 after adjustment for age and BMI) than those of patients with no lumbar spine DSN, no radiologic knee OA, and no clinical hand OA. Postmenopausal women with lumbar spine disc degeneration are characterized by increased CII degradation. The contribution of lumbar spine DSN to CII degradation was similar to, and independent of, the contribution of radiologic knee OA or clinical hand OA. Lumbar spine disc degeneration in elderly patients should be assessed when analyzing levels of CTX-II in studies of knee, hip, and hand OA.

The value of knee arthroscopy in patients with severe radiological osteoarthritis.

This study was performed to assess the value of knee arthroscopy in patients with radiological signs of severe osteoarthritis. A total of 104 patients (50 men, 54 women, average age 60 years) with radiological knee osteoarthritis grade III/IV were followed up after knee arthroscopy between May 1989 and November 1996. The average follow-up time was 5.4 years after surgery. A significant ( p<0.01) increase in the Lysholm score was found, ranging from 40 points before arthroscopy to 69 points at the assessment. A total of 84 patients (81%) reported an increase in their activities of daily living, 44 patients (43%) were still without any complaints. The total outcome was rated very good or good by 67 patients (65%). Only 21 patients (20%) required further surgery before the assessment. Knee arthroscopy is a valuable treatment for patients with pain, swelling, and radiological signs of severe osteoarthritis. It improves the patients' activities of daily living and helps to postpone further surgery.