Symptomatic Radiographic Osteoarthritis Research Articles

Bicycling over a Lifetime Is Associated with Less Symptomatic Knee Osteoarthritis: Data from the Osteoarthritis Initiative.

To evaluate the relationship between a history of bicycling and symptomatic and structural outcomes of knee osteoarthritis (OA), the most common form of arthritis. This was a retrospective, cross-sectional study within the Osteoarthritis Initiative (OAI), where we investigated OAI participants with complete data on bicycling, knee pain, and radiographic evidence of knee OA. We used a self-administered questionnaire at the 96-month OAI visit to identify participation in bicycling during four time periods throughout a participant's lifetime (ages 12-18, 19-34, 35-49, and > 50 years old). Using logistic regression, we evaluated the influence of prior bicycling status (any history, history for each time period, number of periods cycling) on three outcomes at the 48-month OAI visit: frequent knee pain, radiographic OA (ROA), and symptomatic radiographic OA (SOA), adjusting for age and gender. 2607 participants were included; 44.2% were male; mean age was 64.3 (SD 9.0) years; body mass index was 28.5 (SD 4.9) kg/m2. The adjusted risk ratio for the outcome of frequent knee pain, ROA, and SOA among those who reported any history of bicycling compared to non-bicyclers was 0.83 (0.73-0.92), 0.91 (0.85-0.98), and 0.79 (0.68-0.90), respectively. We observed a dose-response among those who participated in bicycling during more time periods. People who participated in bicycling had a lower prevalence of frequent knee pain, ROA, and SOA. The benefit appeared cumulative. This study indicates that bicycling may be favorable to knee health and should be encouraged.

Visualizing pre-osteoarthritis: Integrating MRI UTE-T2* with mechanics and biology to combat osteoarthritis-The 2019 Elizabeth Winston Lanier Kappa Delta Award.

Osteoarthritis (OA) is a leading cause of pain and disability for which disease-modifying treatments remain lacking. This is because the symptoms and radiographic changes of OA occur after the onset of likely irreversible changes. Defining and treating earlier disease states are therefore needed to delay or to halt OA progression. Taking this concept a step further, studying OA pathogenesis before disease onset by characterizing potentially reversible markers of increased OA risk to identify a state of "pre-osteoarthritis (pre-OA)" shifts the paradigm towards OA prevention. The purpose of this review is to summarize the 42 studies comprising the 2019 Kappa Delta Elizabeth Lanier Award where conceptualization of a systems-based definition for "pre-osteoarthritis (pre-OA)" was followed by demonstration of potentially reversible markers of heightened OA risk in patients after anterior cruciate ligament (ACL) injury and reconstruction. In the process, these efforts contributed a new magnetic resonance imaging method of ultrashort echo time (UTE) enhanced T2* mapping to visualize joint tissue damage before the development of irreversible changes. The studies presented here support a transformative approach to OA that accounts for interactions between mechanical, biological, and structural markers of OA risk to develop and evaluate new treatment strategies that can delay or prevent the onset of clinical disease. This body of work was inspired by and performed for patients. Shifting the paradigm from attempting to modify symptomatic radiographic OA towards monitoring and reversing markers of "pre-OA" opens the door for transforming the clinical approach to OA from palliation to prevention.

Prognostic factors for finger interphalangeal joint osteoarthritis: a systematic review.

Radiographic hand OA affects one in five adults. Symptomatic hand OA can result in functional impairment, pain and reduced quality of life. A prevalent form of hand OA is IP joint OA, however prognostic factors for IP joint OA remain poorly understood. This systematic review aimed to identify prognostic factors for IP joint OA, and to summarize the diagnostic criteria for IP joint OA in prognostic studies. EMBASE, MEDLINE, Scopus and The Cochrane Library were searched from inception until 19 February 2020 (PROSPERO CRD42019116782). Eligible studies described diagnostic criteria defining IP joint OA, and assessed potential prognostic factors for IP joint OA. Risk of bias was assessed using a modified Quality in Prognosis Studies (QUIPS) tool and a best evidence synthesis was used. Eighteen studies were included (risk of bias: eight high, three moderate, seven low). All defined OA radiographically, and three studies incorporated clinical symptoms into their definition of OA. Forty-nine potential prognostic factors were assessed. Eight were prognostic: older age in women, female gender (both moderate evidence); family history of Heberden's nodes, Kashin-Beck disease, older age in men, dental occupation in men, finger fracture, parity (all limited evidence). Higher BMI in women (limited evidence) was prognostic for symptomatic radiographic OA. No prognostic factors for symptomatic OA were identified. IP joint OA is most commonly defined radiographically, yet criteria were heterogeneous. Eight prognostic factors for radiographic IP joint OA and one for symptomatic radiographic IP joint OA were identified, all with limited or moderate evidence. Further studies on causality and on prognostic pathways are needed.

Relative prevalence and distribution of knee, hand and foot symptomatic osteoarthritis subtypes in an English population.

In this brief report, we used data from a series of three related cohorts on pain and osteoarthritis (OA) of the knee, hand and foot, which were conducted in North Staffordshire, England. We used a common approach for sampling, data collection and coding, to estimate the relative prevalence of 10 different symptomatic radiographic OA subtypes in the knee, hand and foot and to compare their association with age, sex, socioeconomic position and body mass index. Overall, symptomatic hand OA was more common than knee or foot OA (22.4% vs 17.4% vs 16.5%), due mainly to the high prevalence of nodal interphalangeal joint OA among women. The first carpometacarpal joint OA was the most frequent subtype, with patellofemoral, tibiofemoral, (nodal) interphalangeal and midfoot OA also common. Of the risk factors examined, the greatest differences between subtypes appeared to be their associations with sex and obesity: sex differences were noticeably greater for all forms of hand OA except non-nodal interphalangeal joint OA, while obesity appeared most strongly associated with forms of knee OA. The prevalence of all subtypes was higher among older ages, and among those with lower educational attainment.

Knee Osteoarthritis and the Risk of Medically Treated Injurious Falls Among Older Adults: A Community-Based US Cohort Study.

The risk of falls among adults with knee osteoarthritis (OA) has been documented, yet, to our knowledge no studies have examined knee OA and the risk of medically treated injurious falls (overall and by sex), which is an outcome of substantial clinical and public health relevance. Using data from the Health Aging and Body Composition Knee Osteoarthritis Substudy, a community-based study of white and African American older adults, we tested associations between knee OA status and the risk of injurious falls among 734 participants with a mean ± SD age of 74.7 ± 2.9 years. Knee radiographic OA (ROA) was defined as having a Kellgren-Lawrence grade of ≥2 in at least 1 knee. Knee symptomatic ROA (sROA) was defined as having both ROA and pain symptoms in the same knee. Injurious falls were defined using a validated diagnosis code algorithm from linked Medicare fee-for-service claims. Cox regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). The mean ± SD follow-up time was 6.59 ± 3.12 years. Of the 734 participants, 255 (34.7%) had an incident injurious fall over the entire study period. In the multivariate model, compared with those without ROA or pain, individuals with sROA (HR 1.09 [95% CI 0.73-1.65]) did not have a significantly increased risk of injurious falls. Compared with men without ROA or pain, men with sROA (HR 2.57 [95% CI 1.12-5.91]) had a significantly higher risk of injurious falls. No associations were found for women or by injurious fall type. Knee sROA was independently associated with an increased risk of injurious falls in older men, but not in older women.

Osteoarthritis, mobility-related comorbidities and mortality: an overview of systematic reviews

Purpose: Comorbid chronic conditions are thought to be common in osteoarthritis (OA) patients, particularly mobility-related conditions such as cardiovascular disease (CVD) and diabetes. The impact of OA on these comorbidities and the relationship to mortality is poorly understood. The purpose of this review is to identify systematic reviews (SR)/meta-analyses (MA) that correlate OA and diabetes, CVD and mortality focusing on methodological features and strength of association. Methods: Two focused searches were conducted to find recent SRs/MAs that examined the association between OA and diabetes or CVD (PubMed and Embase, from inception to April 2018) and mortality (PubMed, from inception to September 2018). Supplementary searches were conducted by searching the internet and checking reference lists of identified articles. Only papers published in English were eligible. Both absolute and relative effects as reported in each SR/MA were extracted, with priority given to estimates based on multivariate models (OA versus non-OA) controlling for confounders. Results: Our search initially identified 2,874 records, and after screening, 7 SRs/MAs met inclusion criteria. Of these, one examined the relationship between OA and diabetes (N=49 studies, with over 1 million patients) and two examined CVD (N=16 unique studies, with ∼260,000 patients). For mortality, 3 SRs/MAs were identified (N=17 unique studies, with ∼273,000 patients) and one that conducted an individual patient data MA. The SRs/MAs included high to moderate quality studies that generally controlled for confounders (most often, age and sex). The single review on diabetes identified a statistically significant association between OA and diabetes (OR 1.41, 95% CI: 1.21 to 1.65) (Table 1). Both reviews on CVD also found a significant association between OA and CVD with pooled estimates ranging from a risk ratio (RR) of 1.24 (95% CI: 1.12 to 1.37) to 1.69 (95% CI: 1.13 to 2.53). Neither review that examined OA (any site) and all-cause mortality found a significant association, however the MA of individual patient data found that in U.S. patients, hip and knee OA were associated with increased risk of premature mortality. Two reviews reported that OA was significantly associated with cardiovascular-related death.Table 1Summary of findings based on meta-analyses of OA and comorbidities/mortality (based on multivariate models)PopulationComorbidityAbsolute effect (OA vs. Non-OA)Relative effect (95% CI)1No. studies included in each analysis (total sample size)Any OADiabetesNROR 1.41 (1.21, 1.65)20 (1,040,175)Any OA (sensitivity analysis)2DiabetesNROR 1.32 (1.13, 1.53)5 (9,947)Hand OADiabetesNROR 1.31 (1.07, 1.61)NRHip OADiabetesNROR 0.71 (0.49, 1.04)3 (6,240)Knee OADiabetesNROR 1.51 (1.09, 2.09)5 (9,102)Any OACVDNRRR 1.24 (1.12, 1.37)15 (102,944)Any OACVD38% vs. 9%RR 1.69 (1.13, 2.53)4 (176,358)Any SOACVDNRRR 1.47 (0.91, 2.39)3 (6,037)Any ROACVDNRRR 1.23 (1.02, 1.48)7 (25,362)Hand OACVDNRRR 1.03 (0.85, 1.25)5 (15,728)Hip OACVDNRRR 1.23 (1.11, 1.38)3 (13,968)Knee OACVDNRRR 1.30 (1.00, 1.69)4 (7,796)Any OAHFNRRR 1.40 (1.13, 1.73)5 (87,500)Any OAHF5% vs. 2%RR 2.80 (2.25, 3.49)2 (13,096)Any OAIHDNRRR 1.33 (1.20, 1.46)8 (177,253)Any OAIHD9% vs. 4%RR 1.78 (1.18, 2.69)2 (13,952)Any OAStroke4% vs. 9%RR 1.00 (0.13, 7.87)3 (175,575)Any OAStrokeNRRR 1.11 (0.96, 1.29)6 (151,321)Any OAMI4% vs. 7%RR 0.69 (0.05, 8.98)2 (174,227)Any OATIA2% vs. 6%RR 0.33 (0.27, 0.41)1 (162,479)Any OAAll-cause mortalityNRHR 1.10 (0.97, 1.25)7 (28,559)Any SOAAll-cause mortalityNRHR 0.91 (0.68, 1.23)7 (NR)Any ROAAll-cause mortalityNRHR 1.13 (0.95, 1.35)6 (NR)Hip SOA (U.S.)All-cause mortalityNRHR 1.20 (1.04, 1.37)2 (11,900)Knee SROA (U.S.)All-cause mortalityNRHR 1.23 (1.07, 1.42)2 (4,156)Non-site specific OAAll-cause mortalityNRHR 1.18 (1.08, 1.28)4 (NR)Hand OAAll-cause mortalityNRHR 1.18 (1.07, 1.30)4 (NR)Any OACV deathNRRR 1.53 (1.27, 1.84)6 (16,109)Any OACV death14% vs. 9%HR 1.21 (1.10, 1.34)4 (14,227)Note. Bolded results are statistically significant. All data are summarized from previous reviews. If two reviews reported on the same outcome, both estimates are provided. CVD, cardiovascular disease; HF, heart failure; IHD, ischemic heart disease; MI, myocardial infarction; NR, not reported; ROA, radiographic OA; SOA, symptomatic OA; SROA, symptomatic radiographic OA; TIA, transient ischemic attack; U.S., United States. OR, odds ratio; RR, risk ratio; HR, hazard ratio. 1 Pooled estimate based on meta-analysis. 2 Only studies that used an internationally recognized diagnosis criteria for OA such as ACR criteria or the KL score for OA definition. Open table in a new tab Note. Bolded results are statistically significant. All data are summarized from previous reviews. If two reviews reported on the same outcome, both estimates are provided. CVD, cardiovascular disease; HF, heart failure; IHD, ischemic heart disease; MI, myocardial infarction; NR, not reported; ROA, radiographic OA; SOA, symptomatic OA; SROA, symptomatic radiographic OA; TIA, transient ischemic attack; U.S., United States. OR, odds ratio; RR, risk ratio; HR, hazard ratio. 1 Pooled estimate based on meta-analysis. 2 Only studies that used an internationally recognized diagnosis criteria for OA such as ACR criteria or the KL score for OA definition. Conclusions: This review demonstrates an association between OA and mobility related comorbidities based on evidence assessed as generally high quality. Overall, OA is associated with higher risk of both diabetes and CVD, with knee OA being most closely related. In addition, there is evidence to suggest an association between knee and hip OA and all-cause mortality as well as mortality from cardiovascular causes. There is insufficient evidence to draw conclusions regarding causation.

A multi-faceted, non-drug, non-surgical intervention compared to usual GP care for symptomatic radiographic osteoarthritis of the first metatarsophalangeal joint: a randomised controlled feasibility study

A multi-faceted, non-drug, non-surgical intervention compared to usual GP care for symptomatic radiographic osteoarthritis of the first metatarsophalangeal joint: a randomised controlled feasibility study

Bone Mineral Density and the Risk of Hip and Knee Osteoarthritis: The Johnston County Osteoarthritis Project.

To address knowledge gaps regarding the relationship between bone mineral density (BMD) and incident hip or knee osteoarthritis (OA); specifically, lack of information regarding hip OA or symptomatic outcomes. Using data (n = 1,474) from the Johnston County Osteoarthritis Project's first (1999-2004) and second (2005-2010) followup of participants ages ≥45 years, we examined the association between total hip BMD and both hip and knee OA. Total hip BMD was measured using dual x-ray absorptiometry, and participants were classified into sex-specific quartiles (low, intermediate low, intermediate high, and high). Radiographic OA (ROA) was defined as development of Kellgren/Lawrence grade ≥2. Symptomatic ROA (sROA) was defined as onset of both ROA and symptoms. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). Median followup time was 6.5 years (range 4.0-10.2 years). In multivariate models, and compared with participants with low BMD, those with intermediate high and high BMD were less likely to develop hip sROA (HR 0.52 [95% CI 0.31-0.86] and 0.56 [95% CI 0.31-0.86], respectively; P = 0.024 for trend); high BMD was not associated (HR 0.69 [95% CI 0.45-1.06]) with risk of hip ROA. Compared with participants with low BMD, those with intermediate low and intermediate high total hip BMD were more likely to develop knee sROA (HR 2.15 [95% CI 1.40-3.30] and 1.65 [95% CI 1.02-2.67], respectively; P = 0.325 for trend); similar associations were seen with knee ROA. Our findings suggest that higher BMD may reduce the risk of hip sROA, while intermediate levels may increase the risk of both knee sROA and ROA.

Knee osteoarthritis and the risk of premature mortality in the community: An international individual patient level meta-analysis in 9889 subjects

Purpose: The rising prevalence of osteoarthritis (OA) is recognised has having an impact on the increased need for medical consultations due to pain and functional limitations; however, the effect of OA on mortality is less understood. A recent systematic review has shown that there is currently mixed evidence on the relationship between lower limb OA and all-cause mortality, largely due to heterogeneity in definitions of OA, confounders, and inclusion criteria. The aim of this research was to combine individual patient data (IPD) from major international population-based cohorts using harmonised OA data, and to assess whether subjects with knee OA have an increased association with premature mortality. Methods: General population OA cohort studies were identified by literature review and expert consultation, regardless of whether they had published on the relationship between OA and mortality. Six population-based cohorts and one enhanced risk factor cohort* were identified and available for analysis: three US cohorts (Framingham, Johnston County Osteoarthritis Project and Multicentre Osteoarthritis Study* (MOST)); one UK cohort (Chingford); a Dutch cohort (Rotterdam Study); and an Australian cohort (Tasmanian Older Adult Cohort (TasOAC)). The definition of knee OA was established via an expert consensus study, which selected the two OA variables used in this analysis. Radiographic OA (ROA) was defined as Kellgren and Lawrence (K/L) grade 2 ≥ or equivalent validated scoring methods (e.g. the OARSI atlas). Pain was defined by using either an NHANES-type question (i.e. ‘have you had pain for most days in the last month in your joint’), the WOMAC pain subscale, or alternative equivelent pain question. Subjects were divided into four categories: (1) No OA (ROA-/Pain-); (2) ROA only (ROA+/Pain-); (3) Symptomatic OA (ROA-/Pain+); (4) Symptomatic Radiographic OA (ROA+/Pain+). Included subjects were free from RA, aged 45–80 years old, had complete symptomatic and radiographic OA data, confounder data (age, sex, and race) and mortality data. Complete case analysis was undertaken for all cohorts due to the low level of missingness (<10%). The association between OA and the time to all-cause mortality was assessed using Cox proportional hazard regression models to estimate hazard ratios (HRs) and 95% confidence intervals. Symptomatic radiographic OA (SROA) was assessed by comparing subjects who were ROA+/Pain+ against subjects free from OA (ROA-/Pain-). Symptomatic OA (SOA) compared subjects who were ROA-/Pain+ against ROA-/Pain- subjects. IPD meta-analysis methods were utilised, using a two-stage approach. Individual studies were analysed separately using identical methods and then data was pooled in the second stage using random effects analysis, with Dersimonian and Laird estimation. Heterogeneity was assessed using I-squared and the tau-squared statistic, and uncertainty around tau was accounted for by producing confidence intervals around the pooled estimate using the Hartung-Knapp correction. Results: The number of baseline subjects with complete data ranged from 253 to 3384 in each cohort, totalling 9889 subjects ranging from a median follow-up of 5.6 to 19.8 years. Prevalence of knee SROA ranged from 4.4% in one of the youngest cohorts (Chingford) to 33.3% in the risk enriched MOST cohort. Subjects with SROA had an overall pooled estimate of HR 1.47 (95% CI 1.07, 2.04) in an unadjusted model, with a pooled estimate of HR 1.19 (95% CI 1.04, 1.37) when adjusted for potential confounding factors (figure 1). Subjects with SOA had an overall pooled estimate of HR 1.13 (95% CI 0.70, 1.81) in an unadjusted model, with a pooled estimate of HR 1.19 (95% CI 0.78, 1.81) in the adjusted model (figure 2). Conclusions: Subjects with knee SROA had a 19% increased association with premature death independent of age, sex and race compared to pain-free and ROA-free subjects. This increase was not found in subjects with pain alone (SOA). This international study is one of the largest analyses of well-phenotyped knee osteoarthritis and mortality in the general population.

Race- and Sex-Specific Incidence Rates and Predictors of Total Knee Arthroplasty: Seven-Year Data From the Osteoarthritis Initiative.

To determine race- and sex-specific rates of total knee arthroplasty (TKA) and to document independent effects of demographic factors on TKA incidence in a population with radiographically confirmed osteoarthritis (OA). We used data from the Osteoarthritis Initiative, a US-based, multicenter longitudinal study of knee OA. We selected subjects with radiographic symptomatic OA at baseline and determined TKA incidence rates (ratio of TKAs to time at risk for TKA) over 84 months of followup. We used multivariable Poisson regression to identify independent associations between demographic factors and TKA utilization. During the study period there were 223 TKAs among 1,915 subjects for an incidence of 1.9% (95% confidence interval [95% CI] 1.7-2.2%). The overall rate was 1.9% (95% CI 1.5-2.3%) in men versus 2.0% (95% CI 1.7-2.3%) in women, and 2.2% (95% CI 1.9-2.6%) in whites versus 1.0% (95% CI 0.7-1.5%) in nonwhites. We observed a statistically significant interaction between sex and age (stratified at <65 and ≥65 years at end of followup), wherein male sex was associated with decreased risk of TKA for younger participants (relative risk [RR] 0.32) but not for older participants. Nonwhite race was associated with a decreased risk of TKA for both younger (RR 0.32) and older (RR 0.43) participants. Our finding that nonwhites were less likely to undergo TKA than whites in adjusted analyses confirms racial differences observed in population-based studies and underscores the need for interventions to address lower use of TKA among nonwhites with OA.

Is rugby playing load predictive of lower limb osteoarthritis in former international rugby players?

Purpose: Rugby union (rugby) is a full contact collision sport with global participation of over 7.23 million men, women and children across 120 countries. Osteoarthritis (OA) is a leading cause of pain and chronic disability globally, more commonly diagnosed in older populations. There is a known association between injury and the development of OA; however the relationship between sport, exercise and injury remains ill-defined. As participation in rugby continues to rise and sport, exercise and physical activity are promoted, it is important to understand whether there is an association between sporting exposure and joint loading attributable to sports participation, and any subsequent development of negative musculoskeletal outcomes of the lower limb. The aim of this study was to describe the prevalence of OA within a cohort or former elite International rugby players, and examine which potentially modifiable rugby-related and injury-related risk factors are most predictive of OA-related outcomes. Methods: A cross-sectional questionnaire was sent to former English International rugby players. Both postal and online recruitment strategies were used. Players received an initial overview describing the study’s aims and objectives before its launch, a formal approach to participate following its launch, and reminder communications. Former players reported their playing history, injury history, family history of OA, current pain, sentiments on their rugby career and the sport, and an abbreviated medical history. GP-diagnosed wear and tear, degeneration or OA and joint replacement were reported per person and by joint. Rugby-specific risk factors of total playing duration, duration at International level and total number of matches were tested for association with the primary outcome of any OA (physician diagnosed or joint replacement) at any joint; and the secondary outcome of site-specific OA at the knee or hip. Injury-specific risk factors of any rugby injury, and any joint-specific rugby injury were assessed for association with any OA and lower limb joint-specific OA. Univariable logistic regression was used to assess the association of each predictor with the primary and secondary outcomes. Results: 138 participants responded to this questionnaire. Participant demographics (mean (SD)) are: Age, 62 (15.5); Height 1.8 (0.1) m; Weight, 94.8 (16.2) kg; BMI, 28.9 (3.5) kg/m2. The prevalence of any GP-diagnosed OA was 61.5% and any joint replacement was 27.0%. GP-diagnosed OA at the hip was reported by 19.6% of respondents, with 16.9% reporting hip replacement. GP-diagnosed OA at the knee was reported by 38.5% of players, with 12.2% reporting knee replacement. The majority of players reflected positively on their playing career, with 90.5% of players stating that they would do the same again. Most players would recommend the sport to their relatives (74.3%) and 90.5% of players felt that rugby had enriched their lives. The mean (SD) playing load values are: total years rugby, 32.7 (4.5); number of seasons at International level, 3.8 (2.6); number of matches, 437.7 (185.5). The vast majority of players reported having had a severe injury, defined as 4 weeks or more of reduced participation in exercise, training or sport (86.7%). Severe injury of the knee was more prevalent (38.5%) than for the hip (20.3%). In this unadjusted univariable logistic regression of rugby-related predictors, no association was found between rugby playing load and OA outcomes at any or specific joints (Table 1 - * denotes significance). Rugby-related injury was found to be associated with GP-diagnosed OA, and associations were found between joint-specific rugby injury and OA of the hip (GP-diagnosed and joint replacement) and knee (GP-diagnosed). Conclusions: This study has described the prevalence of OA-outcomes in this population, and demonstrates a higher prevalence of hip and knee OA than many other population-based studies which range from 5.4 to 14.3 for symptomatic radiographic OA of the knee and 0.7–5.5 for symptomatic radiographic OA of the hip. The association of rugby injury (any, knee and hip) with OA reaffirms data previously published, suggesting an increased risk of the development of OA following joint injury. This study has shown that rugby playing load is not predictive of negative OA-outcomes in later life, at the knee and hip. The strong association of rugby injury with OA-outcomes at the knee and hip reinforces that injury is the most significant modifiable-risk factor of these predictors.Table 1The association between rugby and injury-specific risk factors and OA-outcomesPredictorAny GP OAAny TJRGP: HipTJR: HipGP: KneeTJR: KneeInjuryOR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)OR (95% CI)Any1.93 (.71–5.22)0.73 (.25–2.11)2.25 (.49–10.40)1.09 (.29–4.08)1.84 (.62–5.49)0.64 (.17–2.50)Any rugby injury2.57 (1.11–5.94)*0.73 (.30–1.79)0.87 (.32–2.39)0.69 (.25–1.93)2.14 (.85–4.43)0.56 (.18–1.72)Joint-specific rugby injury––4.88 (1.99–11.92)*6.75 (2.65–17.24)*7.15 (3.04–16.78)*1.73 (.58–5.15)RugbyTotal years of play0.96 (.88–1.03)0.97 (.89–1.06)0.97 (.87–1.07)0.97 (.87–1.08)0.97 (.91–1.07)1.03 (.92–1.15)Years at highest level1.03 (.90–1.17)0.99 (.86–1.14)0.99 (.85–1.16)0.95 (.80–1.13)1.01 (.90–1.16)0.96 (.79–1.16)Number of games0.99 (.99–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00)1.00 (1.00–1.00) Open table in a new tab

A comparison of a referral triage tool for knee osteoarthritis with surgeon’s decision making for total knee arthroplasty

s / Osteoarthritis and Cartilage 22 (2014) S57–S489 S385 683 A COMPARISON OF A REFERRAL TRIAGE TOOL FOR KNEE OSTEOARTHRITIS WITH SURGEON’S DECISION MAKING FOR TOTAL KNEE ARTHROPLASTY M. Harrison y, D.V. Cooke z, W. Hopman y, M. Brean x, J. Hope y. yQueens Univ., Kingston, ON, Canada; zOaisys Inc., Kingston, ON, Canada; xOaisys Inc, Kingston, ON, Canada Objective: To assess the ability of a triage tool, based on patient selfreport disability assessment and standardized radiographic score to determine appropriateness for TKA surgery for patients with knee osteoarthritis (OA). Design: A prospective study was performed to assess a triage tool to clinical decision making by the orthopedic surgeon. Participants: Patients with knee pain seen during their initial referral to one of four orthopedic surgeons over a 1-year period. Methods: The study was approved by the institutional research ethics board. Patients were enrolled into the study by an advanced practice physiotherapist (APP). Informed consent was obtained and subjects completed a standardized battery of selfreport disability questionnaires, namely; SF 12, WOMAC, Tegner & Lysholm questionnaires, Functional Comorbidity Index and an Inflammatory Disorder Questionnaire. The APP also collected demographic data and assessed the patient based on a standardized osteoarthritis referral questionnaire WCWL-PRS. Standardized knee radiographs were scored based on joint space width (0-3), femoral osteophytes (0-3), tibial erosion (0-4) and subluxation (0-3) with a total score from zero to 13. 5 Radiographic assessment was performed by trained readers who were blinded to the clinical data. The diagnosis and decision for surgery was performed by the orthopedic surgeon, independently from the data collection of the clinical disability questionnaires. Information from the orthopedic consultation letter to the referring physician was abstracted by a single trained observer. The diagnosis and treatment recommendations and decision for surgery, as well as any reasonswhy the subject did notwant surgery were recorded. Statistical analysis was performed to assess correlations between the diagnosis, appropriateness for surgery and whether the subjects had surgery with the various disability questionnaires and radiographic assessment. Results: Of the 173 patients enrolled, 46 were assessed by the orthopedic surgeon as being not to be appropriate for surgery (Group 1) and 127 were deemed as being appropriate candidates for surgery (TKA) (Group 2). Statistical analysis showed that most disability questionnaires were positively correlated with subjects being appropriate for surgery (Table 1). A step-wise logistic regression analysis was performed to determine what variables would best distinguish between groups. The independent variables in the final model were, age, WOMAC total score and total radiographic score. The odds ratio for being appropriate for surgery increased by 1.90 for every one point increase in the total radiographic score, by 2.03 for every ten year increase in age and by 1,03 for every 10 point increase in WOMAC score (Table 2). There were 48 subjects who were felt to be appropriate for TKA , but who refused surgery for a variety of reasons. One subjects might have multiple reasons why they declined surgery. The common reasons to decline surgery were; minimal symptoms (37), brace treatment (6), obesity (6), severe medical condition(6), age (6) and other MSK condition (1). We subdivided the subjects who were deemed appropriate for surgery into two groups , those who declined surgery and those who underwent surgery. We then repeated the statistical analysis with three groups (Group 1 not appropriate, Group 2 appropriate but declined and Group3 had surgery)(Table 3). As with the previous statistical analysis the disability questionnaires were correlated with the three groups. Post-Hoc analysis was performed using the Tukey test. This identified that Group 1 was statistically different from Group 3 for patient age. Group 3 was statistically different from Groups 1 & 2 for the physical component of the SF-12, all components of the WOMAC and the total WCWL score. The radiographic scores for joint space narrowing and total radiographic score were the only variables that stratified the subjects into three separate groups, with group 1 different from group 2 which was also different from group 3. Conclusion: These results suggest that an evidence based triage tool based on the combination of patient age, total WOMAC score and total radiographic score may be useful to determine the need for TKA surgery, since it correlates highly which surgeon’s decision for surgery. Further optimization of the triage tool may include simple questions to address the common reasons why patients declined surgery (significant medical condition, obesity and patient desire to avoid surgery). 684 SUBJECTS WITH SELF-REPORTED BASELINE INJURY HAVE AN INCREASED RISK OF SYMPTOMATIC RADIOGRAPHIC KNEE OSTEOARTHRITIS OVER TWENTY-YEARS K.M. Leyland y, M.T. Sanchez-Santos y, S. Kluzek y, D. Prieto-Alhambra y, T.D. Spector z, D.J. Hart z, J. Newton y, N.K. Arden yx. yUniv. of Oxford, Oxford, United Kingdom; z St. Thomas’ Hosp., London, United Kingdom; xUniv. of Southampton, Southampton, United Kingdom Purpose: Knee injury has been previously identified as a strong predictor of both radiographic and symptomatic knee-osteoarthritis (ROA), primarily in cross-sectional, short-term longitudinal studies (<10 years) or in young adult cohorts. This research investigated the association between self-reported knee injuries in middle-aged women and the risk of developing clinically relevant symptomatic radiographic knee osteoarthritis over the subsequent nineteen years. Methods: The Chingford study, a UK population based prospective cohort of women recruited in 1989 was used for the analysis. All subjects without evidence of pain or radiographic osteoarthritis (ROA) in either knee and at least one follow-up visit were included. Subjects with any history of rheumatoid arthritis were excluded. The injury question at baseline asked “have you ever injured your knees, enough to rest them for a week?” Knee ROA was defined as Kellgren and Lawrence grade 2 or above (including knee replacements), and pain was assessed as 15 or more days in the previous month. A subject was positive for symptomatic radiographic osteoarthritis (SROA) if they had both pain and ROA in the same knee on the same visit. A proportional odds model within a discrete-time survival analysis was used to examine the risk of SROA using 5-year intervals over twenty-years between subjects with and without reported previous injury at baseline. The model was adjusted for age, BMI and weekly walking distance. Results: 64.3% (n1⁄4645) out of the original 1003 subjects were knee pain and ROA free at baseline, had at least one follow-up point and did not have rheumatoid arthritis. Mean follow-up for subjects with injury (n1⁄4191) was 14.9 years (SD 4.9), and 15.2 years (SD 5.2) for subjects without previous self-reported injury (n1⁄4454). The risk of developing SROA over any five-year period was significantly increased for women who reported previous injury at baseline compared to injury-free women (OR 2.22 [95% CI 1.39, 3.54]). The time-varying hazard rate was significantly different between groups at year 10 and year 15 (p<0.05) (see figure). Conclusions: Self-report of even mild knee injury is significantly associated with an increased risk of developing clinically relevant symptomatic knee osteoarthritis up to twenty years after the original injury. Efforts to identify and prevent knee injuries of all levels of severity at a community level may help reduce the long-term risk of incident knee osteoarthritis.

Meeting Physical Activity Guidelines and the Risk of Incident Knee Osteoarthritis: A Population‐Based Prospective Cohort Study

Knee osteoarthritis (OA) is a leading cause of disability and joint pain. Although other risk factors of knee OA have been identified, how physical activity affects incident knee OA remains unclear. Using data from the first (1999-2004) and second (2005-2010) followup periods of the Johnston County Osteoarthritis Project study, we tested the association between meeting physical activity guidelines and incident knee outcomes among 1,522 adults ages ≥45 years. The median followup time was 6.5 years (range 4.0-10.2 years). Physical activity at baseline (moderate-equivalent physical activity minutes/week) was calculated using the Minnesota Leisure Time Physical Activity questionnaire. Incident knee radiographic OA (ROA) was defined as the development of Kellgren/Lawrence grade ≥2 in a knee at followup. Incident knee symptomatic ROA (sROA) was defined as the development of ROA and symptoms in at least 1 knee at followup. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for interval-censored data. In multivariable models, meeting the 2008 Department of Health and Human Services (HHS) physical activity guidelines (≥150 minutes/week) was not significantly associated with ROA (HR 1.20 [95% CI 0.92-1.56]) or sROA (HR 1.24 [95% CI 0.87-1.76]). Adults in the highest level (≥300 minutes/week) of physical activity had a higher risk of knee ROA and sROA compared with inactive (0 to <10 minutes/week) participants; however, these associations were not statistically significant (HR 1.62 [95% CI 0.97-2.68] and HR 1.42 [95% CI 0.76-2.65], respectively). Meeting the HHS physical activity guidelines was not associated with incident knee ROA or sROA in a cohort of middle-aged and older adults.

The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults: cross-sectional findings from the Clinical Assessment Study of the Foot

ObjectivesTo estimate the population prevalence of symptomatic radiographic osteoarthritis (OA) affecting the 1st metatarsophalangeal joint (MTPJ), 1st and 2nd cuneometatarsal joints (CMJs), navicular first cuneiform joint (NCJ) and talonavicular joint...

OP0315 Ultrasound Features of Inflammation in the Knee Joint and its Relationship to Pain and Radiographic Osteoarthritis

BackgroundUltrasound (US) is a useful imaging modality that allows the evaluation of features suggestive of inflammation in osteoarthritis (OA). US features are more common in those with painful knee OA...

OP0032 Population Prevalence of Symptomatic Radiographic Foot Osteoarthritis in Community-Dwelling Older Adults: The Clinical Assessment Study of the Foot (CASF)

BackgroundSymptomatic osteoarthritis (OA) affects the daily lives of 10% of people aged >60 years. Although foot pain is common, the foot is the least studied joint complex affected by OA....

Screening for hip and knee osteoarthritis in the general population: predictive value of a questionnaire and prevalence estimates

Objective:To study the feasibility and validity of a two-step telephone screening procedure for symptomatic knee and hip osteoarthritis (OA) in the general population.Method:The screening questionnaire was based on signs and...

Relationship between pain and medial knee joint loading in mild radiographic knee osteoarthritis

The relationship between knee pain and radiographic evidence of knee osteoarthritis (OA) is notoriously imperfect. In particular, conditions that distinguish individuals with symptoms from those with comparable radiographic involvement who remain asymptomatic are unclear. We investigated dynamic loading across the knee in individuals with mild radiographic OA who were distinguished by the presence or absence of knee pain. Subjects were recruited into 3 groups: symptomatic with a Kellgren/Lawrence (K/L) grade of 2 (n = 52), asymptomatic with a K/L grade of 2 (n = 19), and asymptomatic with a K/L grade of 0 or 1 (n = 37), the latter representing a normal comparator group. Dynamic knee loading was assessed with gait analysis, and both the peak external knee adduction moment and the knee adduction angular impulse were determined. Peak knee adduction moment and knee adduction angular impulse were 19% and 30% higher, respectively, in symptomatic K/L grade 2 individuals than in asymptomatic individuals with the same radiographic grade (P < 0.05). Conversely, the asymptomatic K/L grade 2 group did not differ from the K/L grade 0-1 normal comparator group (P = 1.00). Among individuals with mild radiographic knee OA (K/L grade 2), those who are symptomatic have significantly higher medial compartment loads than those who are asymptomatic, whereas those who are asymptomatic do not differ from normal controls (asymptomatic K/L grade 0 or 1). These findings suggest a biomechanical component to the distinction between asymptomatic and symptomatic radiographic OA, which may be pathophysiologically important.

Genetic Background Increases the Risk of Hip Osteoarthritis

Using a cohort of 49 families with at least one affected female sibling pair who had total hip arthroplasty for end-stage primary osteoarthritis, we determined the prevalence and relative risk of symptomatic and radiographic osteoarthritis in 145 children. The relative risk of symptomatic radiographic osteoarthritis in these 145 offspring was 3.5 times greater than in 119 age-matched controls (95% confidence interval; range, 2.0-6.2). Most symptoms and radiographic changes involved the hip. Results of this study showed vertical transmission of primary osteoarthritis and that genetic influences play a major role in osteoarthritis of the hip in the Caucasian population.

Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy.

To evaluate the influence of age, sex, body mass index (BMI), extent of meniscal resection, cartilage status, and knee load on the development of radiographically evident osteoarthritis (OA) of the knee and knee symptoms after meniscal resection. We evaluated 317 patients with no cruciate ligament injury (mean +/- SD age 54 +/- 11 years) who had undergone meniscal resection 15-22 years earlier (followup rate 70%), with radiographic and clinical examination. The Knee injury and Osteoarthritis Outcome Score was used to quantify knee-related symptoms. Sixty-eight unoperated subjects identified from national population records were included as a reference group. Symptomatic radiographic OA (corresponding to Kellgren/Lawrence grade > or =2) was present in 83 of 305 operated knees (27%) and 7 of 68 control knees (10%) (relative risk 2.6, 95% confidence interval [95% CI] 1.3-6.1). Patients who had undergone total meniscectomy and subjects with obesity (BMI > or =30) had a greater likelihood of tibiofemoral radiographic OA than those who had undergone partial meniscal resection and those with a BMI <25, respectively. Furthermore, degenerative meniscal tear, intraoperative cartilage changes, and lateral meniscectomy were associated with radiographic OA more frequently than were longitudinal tear, absence of cartilage changes, and medial meniscectomy, respectively. Symptomatic tibiofemoral or patellofemoral radiographic OA was associated with obesity, female sex, and degenerative meniscal tear. Contributing risk factors for OA development after meniscal resection are similar to risk factors for common knee OA. Systemic factors and local biomechanical factors interact. Obesity, female sex, and preexisting early-stage OA are features associated with poor self-reported and radiographic outcome. Partial meniscal resection is associated with less radiographic OA over time than is total meniscectomy.