Osteoarthritis Trials Research Articles

Is there a difference in the analgesic response to intra-articular bupivacaine injection in people with knee osteoarthritis pain with or without central sensitisation? Protocol of a feasibility randomised controlled trial

IntroductionPain is the main symptom of osteoarthritis (OA) with approximately 50% of patients reporting moderate-to-severe pain. Total knee replacement (TKR) is the ultimate treatment option to alleviate pain in knee...

Pain in clinical trials for knee osteoarthritis: estimation of regression to the mean.

Pain in clinical trials for knee osteoarthritis: estimation of regression to the mean.

Bibliometric Analysis of Publications in Clinical Trials on Knee Osteoarthritis Between 2001 and 2022.

Clinical treatment of knee osteoarthritis has gained great interest, and numerous clinical studies have been reported. Few studies have described the detailed characterizations of clinical trials on knee osteoarthritis. This study is to identify, visualize, and characterize the clinical trials in knee osteoarthritis research. Articles published in recent two decades were extracted from the Web of Science core collection database using a query based on MeSH terms and topics of knee osteoarthritis and clinical trial. Basic characteristics of publications were analyzed based on the publication year, authors, institutions, counties, and keywords covered in the article. CiteSpace and VOS viewer were used for data visualization. The data were retrieved on May 28, 2022. A total of 1972 trials on knee osteoarthritis were identified. The number of publications has experienced rapid growth in the past two decades. America, England, and China had strong contributions in publication. Osteoarthritis and Cartilage, Annals of the Rheumatic Diseases and American Journal of Sports Medicine were highly cited and bellwether journals. Clustering mapping of the collaborative network, co-citation, and co-occurrence analyses showed that the research hotspots are mainly focused on disease-modifying medications, intra-articular injections, physical therapy for symptom control, lifestyle intervention, Chinese medicine treatment, and knee replacement. Clinical treatments of knee OA are evolving. Pharmacologic therapy, intra-articular therapy, nonpharmacologic therapy including exercise or diet, self-management programs, Chinese medicine treatment, and knee replacement were highly represented in clinical trials of knee OA. Adjustment of combination therapy may be the next study focus in the future.

Methodological quality of randomized controlled trials of home-based rehabilitation in knee osteoarthritis: A cross-sectional survey

Background/Aim: This study aimed to evaluate the methodological quality of randomized controlled trials (RCTs) that examine home-based rehabilitation (HBR) trials for knee osteoarthritis (KOA) using the Physiotherapy Evidence Database (PEDro) scale and the nine methodology-related items of the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
 Methods: Three electronic databases were scanned from baseline to October 10, 2021. Two reviewers independently evaluated the articles according to the two inclusion criteria: (1) in individuals diagnosed with KOA, at least one group received home-based rehabilitation as a study intervention and (2) at least one group received a comparison intervention or no intervention. The methodological quality of the included studies (n=22) was assessed using the PEDro scale and nine items of the CONSORT 2010 statement.
 Results: Among 1557 RCTs, 22 studies that fulfilled our criteria were included in the review. The mean PEDro scale score was 5.77 (1.54). This result reflects moderate methodological quality. Concealed allocation (6; 27.3%), blinding of subjects (4; 18.2%), and (0; 0.0%) of therapists associated with the methodological quality were not reported in most studies. An author’s expertise in epidemiology and/or statistics was 0.78 points (95% confidence interval [CI] 0.11–1.44), the multicenter study 0.94 points (95% CI: 0.19–1.68), and a one-unit increase in the total score of the CONSORT statement led to an increase in methodological quality of 0.55 points (95% CI: 0.34–0.76).
 Conclusion: The methodological quality of most RCTs examining HBR in KOA that we included in our systematic review was moderate. The adherence of journals and authors to CONSORT checklists in reporting of studies may lead to an improvement in the methodological quality of future published studies.

Adaptation of the WOMAC for Use in a Patient Preference Study.

To adapt a patient-reported outcome (PRO) measure, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), into efficacy attributes for a discrete choice experiment (DCE) survey designed to quantify the relative importance of endpoints commonly used in knee osteoarthritis (KOA) trials. The adaptation comprised four steps: (1) selecting domains of interest; (2) determining presentation and framing of selected attributes; (3) determining attribute levels; and (4) developing choice tasks. This process involved input from multiple stakeholders, including regulators, health preference researchers, and patients. Pretesting was conducted to evaluate if patients comprehended the adapted survey attributes and could make trade-offs among them. The WOMAC pain and function domains were selected for adaption to two efficacy attributes. Two versions of the discrete choice experiment (DCE) instrument were created to compare efficacy using (1) total domain scores and (2) item scores for "walking on a flat surface." Both attributes were presented as improvement from baseline scores by levels of 0%, 30%, 50%, and 100%. Twenty-six participants were interviewed in a pretest of the instrument (average age 60years; 58% female; 62% had KOA for ≥ 5years). The participants found both versions of attributes meaningful and relevant for treatment decision-making. They demonstrated willingness and ability to tradeoff improvements in pain and function separately, though many perceived them as inter-related. This study adds to the growing literature regarding adapting PRO measures for patient preference studies. Such adaptation is important for designing a preference study that can incorporate a clinical trial's outcomes with PRO endpoints.

Discordance Between Self-Reported and Performance-Based Physical Function in Patients Who Have Knee Osteoarthritis: Associations With Pain Intensity and Negative Affect

BackgroundAlthough self-reported measures of physical disability are strong indication criterion for total knee arthroplasty (TKA) in painful knee osteoarthritis (OA), some patients may report greater-than-observed disability. Contributing factors to this discordance are relatively unexplored. We aimed to examine whether pain and negative affect, including anxiety and depression, were associated with the discordance of self-reported measures with performance-based measures (PPM) of physical function. MethodsWe used cross-sectional data (n = 212) from two randomized rehabilitation trials in knee OA. All patients were assessed for knee pain intensity and symptoms of anxiety and depression. Self-reported function was assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical-function subscale. Objective performance-based measures (PPMs) of physical function were assessed by timed gait and stair tests. Continuous discordance scores were quantified by the difference in percentiles between WOMAC and PPMs (WOMAC-PPM), where a positive discordance, WOMAC-PPM >0, implied greater perceived than observed disability. ResultsAround 1 in 4 patients had >20 percentile units in WOMAC-PPM discordance. In Bayesian regression analyses, knee pain intensity had >99% posterior probability of positive associations with WOMAC-PPM discordance. Among patients awaiting TKA, anxiety intensity had approximately 99% probability of positive associations with discordance, and these associations had >65% probability of exceeding 10 percentile units. In contrast, depression had low (79% to 88%) probability of any association with discordance. ConclusionIn patients who have knee OA, a sizable proportion reported substantially greater physical disability than actually observed. Pain and anxiety intensity, but not depression, were meaningful predictors of this discordance. If validated, our findings may help in refining patient selection criteria for TKA.

Quantitative bone marrow lesion, meniscus, and synovitis measurement: current status.

Imaging plays a pivotal role in osteoarthritis research, particularly in epidemiological and clinical trials of knee osteoarthritis (KOA), with the ultimate goal being the development of an effective drug treatment for future prevention or cessation of disease. Imaging assessment methods can be semi-quantitative, quantitative, or a combination, with quantitative methods usually relying on software to assist. The software generally attempts image segmentation (outlining of relevant structures). New techniques using artificial intelligence (AI) or deep learning (DL) are currently a frequent topic of research. This review article provides an overview of the literature to date, focusing primarily on the current status of quantitative software-based assessment techniques of KOA using magnetic resonance (MR) imaging. We will concentrate on the imaging evaluation of three specific structural imaging biomarkers: bone marrow lesions (BMLs), meniscus, and synovitis consisting of effusion synovitis (ES) and Hoffa's synovitis (HS). A brief clinical and imaging background review of osteoarthritis evaluation, particularly relating to these three structural markers, is provided as well as a general summary of the software methods. A summary of the literature with respect to each KOA assessment method will be presented overall as well as with respect to each specific biomarker individually. Novel techniques, as well as future goals and directions using quantitative imaging assessment, will be discussed.

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.

Effect of Curcuma longa extract on serum inflammatory markers and MRI-based synovitis in knee osteoarthritis: secondary analyses from the CurKOA randomised trial

BackgroundCurcuma longa (CL) extract is modestly effective for relieving knee symptoms in knee osteoarthritis (OA) patients; however, its mechanism of action is unclear. PurposeWe aimed to determine the effects of CL treatment on serum inflammatory markers over 12 weeks and to explore its potential effects on synovitis assessed by contrast-enhanced magnetic resonance imaging (CE-MRI) of the knee. MethodsSecondary analyses were conducted on the CL for knee OA (CurKOA) trial, which compared CL (n = 36) and placebo (n = 34) over 12 weeks for the treatment of knee OA. Systemic inflammatory markers (TNFα, IL6, and hsCRP) and a cartilage extracellular matrix degradative enzyme (MMP-3) were measured. A subgroup of participants (CL, n = 7; placebo, n = 5) underwent CE-MRI at baseline and a 12-week follow-up. ResultsOver 12 weeks, there were no between-group differences in change in hsCRP, IL-6, and TNFα levels. MMP-3 levels decreased in both CL (-1.31 ng/ml [95%CI: -1.89 to -0.73]) and placebo (-2.34 ng/ml [95%CI: -2.95 to -1.73]) groups, with the placebo group having a slightly greater decrease (1.03 ng/ml [95%CI: 0.19 to 1.88]). Most (10 of 12) sub-study participants had normal synovial thickness scores at baseline. One participant had mild synovitis in each of the placebo and CL groups. Synovitis status was stable for all except two participants, one each in the CL and placebo group, whose synovitis score increased. ConclusionThis is the first study that explored the effect of CL treatment on local and systemic inflammation using biochemical markers and CE-MRI outcomes on knee OA patients. Secondary analyses from this pilot study suggest that CL is unlikely to have clinically significant effects on systemic (inflammatory and cartilage) or local synovitis (CE-MRI) biomarkers compared to placebo. The mechanism of action for CL effect on pain remains unclear.

A Two-Step, Trajectory-Focused, Analytics Approach to Attempt Prediction of Analgesic Response in Patients with Moderate-to-Severe Osteoarthritis.

We sought to predict analgesic response to daily oral nonsteroidal anti-inflammatory drugs (NSAIDs) or subcutaneous tanezumab 2.5mg (every 8weeks) at week16 in patients with moderate-to-severe osteoarthritis, based on initial treatment response over 8weeks. Data were derived from three randomized controlled trials of osteoarthritis. A two-step, trajectory-focused, analytics approach was used to predict patients as responders or non-responders at week16. Step1 identified patients using a data-element combination method (based on pain score at baseline, pain score at week8, pain score monotonicity at week8, pain score path length at week8, and body site [knee or hip]). Patients who could not be identified in step1 were predicted in step2 using a k-nearest neighbor method based on pain score and pain response level at week8. Our approach predicted response with high accuracy in NSAID-treated (83.2-90.2%, n = 931) and tanezumab-treated (84.6-91.0%, n = 1430) patients regardless of the efficacy measure used to assess pain, or the threshold used to define response (20%, 30%, or 50% improvement from baseline). Accuracy remained high using 50% or 20% response thresholds, with 50% and 20% yielding generally slightly better negative and positive predictive value, respectively, relative to 30%. Accuracy was slightly better in patients aged ≥ 65years relative to younger patients across most efficacy measure/response threshold combinations. Analyzing initial 8-week analgesic responses using a two-step, trajectory-based approach can predict future response in patients with moderate-to-severe osteoarthritis treated with NSAIDs or 2.5mg tanezumab. These findings demonstrate that prediction of treatment response based on a single dose of a novel therapeutic is possible and that predicting future outcomes based on initial response offers a way to potentially advance the approach to clinical management of patients with osteoarthritis. NCT02528188, NCT02709486, NCT02697773.

Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee.

Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee.

Astragalin mitigates inflammatory osteolysis by negatively modulating osteoclastogenesis via ROS and MAPK signaling pathway

Inflammatory bone destruction has gradually attracted attention worldwide and has been observed in several kinds of pathological bone diseases, such as osteoarthritis, osteomyelitis, rheumatic arthritis, and other infectious clinical trials in the skeletal system. In this regard, excessive osteoclasts and bone resorption activity participate in osteolytic processes. Thus, negatively modulating osteoclast differentiation and bone erosion has been considered an effective therapeutic strategy to limit the poor progression of inflammatory osteolysis. Astragalin (AST) is a bioactive component of traditional Chinese drugs, such as Rosa agrestis, which presents anti-inflammatory and antioxidant effects. However, it is unclear how AST may play an essential role in regulating the dynamic balance of the bone matrix by affecting osteoclastogenesis. This study found that AST could inhibit osteoclastic formation and bone resorption activity in a dose‐dependent manner without cytotoxicity. Administration of AST also inhibited the expression of cathepsin K, c-Fos, NFATc1, and TRAP at different stages of mRNA and protein levels during osteoclastogenesis. Reactive oxygen species (ROS) signalling could also be modulated by treatment with AST during RANKL-induced osteoclast differentiation through the Nrf2-HO1 signalling pathway. Additionally, AST could negatively regulate mitogen-activated protein kinase (MAPK) signalling in this process. In vivo, AST significantly reduced lipopolysaccharide (LPS)-induced bone loss in an osteolytic mouse model. AST might be a promising therapeutic candidate for treating osteolytic bone diseases in the future.

Protocol for the development of a core domain set for individuals with ankle osteoarthritis

BackgroundAnkle osteoarthritis (OA) is a debilitating health condition that is increasing in prevalence. Currently, there are no evidence-based guidelines for managing ankle OA. One of the current challenges to establishing guidelines is the lack of a widely agreed-upon set of outcome measures that are consistently used in ankle OA research. Without a set of agreed-upon outcome measures, it is difficult to synthesise clinical trial outcomes through meta-analysis—an essential element of evidence-informed practice. In order to develop an appropriate set of outcome measures for ankle OA, it is important first to develop a core domain set. In this protocol, we describe the methodological approach that we will use to develop such a core domain set for ankle OA.MethodsWe established an international steering committee to guide the development of a core domain set for ankle OA. The core domain set development will follow a multi-staged approach consisting of three phases, involving participation by patients and clinicians/healthcare professionals. In phase 1, a list of candidate domains will be gleaned from (a) a scoping review of outcome measures used in ankle OA research, (b) qualitative interviews with individuals with ankle OA, and (c) qualitative interviews with healthcare professionals with expertise in ankle OA. In phase 2, the steering committee will review and generate a list of candidate domains from those gleaned in phase 1. In phase 3, this list of candidate domains will be considered in a Delphi process to reach a consensus on a core domain set. We anticipated this will involve 3 rounds of surveys.ConclusionThis protocol describes the methods that will be used to develop a core domain set of health-related aspects for ankle OA. Importantly, it will include both healthcare professional and patient involvement. This is a prerequisite step to developing a core outcome set for ankle OA that should be reported in all clinical trials for ankle OA. The findings will be widely disseminated across peer-refereed publication(s) and national and international conferences, as well as via relevant professional societies, patient support group organisations, and social media platforms.Project registrationThis project is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database on 17 March 2021. https://www.comet-initiative.org/Studies/Details/1837.

P13. Transduction of the rat spinal cord using adenoassociated virus serotype 2.5

<h3>BACKGROUND CONTEXT</h3> Gene therapy is a method by which exogenous genes are introduced to treat disease or deliver drugs of interest. This is commonly done through either direct gene delivery in vivo or ex vivo through transduction of cells that are to be transplanted. There are several vectors for delivering genes, including viral vectors, naked plasmids, electroporation and lipid nanoparticles. Adeno-associated viruses (AAVs) are commonly used and considered to be well tolerated by the brain, muscles, nerves and multiple cell types. Rat Schwann cells are transduced efficiently by AAV1 whereas human Schwann cells are better transduced with AAV2 and 6. Rat nerves segments have demonstrated to be efficiently transduced by AAV1, 5, 7 and 9 whereas human nerves prefer AAV2. Many studies also agree that AAV1, 2, 4, 8 and 9 are optimal serotypes for CNS. We have utilized a novel viral vector, AAV serotype 2.5, that is a chimera of AAV2 vector modified with 5 amino acids from AAV1. AAV2.5 has shared characteristics of AAV1 and AAV2 with enhanced transduction for multiple cell types, such as in the muscle and articular tissue. Since AAV2.5 is not a naturally occurring virus, there is lower cross-reactivity to AAV2 antibodies. However, the ability of AAV2.5 to transduce tissues of the central (CNS) and peripheral nervous system (PNS) is not well understood. <h3>PURPOSE</h3> The purpose of this study is to determine the trophism and transduction efficiency of AAV2.5 for CNS and PNS tissue through in vitro transduction of dorsal root ganglion derived neurons, Schwann cells, and in vivo transduction of spinal cord. We predict that since AAV1 and AAV2 have known tropism for CNS and PNS cells to different extents depending on cell type, that the chimera AAV2.5 would be broadly effective. <h3>STUDY DESIGN/SETTING</h3> Cell culture and animal study. <h3>METHODS</h3> The cDNA encoding green fluorescent protein (GFP) was cloned into the conventional AAV packaging vector pTRUF2. For generation of self-complementing AAV vector plasmids, the cDNAs for GFP were directionally inserted into the SacII, NotI sites of pHpa-trs-SK plasmid. Transcription was driven by the cytomegalovirus promoter. Primary Schwann cells were isolated from the sciatic nerves of postnatal day 5 rat pups and dorsal root ganglion (DRG) neurons from embryonic day 15 rat pups. The cells were plated at a density of 125,000 cells per well and infected with 104 viral genomes per cell. For in vivo transduction of spinal cord tissue, 4 µL of 5 × 106– 5 × 1010vg/mL of AAV2.5-GFP was injected into 4 positions at T9. Immunostaining for markers of different spinal cord cell types colabeled with anti-GFP was done. <h3>RESULTS</h3> AAV2.5 was able to successfully infect DRG neurons and Schwann cells. AAV-2.5 vector was much more efficient than the commonly used AAV2 vector at transducing the Schwann cells. Cell survival and gene product production by AAV2.5 was greater than electroporation. When AAV2.5 -GFP was injected into the spinal cord there was a dose dependent increase in GFP expression by neurons and astrocytes up to 4 mm away from the injection site. <h3>CONCLUSIONS</h3> The study presents a novel vector for broad transduction in vivo or ex vivo of cells in the CNS and PNS. AAV2.5 was more efficient than the more commonly used AAV2 vector or electroporation. Since AAV2.5 is presently in phase 1 trials for osteoarthritis (NCT02790723), this vector type presents an interesting clinical translation opportunity for spinal cord and peripheral nerve injuries/diseases. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

A qualitative study exploring clinicians' views on clinical trials in thumb carpometacarpal joint osteoarthritis.

AimsOsteoarthritis (OA) affecting the thumb carpometacarpal joint (CMCJ) is a common painful condition. In this study, we aimed to explore clinicians’ approach to management with a particular focus on the role of specific interventions that will inform the design of future clinical trials.MethodsWe interviewed a purposive sample of 24 clinicians, consisting of 12 surgeons and 12 therapists (four occupational therapists and eight physiotherapists) who managed patients with CMCJ OA. This is a qualitative study using semi-structured, online interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.ResultsA total of 14 themes were developed, six of which were developed relating to the clinical management of CMCJ OA: 1) A flexible ‘ladder’ approach starting with conservative treatment first; 2) The malleable role of steroid injection; 3) Surgery as an invasive and risky last resort; 4) A shared and collaborative approach; 5) Treating the whole person; and 6) Severity of life impact influences treatment. The remaining eight themes were developed relating to clinical trial barriers and facilitators: 1) We need to embrace uncertainty; 2) You are not losing out by taking part; 3) It is difficult to be neutral about certain treatments; 4) Difficult to recruit to ‘no treatment’ ; 5) Difficult to recruit to a trial comparing no surgery to surgery; 6) Patients are keen to participate in research; 7) Burden on staff and participants; and 8) A enthusiasm for a variety of potential trial arms.ConclusionOur findings contribute to a better understanding of how clinicians manage thumb CMCJ OA in their practice settings. Our study also provides useful insights informing the design of randomized clinical trials involving steroid injections and surgery in people with thumb CMCJ OA.Cite this article: Bone Jt Open 2022;3(4):321–331.

The Science of Placebo, to Understand the Importance of Placebo Effects in OA:

A placebo is an inert substance that produces beneficial therapeutic effects. In the context of clinical trials, the placebo response refers to an improvement in symptoms in study participants assigned to placebo treatment. High placebo responses pose a substantial impediment to distinguishing active treatment effects and may in part account for the failure to identify effective treatments in clinical trials in osteoarthritis (OA) and other conditions. The treatment response to placebos has been to linked to an effect on opioid receptors in the brain.

EXERCISE AND EDUCATION VS. SALINE INJECTIONS FOR KNEE OSTEOARTHRITIS: A RANDOMISED CONTROLLED EQUIVALENCE TRIAL

Purpose: Exercise and education are recommended as primary treatments for knee osteoarthritis (OA), but adequate placebo-controlled studies are lacking probably due to unclear mechanisms of action, difficulties with blinding, and the complexity of the interventions. Recent advances in open-label placebo research have shown that considerable placebo responses can be elicited by inert substances if applied adequately. Intra-articular (IA) saline injection is one such inert treatment and is a commonly used comparator in clinical trials for knee OA.

UNSUPERVISED EXERCISE ADHERENCE RATES IN CLINICAL TRIALS FOR KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW

Purpose: Exercise is a beneficial intervention for knee osteoarthritis, and unsupervised exercise programs are a common and recommended adjunct to most clinical interventions. However, it is unknown how adherence with unsupervised programs affects outcomes, and it is unclear if current clinical trials are capturing information regarding adherence. The purpose of this systematic review was to identify the extent and quality of reporting adherence to unsupervised exercise programs in clinical trials for knee osteoarthritis.

BIOMARKERS IN HAND OSTEOARTHRITIS

Purpose: There is an unmet need of positive clinical trials in hand osteoarthritis (OA). Knowledge of the appropriate pathways to target is essential in developing new therapies. Biomarkers of tissue turnover may reflect presence of disease as well as disease state and character, thereby elucidating the pathways involved in the disease process. In the HOPE study, patients treated with prednisolone showed a significantly reduced VAS pain as compared to patients receiving placebo. In this study we aim to investigate whether biomarkers of tissue turnover and inflammation are associated with hand OA disease characteristics, whether biomarker levels can predict response to therapy and whether these are influenced by therapy.

RELEVANCE OF WITHIN-GRADE CARTILAGE ASSESSMENT USING THE MOAKS SCORING INSTRUMENT AND CORRESPONDING QUANTITATIVE CARTILAGE THICKNESS LOSS: DATA FROM THE OAI FNIH BIOMARKERS CONSORTIUM STUDY

Purpose: Both semi-quantitative (SQ) MOAKS cartilage scores and quantitative (Q) cartilage thickness measurements are used as outcome measures in observational studies and interventional knee osteoarthritis (OA) trials. Both methods are considered complementary. SQ scoring by experts is considered less sensitive to change compared to Q approaches based on cartilage segmentation particularly regarding subtle wide-spread cartilage loss. On the other hand, change in focal defects commonly is not covered by Q approaches as these may be too subtle in the context of segmentation of an entire subregion.