Identifying Phenotypes of Knee Osteoarthritis by Separate Quantitative Radiographic Features May Improve Patient Selection for More Targeted Treatment

2013 ◽  
Vol 40 (6) ◽  
pp. 891-902 ◽  
Author(s):  
Margot B. Kinds ◽  
Anne C.A. Marijnissen ◽  
Max A. Viergever ◽  
Pieter J. Emans ◽  
Floris P.J.G. Lafeber ◽  
...  
Keyword(s):  
Bone Density ◽  
Clinical Characteristics ◽  
Joint Space Width ◽  
Specific Treatment ◽  
Joint Space ◽  
Radiographic Features ◽  
Knee Oa ◽  
Improve Patient Selection ◽  
Space Width ◽  
Varus Angle

Objective.Expression of osteoarthritis (OA) varies significantly between individuals, and over time, suggesting the existence of different phenotypes, possibly with specific etiology and targets for treatment. Our objective was to identify phenotypes of progression of radiographic knee OA using separate quantitative features.Methods.Separate radiographic features of OA were measured by Knee Images Digital Analysis (KIDA) in individuals with early knee OA (the CHECK cohort: Cohort Hip & Cohort Knee), at baseline and at 2-year and 5-year followup. Hierarchical clustering was performed to identify phenotypes of radiographic knee OA progression. The phenotypes identified were compared for changes in joint space width (JSW), varus angle, osteophyte area, eminence height, bone density, for Kellgren-Lawrence (K-L) grade, and for clinical characteristics. Logistic regression analysis evaluated whether baseline radiographic features and demographic/clinical characteristics were associated with each of the specific phenotypes.Results.The 5 clusters identified were interpreted as “Severe” or “No,” “Early” or “Late” progression of the radiographic features, or specific involvement of “Bone density.” Medial JSW, varus angle, osteophyte area, eminence height, and bone density at baseline were associated with the Severe and Bone density phenotypes. Lesser eminence height and bone density were associated with Early and Late progression. Larger varus angle and smaller osteophyte area were associated with No progression.Conclusion.Five phenotypes of radiographic progression of early knee OA were identified using separate quantitative features, which were associated with baseline radiographic features. Such phenotypes might require specific treatment and represent relevant subgroups for clinical trials.

Quantitative Radiographic Features of Early Knee Osteoarthritis: Development Over 5 Years and Relationship with Symptoms in the CHECK Cohort

2012 ◽  
Vol 40 (1) ◽  
pp. 58-65 ◽  
Author(s):  
MARGOT B. KINDS ◽  
ANNE C.A. MARIJNISSEN ◽  
JOHANNES W.J. BIJLSMA ◽  
MAARTEN BOERS ◽  
FLORIS P.J.G. LAFEBER ◽  
...  
Keyword(s):  
Bone Density ◽  
Clinical Outcome ◽  
Joint Space Width ◽  
Joint Damage ◽  
Computer Assisted ◽  
Digital Analysis ◽  
Radiographic Features ◽  
Early Oa ◽  
Varus Angle ◽  
Over Time

Objective.To evaluate whether computer-assisted, interactive digital analysis of knee radiographs enables identification of different quantitative features of joint damage, and to evaluate the relationship of such features with each other and with clinical characteristics during 5-year followup in early osteoarthritis (OA).Methods.Knee radiographs from the Cohort Hip and Cohort Knee (CHECK) study, including 1002 individuals with early OA complaints, were evaluated for different measures with knee images digital analysis (KIDA). To aid definition of different radiographic features of OA, principal component analysis of KIDA was used. Features were correlated (Pearson) to each other, evaluated for changes over time, and related to clinical outcome (Western Ontario and McMaster Universities Osteoarthritis Index for pain and function) using baseline, 2-year, and 5-year followup data.Results.The identified radiographic features were joint space width (JSW: minimum, medial, lateral), varus angle, osteophyte area, eminence height, and bone density. The features progressed in severity at different times during followup: early (medial JSW, osteophyte area), late (minimum and lateral JSW, eminence height), and both early and late (varus angle, bone density). Correlations between different radiographic features varied between timepoints. The JSW features were most strongly related to each other (largest r = 0.82), but also, e.g., osteophytes and bone density were correlated (largest r = 0.33). The relationships with clinical outcome varied over time, but were most commonly found for osteophyte area and JSW.Conclusion.In this early OA cohort, different radiographic features were identified that progressed at different rates between timepoints. The relations between radiographic features and with clinical outcome varied over time. This implies that longitudinal evaluation of different features can improve insight into progression of OA.

scholarly journals Association between disease progression and depression onset in persons with radiographic knee osteoarthritis

Rheumatology ◽  
2020 ◽  
Vol 59 (11) ◽  
pp. 3390-3399
Author(s):  
Alan M Rathbun ◽  
Michelle D Shardell ◽  
Alice S Ryan ◽  
Michelle S Yau ◽  
Joseph J Gallo ◽  
...  
Keyword(s):  
Disease Progression ◽  
Disease Severity ◽  
Gait Speed ◽  
Joint Space Width ◽  
Joint Space ◽  
Knee Oa ◽  
Increased Risk ◽  
Pain Subscale ◽  
Space Width

Abstract Objectives Osteoarthritis (OA) disease progression may lead to deteriorating psychosocial function, but it is unclear what aspects of disease severity are related to the onset of depression. This study assessed which components of OA disease progression cumulatively contribute to depression onset in persons with radiographic knee OA. Methods Osteoarthritis Initiative participants (n = 1651) with radiographic disease (Kellgren-Lawrence grade ≥2) in one or both knees and below the screening threshold for probable depression [Center for Epidemiological Studies Depression (CES-D) scale <16] at baseline were included. Disease severity was measured from baseline to the third annual follow-up visit using joint space width, 20-meter gait speed, and the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, each categorized into quintiles. Depression onset (CES-D ≥ 16) was assessed annually at four follow-up visits. Marginal structural models that account for time-dependent confounding and attrition evaluated the association between each time-varying disease severity measure and depression onset. Results Each disease severity measure exhibited a non-linear relationship concerning the probability of depression onset, with the higher quintiles generally being associated with a larger risk. The highest quintile (relative to the lowest) of joint space width and gait speed were both significantly associated with depression onset. By contrast, none of the higher pain quintiles compared with the lowest were significantly associated with the onset of depression. Conclusion Faster disease progression as measured by either worsening structural severity or decreasing physical performance corresponds to an increased risk of depression among individuals with radiographic knee OA.

scholarly journals Baseline clinical characteristics of predicted structural and pain progressors in the IMI-APPROACH knee OA cohort

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001759
Author(s):  
Eefje Martine van Helvoort ◽  
Christoph Ladel ◽  
Simon Mastbergen ◽  
Margreet Kloppenburg ◽  
Francisco J Blanco ◽  
...  
Keyword(s):  
Structural Damage ◽  
Clinical Characteristics ◽  
Rating Scale ◽  
Pearson Correlation ◽  
Joint Space Width ◽  
Correlation Coefficients ◽  
Joint Space ◽  
Numeric Rating Scale ◽  
Knee Oa ◽  
Private Research

ObjectivesTo describe the relations between baseline clinical characteristics of the Applied Public-Private Research enabling OsteoArthritis Clinical Headway (IMI-APPROACH) participants and their predicted probabilities for knee osteoarthritis (OA) structural (S) progression and/or pain (P) progression.MethodsBaseline clinical characteristics of the IMI-APPROACH participants were used for this study. Radiographs were evaluated according to Kellgren and Lawrence (K&L grade) and Knee Image Digital Analysis. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Numeric Rating Scale (NRS) were used to evaluate pain. Predicted progression scores for each individual were determined using machine learning models. Pearson correlation coefficients were used to evaluate correlations between scores for predicted progression and baseline characteristics. T-tests and χ2 tests were used to evaluate differences between participants with high versus low progression scores.ResultsParticipants with high S progressions score were found to have statistically significantly less structural damage compared with participants with low S progression scores (minimum Joint Space Width, minJSW 3.56 mm vs 1.63 mm; p<0.001, K&L grade; p=0.028). Participants with high P progression scores had statistically significantly more pain compared with participants with low P progression scores (KOOS pain 51.71 vs 82.11; p<0.001, NRS pain 6.7 vs 2.4; p<0.001).ConclusionsThe baseline minJSW of the IMI-APPROACH participants contradicts the idea that the (predicted) course of knee OA follows a pattern of inertia, where patients who have progressed previously are more likely to display further progression. In contrast, for pain progressors the pattern of inertia seems valid, since participants with high P score already have more pain at baseline compared with participants with a low P score.

scholarly journals OP0185 KNEE JOINT DISTRACTION IS MORE EFFICIENT IN RESTORING CARTILAGE THICKNESS THAN HIGH TIBIAL OSTEOTOMY IN PATIENTS WITH SEVERE KNEE OSTEOARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 114.2-115
Author(s):  
M. Jansen ◽  
S. Maschek ◽  
R. Van Heerwaarden ◽  
S. Mastbergen ◽  
W. Wirth ◽  
...  
Keyword(s):  
Stock Options ◽  
Joint Space Width ◽  
Joint Space ◽  
Cartilage Thickness ◽  
Tibial Osteotomy ◽  
Knee Oa ◽  
Leg Axis ◽  
Cartilage Restoration ◽  
Joint Distraction ◽  
Space Width

Background:Both high tibial osteotomy (HTO) and knee joint distraction (KJD) are joint preserving surgical techniques unloading the affected femorotibial compartment in patients with knee osteoarthritis (OA). While HTO permanently unloads the more affected compartment (MAC) by overcorrecting the leg axis, KJD temporarily unloads the whole joint by separating the tibia and femur for 5 mm for 6 weeks. In a previous randomized controlled trial (RCT), comparable clinical benefit and radiographic joint space width (JSW) increase over 2 years follow-up were demonstrated for both treatments1. Yet, comparison of JSW before and after HTO may be unreliable, as pseudo-widening of the unloaded compartment may occur due to the induced leg axis change. Therefore, direct cartilage thickness measurements need to be compared between KJD and HTO, to accurately evaluate the efficacy of both treatment options on cartilage structure.Objectives:To compare two-year cartilage thickness changes after treatment with KJDvsHTO and identify factors predicting cartilage thickness restoration.Methods:Patients indicated for HTO were randomized to KJD (KJDHTO) or HTO treatment. Patients indicated for total knee arthroplasty received KJD (KJDTKA). Standardized semi-flexed weight-bearing radiographs and 3T MRIs with 3D spoiled gradient recalled imaging sequence with fat suppression (SPGR-fs) were acquired before and two years after surgical treatment. Cartilage thickness in the knee was measured using Chondrometrics Works 3.0 software. On the radiographs the mean JSW in the MAC were measured with KIDA software. Readers were blinded to the type of intervention and acquisition order. The primary and secondary outcomes were the mean MAC cartilage thickness (ThCtAB) and percentage of denuded bone area (dABp) change before and two years after treatment (MRI), with radiographic joint space width (JSW) used as a reference.Results:No statistically significant differences in the baseline characteristics were seen between KJDHTO(n=18) and HTO (n=33). The KJDTKAgroup (n=18) had a higher age and Kellgren-Lawrence grade (KLG) than the HTO and KJDHTOgroups.KJDHTOpatients did not show significant changes in MAC cartilage thickness, dABp, or JSW over time (all p>0.10; figure 1). HTO patients displayed a decrease in MAC cartilage thickness and an increase in dABp (both p<0.03), but an increase in JSW (p=0.006). KJDTKAshowed a significant increase in MAC cartilage thickness and JSW and decrease in dABp (all p<0.01). Baseline OA severity was the strongest predictor of cartilage restoration. KJD patients with severe OA (KJDsevere; KLG ≥3) showed significant restoration (all p<0.01; figure 2); mild OA patients (KJDmild; KLG ≤2) showed a slight deterioration. KJDsevereshowed a significantly greater cartilage restoration response in the MAC than HTOseverefor cartilage thickness (p=0.005) and dABp (p=0.003), but not JSW change (p=0.521). The changes in all three parameters did not differ significantly between KJDmildand HTOmild(all p>0.08).Conclusion:In patients with severe knee OA, KJD is more efficient in restoring cartilage thickness than HTO is. In these patients, KJD causes significant cartilage restoration while HTO, despite shifting the leg axis and demonstrating radiographic joint space widening, shows loss of cartilage as measured on MRI. In patients with mild knee OA, neither HTO nor KJD treatment results in significant cartilage restoration and both treatments show a slight deterioration that is likely the result of natural OA progression. As such, this research promotes the choice KJD as joint-preserving surgery in case of knee OA patients with more severe structural damage.References:[1]MP Jansenet al, Cartilage 2019.Disclosure of Interests:Mylène Jansen: None declared, Susanne Maschek Shareholder of: Stock/stock options at Condrometrics GmbH, Employee of: Employment at Condrometrics GmbH, Ronald Van Heerwaarden: None declared, Simon Mastbergen: None declared, Wolfgang Wirth Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy to Galapagos NV, Employee of: Employment at Condrometrics GmbH, Floris Lafeber Shareholder of: Co-founder and shareholder of ArthroSave BV, Felix Eckstein Shareholder of: Stock/stock options at Condrometrics GmbH, Consultant of: Consultancy at Merck KGaA, Samumed, Bioclinica, Galapagos, Servier, Novartis, Employee of: Employment at Condrometrics GmbH, Speakers bureau: Development of educational presentations for Medtronic

CLINICAL RADIOGRAPHIC FEATURES OF THE WRIST WITHOUT OSTEOARTHRITIS AND ITS RELATIONS TO AGE AND SEX IN JAPANESE

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 59-65
Author(s):  
Takeshi Katayama ◽  
Hiroshi Ono ◽  
Kazuhiko Furuta ◽  
Manabu Akahane ◽  
Shohei Omokawa
Keyword(s):  
Joint Space Width ◽  
Joint Space ◽  
Height Ratio ◽  
Men And Women ◽  
Radiographic Features ◽  
Radial Inclination ◽  
Age Related ◽  
The Difference ◽  
Space Width ◽  
Carpal Height

The purpose of this study was to identify a clinical radiographic features containing the measurements of carpal alignment, configuration, and joint space width of the wrist without osteoarthritis (OA) in Japanese. We also aimed to analyse age-related correlations in these parameters with reference to the difference between men and women. A total of 184 cases were analysed to establish the following relations: (1) Sex-related differences in the morphology and joint space width of the wrist without OA; (2) correlation coefficient between these parameters and age according to sex. This study suggests that carpal height ratio (CHR) was higher in men than in women. Also the ulnar variance (UV) increased and the radial inclination (RI) decreased with age in both men and women, and the volar tilt (VT) decreased with age in women.

scholarly journals Clinical Efficacy of a Single-dose of Platelet Rich Plasma in the Management of Early Knee Osteoarthritis: A Randomized Controlled Study With Mri Assessment and Evaluation of Optimal Dose

2020 ◽  
Author(s):  
Himanshu Bansal ◽  
Jerry Leon ◽  
Jeremy L. Pont ◽  
David A. Wilson ◽  
Sathya Meonah ST ◽  
...  
Keyword(s):  
Single Dose ◽  
Clinical Efficacy ◽  
Platelet Rich Plasma ◽  
Joint Space Width ◽  
Joint Space ◽  
Trial Registration ◽  
Controlled Study ◽  
Absolute Count ◽  
Knee Oa ◽  
Space Width

Abstract Background: Osteoarthritis (OA) causes substantial physical disability that limits a person's ability to indulge in daily activities. Non-steroidal anti-inflammatory drugs provide only minimal symptomatic benefit and are associated with mild to severe side effects, thus limiting its continuous use. This being the case, new alternate healing strategies with minimal adverse effects are being explored scientifically. In our study we have attempted to evaluate the clinical efficacy of a single dose of Platelet Rich Plasma (PRP) in treating osteoarthritis. Our primary objectives are:i) To optimise the correct dose of PRP preparation to achieve therapeutic relief in knee OAii) To identify the therapeutic efficacy of PRP in selected patients suffering from symptomatic primary knee OA through Randomized Clinical Trials and analyse the possible outcome using MRI analysis.Methods: A randomized, double-blind, 12-month, placebo-controlled study was conducted in 100 outpatients. PRP was prepared from the blood drawn from the subjects and administered intra-articularly guided by ultrasound. The degree of pain was assessed using WOMAC scores, the International Knee Documentation Committee score (IKDC) and six-minute pain free walking distance. The joint space width and articular cartilage thickness was evaluated through x-ray, ultrasonagraphy and MRI.Result: PRP with absolute count of approximately 100 billion platelets brings out significant therapeutic relief. The WOMAC scores showed reduction from 54.7 at baseline to 28.8 at one month, and 29.9 at 3 months showing efficacy of PRP over placebo. Improvement was evident in one month scores of IKDC tests (Baseline- 53.6; 1 month - 76.9) and VAS (Baseline - 5.8; 1 month - 2.46) followed by slight decline at 3, 6-month and one-year scores. Similarly, the pain-free distance covered during a 6-min walk was significantly improved at one month in both the groups (PRP-146 ft.; placebo-122 ft; p value <0.001). No change is seen on MRI and Joint space width.Conclusion: 7 times Concentration and absolute count of 100 billion platelets is crucial in a PRP formulation to be therapeutically effective in alleviating symptoms in moderate knee OA. The results indicate prevention of structural modification in the PRP group and better chondroprotective effects compared to placebo group.Trial Registration: This study has been registered in the US Clinical Trial Registry (U.S. National Library of Medicine) with Trial registration no. 04198467. Date of registration: December 13, 2019. (Retrospectively registered) URL - https://clinicaltrials.gov/ct2/show/NCT04198467?term=04198467&draw=2&rank=1

scholarly journals Association between current medication use and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative

Rheumatology ◽  
2021 ◽  
Author(s):  
Thomas A Perry ◽  
Xia Wang ◽  
Michael Nevitt ◽  
Christina Abdelshaheed ◽  
Nigel Arden ◽  
...  
Keyword(s):  
Reference Group ◽  
Medication Use ◽  
Joint Space Width ◽  
Joint Space ◽  
Knee Oa ◽  
Current Medication ◽  
History Of ◽  
Osteoarthritis Initiative ◽  
Space Width

Abstract Objective Use of specific medications may accelerate the progression of radiographic knee OA (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA. Methods We used longitudinal data from the Osteoarthritis Initiative (OAI), an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (Kellgren–Lawrence grade ≥2) and excluded those with a history of knee-related injury/surgery and other musculoskeletal disorders. Current medication use (use/non-use in the previous 30 days) and radiographic medial minimum joint space width (mJSW) data were available at baseline and annually up to 96 months follow-up. We used random effects, panel regression to assess the association between current medication use (non-users as reference group) and change in mJSW. Results Of 2054 eligible participants, 2003 participants with baseline mJSW data were included [55.7% female, mean age 63.3 (s.d. 8.98) years]. Of seven medication classes, at baseline NSAIDs were the most frequently used analgesia (14.7%), anti-histamine (10.4%) use was frequent and the following comorbidity medications were used most frequently: statins (27.4%), anti-hypertensives (up to 15.0%), anti-depressant/anxiolytics/psychotropics (14.0%), osteoporosis-related medication (10.9%) and diabetes-related medication (6.9%). Compared with current non-users, current use of NSAIDs was associated with a loss of mJSW (b = −0.042, 95% CI −0.08, −0.0004). No other associations were observed. Conclusions In current users of NSAIDs, mJSW loss was increased compared with current non-users in participants with RKOA. Clinical trials are required to assess the potential disease-modifying effects of these medications.

scholarly journals Identification of early response to hypertonic dextrose prolotherapy markers in knee osteoarthritis patients by an inflammation-related cytokine array

2020 ◽  
Author(s):  
Hsing-Chun Kuo ◽  
Po-Jung Pan ◽  
Jia-Chi Wang ◽  
Chih-Chun Tsai
Keyword(s):  
Synovial Fluid ◽  
Knee Joint ◽  
Protein Expression ◽  
Joint Space Width ◽  
Joint Space ◽  
Knee Oa ◽  
Womac Index ◽  
Minimum Joint Space Width ◽  
Space Width ◽  
Hypertonic Dextrose

Abstract BACKGROUND/AIMOsteoarthritis (OA) is one of the most common forms of arthritis, and hypertonic dextrose prolotherapy has long been used clinically to treat knee OA. The aim of this study was to investigate the inflammation-related protein-expression profile characterizing the efficacy of the hypertonic dextrose prolotherapy in knee OA as prognostic markers.METHODSOA patients over the age of 65 were recruited for Western Ontario McMaster University Osteoarthritis (WOMAC) index, knee X ray evaluation and knee joint synovial fluid analysis before and after hypertonic dextrose prolotherapy. The expressions of inflammation-related factors were measured using a novel cytokine antibody array methodology. The cytokine levels were quantified by quantitative protein expression and analyzed by ELISA using the patients’ knee-joint synovial fluid. The WOMAC Index and minimum joint space width prior to receiving the intra-articular injection and at 2-week intervals were compared.RESULTS12 patients who received OA intervention were enrolled and finally a clinical evaluation of 12 knee joints and knee synovial fluid samples were analyzed. In this study, after receiving hypertonic dextrose prolotherapy, the OA patients clearly demonstrated a significant improvement in WOMAC index and increasing tendency in the medial minimum joint space width after intervention. Meanwhile, we observed a significantly associated tendency between the high-glucose treatment of knee OA and the upregulation of MMP2, TIMP-1, EGF, CXCL9 and IL-22. These findings provide knee OA patients receiving hypertonic dextrose prolotherapy, which accompanying with the improvement of knee pain, stiffness, and function and increasing tendency in the medial minimum joint space width.

scholarly journals Are Stem Cells Derived from Synovium and Fat Pad Able to Treat Induced Knee Osteoarthritis in Rats?

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Reza Zare ◽  
Nader Tanideh ◽  
Behrooz Nikahval ◽  
Maryam Sadat Mirtalebi ◽  
Nasrollah Ahmadi ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Synovial Membrane ◽  
Joint Space Width ◽  
Specific Treatment ◽  
Joint Space ◽  
Treated Group ◽  
Male Rats ◽  
Fat Pad ◽  
Space Width

Background. Osteoarthritis (OA) is a chronic disease and a significant cause of joint pain, tenderness, and limitation of motion. At present, no specific treatment is available, and mesenchymal stem cells (MSCs) have shown promising potentials in this regard. Herein, we aimed to evaluate the repairing potentials of stem cells derived from the synovium and fat pad in the treatment of OA. Methods. Twenty-eight male rats (220±20 g, aged 10-12 weeks), were randomly divided into four groups (n=7): C1: nontreated group, C2: Hyalgan-treated group, E1: adipose tissue-derived stem cell-treated group, and E2: synovial membrane-based stem cell-treated group. Collagenase type II was injected into the left knee; after eight weeks, OA was developed. Then, stem cells were injected, and rats were followed for three months. Afterward, specimens and radiological images were investigated. p value ≤ 0.05 was set as statistically significant. Results. Compared to the C1 group, the E1 and E2 groups showed significantly better results in all six pathological criteria as well as joint space width and osteophytes of medial tibial, medial femoral, and medial fabellar condyles (p≤0.001). Similarly, compared to the C2 group, the E1 and E2 groups had better scores regarding surface, matrix, cell distribution, and cell population viability (p<0.05). E2 showed considerably higher scores compared to C2 regarding subchondral bone and cartilage mineralization (p<0.05). The joint space width was similar between the C2 and E groups. Conclusion. Treatment of OA with MSCs, particularly synovial membrane-derived stem cells, not only prevented but also healed OA of the knee to some extent in comparison to the Hyalgan and nontreatment groups.

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