Journal Article

Early pre-radiographic structural pathology precedes the onset of accelerated knee osteoarthritis

McAlindon, Timothy E., Driban, Jeffrey B., Price, Lori Lyn, Barbe, Mary F., MacKay, James W., Ward, Robert J., Davis, Julie E., Eaton, Charles B., Lo, Grace H., Pang, Jincheng, Harkey, Matthew S., Lu, Bing, Stout, Alina C., Zhang, Ming

2019

Overview

Background Accelerated knee osteoarthritis (AKOA) is characterized by more pain, impaired physical function, and greater likelihood to receive a joint replacement compared to individuals who develop the typical gradual onset of disease. Prognostic tools are needed to determine which structural pathologies precede the development of AKOA compared to individuals without AKOA. Therefore, the purpose of this manuscript was to determine which pre-radiographic structural features precede the development of AKOA. Methods The sample comprised participants in the Osteoarthritis Initiative (OAI) who had at least one radiographically normal knee at baseline (Kellgren-Lawrence [KL] grade  <  1). Participants were classified into 2 groups based on radiographic progression from baseline to 48 months: AKOA (KL grade change from <  1 to >  3) and No AKOA. The index visit was the study visit when participants met criteria for AKOA or a matched timepoint for those who did not develop AKOA. Magnetic resonance (MR) images were assessed for 12 structural features at the OAI baseline, and 1 and 2 years prior to the index visit. Separate logistic regression models (i.e. OAI baseline, 1 and 2 years prior) were used to determine which pre-radiographic structural features were more likely to antedate the development of AKOA compared to individuals not developing AKOA. Results At the OAI baseline visit, degenerative cruciate ligaments (Odds Ratio [OR] = 2.2, 95% Confidence Interval [CI] = 1.3,3.5), infrapatellar fat pad signal intensity alteration (OR = 2.0, 95%CI = 1.2,3.2), medial/lateral meniscal pathology (OR = 2.1/2.4, 95%CI = 1.3,3.4/1.5,3.8), and greater quantitative knee effusion-synovitis (OR = 2.2, 95%CI = 1.4,3.4) were more likely to antedate the development of AKOA when compared to those that did not develop AKOA. These results were similar at one and two years prior to disease onset. Additionally, medial meniscus extrusion at one year prior to disease onset (OR = 3.5, 95%CI = 2.1,6.0) increased the likelihood of developing AKOA. Conclusions Early ligamentous degeneration, effusion/synovitis, and meniscal pathology precede the onset of AKOA and may be prognostic biomarkers.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Anterior Cruciate Ligament - diagnostic imaging / Anterior Cruciate Ligament - pathology / Arthritis / Bone marrow / Bone marrow lesion / Cartilage / Degeneration / Disease Progression / Effusion / Effusion-synovitis / Epidemiology / Female / Humans / Injuries / Internal Medicine / Knee / Ligament / Ligaments / Longitudinal Studies / Magnetic Resonance Imaging / Male / Medicine / Medicine & Public Health / Menisci, Tibial - diagnostic imaging / Menisci, Tibial - pathology / Meniscus / Middle Aged / Musculoskeletal diseases / NMR / Nuclear magnetic resonance / Orthopedics / Osteoarthritis / Osteoarthritis - from basic and translational approaches to clinical practice / Osteoarthritis, Knee - diagnosis / Osteoarthritis, Knee - pathology / Pain / Pathophysiology of musculoskeletal disorders / Posterior Cruciate Ligament - diagnostic imaging / Posterior Cruciate Ligament - pathology / Prognosis / Regression analysis / Rehabilitation / Research Article / Rheumatology / Risk Factors / Sports Medicine / Studies / Synovitis / Synovitis - diagnostic imaging / Synovitis - pathology / Tendons / Time Factors