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Groupings of coexisting MRI lesions of the tibiofemoral and patellofemoral joints were linked to the risk of subsequent radiographic osteoarthritis, investigators reported. Their analysis of data from the prospective, observational MOST study was published online Sept. 28 in Arthritis and Rheumatism.
“The magnitude of lesions such as cartilage damage and coexisting meniscal damage appear to be the main distinction between the subgroups,” said Dr. Jingbo Niu of Boston University and her associates. Several studies have linked individual MRI lesions with incident knee OA, but patterns of coexisting lesions more accurately reflect real-world injuries, such as anterior cruciate ligament tears, which tend to affect more than one knee structure, the investigators noted.
Because directly comparing lesions in a multivariate model does not account for chronology, the investigators used latent class analysis to identify subgroups of coexisting MRI lesions of the tibiofemoral and patellofemoral joints, such as cartilage damage, meniscal tear, meniscal extrusion, synovitis, and effusion. Then they modeled associations between these subgroups and incident OA of the knee (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.3943).
Among 885 knees from the MOST study, 203 developed radiographic tibiofemoral OA and 64 developed patellofemoral OA after up to 84 months of follow-up, the researchers reported. Latent class analysis identified four groups of MRI lesions for each knee joint, which exhibited sequentially increasing baseline severity for all MRI features except meniscal damage, the investigators added.
For the patellofemoral joint, the odds of incident knee OA rose sequentially with increasing MRI severity, ranging from 1.0 for minimal lesions to 13.7 for severe lesions (95% confidence interval, 5.0-37.0), according to the study. In contrast, the odds of incident knee radiographic OA (ROA) of the tibiofemoral joint were highest for the “mild” and “severe” groups, which had the most meniscal damage and the most extensive history of knee injury and surgery. Odds ratios for these two groups were 5.6 (95% CI, 3.4-9.4) and 5.0 (95% CI, 2.8-9.0), respectively, said the researchers. “Meniscal damage might play a prominent role in the development of incident ROA in the tibiofemoral joint but not the patellofemoral joint,” they added.
Patients in the MOST study had a high risk of knee OA at baseline, which could limit the generalizability of the findings, Dr. Niu and her associates noted.
The National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Disease, both a part of the National Institutes of Health, supported the study. The investigators did not report conflicts of interest.
It was not until recently that the osteoarthritis community directed a shift toward new ways of halting joint damage rather than the palliative approach of analgesics followed by joint replacement. However, the sequential failures of novel disease-modifying therapies attempting to target diverse pathogenic mechanisms have highlighted the need to target early disease and to better identify and target distinct disease phenotypes. In this light of recent efforts to uncover the various mechanisms leading to joint deterioration, Niu et al. have used a novel approach to detect distinct clusters of multiple joint abnormalities on MRI at the preradiographic stage. They also examined the association between each cluster and the risk of radiographic OA during follow-up.
Probably the most important [conclusion from this study] is that it is possible to identify distinct phenotypes of joint damage as early as at the preradiographic phase. Consequently, it is intuitive that alternative pathways caused by various risk factors exist and play diverse roles in the process of joint destruction. Phenotyping patients in regards to their genetic profile, serologic, and MRI markers, demographic features, metabolic status, etc., is promising and probably the best solution to achieve improvements in the way we are treating OA patients.
The use of these results to assess prognosis seems premature in clinical research and inappropriate in the clinical setting. Nevertheless, the latent class analysis is an attractive approach in the field of OA and can aid in unraveling the pathogenesis of this enigmatic disease.
Dr. Leticia A. Deveza and Dr. David J. Hunter are with the department of rheumatology at the University of Sydney. They declared no conflicts of interest. These comments are from their accompanying editorial (Arthritis Rheum. 2015 Sep 28 doi: 10.1002/art.39439).
It was not until recently that the osteoarthritis community directed a shift toward new ways of halting joint damage rather than the palliative approach of analgesics followed by joint replacement. However, the sequential failures of novel disease-modifying therapies attempting to target diverse pathogenic mechanisms have highlighted the need to target early disease and to better identify and target distinct disease phenotypes. In this light of recent efforts to uncover the various mechanisms leading to joint deterioration, Niu et al. have used a novel approach to detect distinct clusters of multiple joint abnormalities on MRI at the preradiographic stage. They also examined the association between each cluster and the risk of radiographic OA during follow-up.
Probably the most important [conclusion from this study] is that it is possible to identify distinct phenotypes of joint damage as early as at the preradiographic phase. Consequently, it is intuitive that alternative pathways caused by various risk factors exist and play diverse roles in the process of joint destruction. Phenotyping patients in regards to their genetic profile, serologic, and MRI markers, demographic features, metabolic status, etc., is promising and probably the best solution to achieve improvements in the way we are treating OA patients.
The use of these results to assess prognosis seems premature in clinical research and inappropriate in the clinical setting. Nevertheless, the latent class analysis is an attractive approach in the field of OA and can aid in unraveling the pathogenesis of this enigmatic disease.
Dr. Leticia A. Deveza and Dr. David J. Hunter are with the department of rheumatology at the University of Sydney. They declared no conflicts of interest. These comments are from their accompanying editorial (Arthritis Rheum. 2015 Sep 28 doi: 10.1002/art.39439).
It was not until recently that the osteoarthritis community directed a shift toward new ways of halting joint damage rather than the palliative approach of analgesics followed by joint replacement. However, the sequential failures of novel disease-modifying therapies attempting to target diverse pathogenic mechanisms have highlighted the need to target early disease and to better identify and target distinct disease phenotypes. In this light of recent efforts to uncover the various mechanisms leading to joint deterioration, Niu et al. have used a novel approach to detect distinct clusters of multiple joint abnormalities on MRI at the preradiographic stage. They also examined the association between each cluster and the risk of radiographic OA during follow-up.
Probably the most important [conclusion from this study] is that it is possible to identify distinct phenotypes of joint damage as early as at the preradiographic phase. Consequently, it is intuitive that alternative pathways caused by various risk factors exist and play diverse roles in the process of joint destruction. Phenotyping patients in regards to their genetic profile, serologic, and MRI markers, demographic features, metabolic status, etc., is promising and probably the best solution to achieve improvements in the way we are treating OA patients.
The use of these results to assess prognosis seems premature in clinical research and inappropriate in the clinical setting. Nevertheless, the latent class analysis is an attractive approach in the field of OA and can aid in unraveling the pathogenesis of this enigmatic disease.
Dr. Leticia A. Deveza and Dr. David J. Hunter are with the department of rheumatology at the University of Sydney. They declared no conflicts of interest. These comments are from their accompanying editorial (Arthritis Rheum. 2015 Sep 28 doi: 10.1002/art.39439).
Groupings of coexisting MRI lesions of the tibiofemoral and patellofemoral joints were linked to the risk of subsequent radiographic osteoarthritis, investigators reported. Their analysis of data from the prospective, observational MOST study was published online Sept. 28 in Arthritis and Rheumatism.
“The magnitude of lesions such as cartilage damage and coexisting meniscal damage appear to be the main distinction between the subgroups,” said Dr. Jingbo Niu of Boston University and her associates. Several studies have linked individual MRI lesions with incident knee OA, but patterns of coexisting lesions more accurately reflect real-world injuries, such as anterior cruciate ligament tears, which tend to affect more than one knee structure, the investigators noted.
Because directly comparing lesions in a multivariate model does not account for chronology, the investigators used latent class analysis to identify subgroups of coexisting MRI lesions of the tibiofemoral and patellofemoral joints, such as cartilage damage, meniscal tear, meniscal extrusion, synovitis, and effusion. Then they modeled associations between these subgroups and incident OA of the knee (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.3943).
Among 885 knees from the MOST study, 203 developed radiographic tibiofemoral OA and 64 developed patellofemoral OA after up to 84 months of follow-up, the researchers reported. Latent class analysis identified four groups of MRI lesions for each knee joint, which exhibited sequentially increasing baseline severity for all MRI features except meniscal damage, the investigators added.
For the patellofemoral joint, the odds of incident knee OA rose sequentially with increasing MRI severity, ranging from 1.0 for minimal lesions to 13.7 for severe lesions (95% confidence interval, 5.0-37.0), according to the study. In contrast, the odds of incident knee radiographic OA (ROA) of the tibiofemoral joint were highest for the “mild” and “severe” groups, which had the most meniscal damage and the most extensive history of knee injury and surgery. Odds ratios for these two groups were 5.6 (95% CI, 3.4-9.4) and 5.0 (95% CI, 2.8-9.0), respectively, said the researchers. “Meniscal damage might play a prominent role in the development of incident ROA in the tibiofemoral joint but not the patellofemoral joint,” they added.
Patients in the MOST study had a high risk of knee OA at baseline, which could limit the generalizability of the findings, Dr. Niu and her associates noted.
The National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Disease, both a part of the National Institutes of Health, supported the study. The investigators did not report conflicts of interest.
Groupings of coexisting MRI lesions of the tibiofemoral and patellofemoral joints were linked to the risk of subsequent radiographic osteoarthritis, investigators reported. Their analysis of data from the prospective, observational MOST study was published online Sept. 28 in Arthritis and Rheumatism.
“The magnitude of lesions such as cartilage damage and coexisting meniscal damage appear to be the main distinction between the subgroups,” said Dr. Jingbo Niu of Boston University and her associates. Several studies have linked individual MRI lesions with incident knee OA, but patterns of coexisting lesions more accurately reflect real-world injuries, such as anterior cruciate ligament tears, which tend to affect more than one knee structure, the investigators noted.
Because directly comparing lesions in a multivariate model does not account for chronology, the investigators used latent class analysis to identify subgroups of coexisting MRI lesions of the tibiofemoral and patellofemoral joints, such as cartilage damage, meniscal tear, meniscal extrusion, synovitis, and effusion. Then they modeled associations between these subgroups and incident OA of the knee (Arthritis Rheum. 2015 Sep 28. doi: 10.1002/art.3943).
Among 885 knees from the MOST study, 203 developed radiographic tibiofemoral OA and 64 developed patellofemoral OA after up to 84 months of follow-up, the researchers reported. Latent class analysis identified four groups of MRI lesions for each knee joint, which exhibited sequentially increasing baseline severity for all MRI features except meniscal damage, the investigators added.
For the patellofemoral joint, the odds of incident knee OA rose sequentially with increasing MRI severity, ranging from 1.0 for minimal lesions to 13.7 for severe lesions (95% confidence interval, 5.0-37.0), according to the study. In contrast, the odds of incident knee radiographic OA (ROA) of the tibiofemoral joint were highest for the “mild” and “severe” groups, which had the most meniscal damage and the most extensive history of knee injury and surgery. Odds ratios for these two groups were 5.6 (95% CI, 3.4-9.4) and 5.0 (95% CI, 2.8-9.0), respectively, said the researchers. “Meniscal damage might play a prominent role in the development of incident ROA in the tibiofemoral joint but not the patellofemoral joint,” they added.
Patients in the MOST study had a high risk of knee OA at baseline, which could limit the generalizability of the findings, Dr. Niu and her associates noted.
The National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Disease, both a part of the National Institutes of Health, supported the study. The investigators did not report conflicts of interest.
FROM ARTHRITIS & RHEUMATISM
Key clinical point: Phenotypes of MRI lesions of the tibiofemoral and patellofemoral joints were differentially associated with risk of incident radiographic osteoarthritis.
Major finding: An MRI of the tibiofemoral and patellofemoral joints revealed minimal, mild, moderate, and severe lesions, with corresponding changes in the odds of incident OA.
Data source: Analysis of cohort data for 885 knees from the multicenter, prospective, observational MOST study.
Disclosures: The National Institute on Aging and National Institute of Arthritis and Musculoskeletal and Skin Disease, both a part of the National Institutes of Health, supported the study. The investigators did not report conflicts of interest.
