Self-reported data on swelling and morning stiffness showed comparable efficacy to MRI in predicting incident radiographic knee osteoarthritis, according to findings presented here.
Healio May 4, 2019
TORONTO — “There is relevant inflammation on MRI in the OA process,” Jos Runhaar PhD, of the department of general practice at Erasmus University Medical Center in Rotterdam, Netherlands, said. “We see that inflammation is related to the incidence of radiographic OA, and progression of both radiographic and symptomatic knee arthritis.”
However, Runhaar noted that MRI remains an expensive measure. “Also, if we want to use MRI for prediction, we are not quite sure how well it predicts,” he said. “We are not quite sure if it is better than some patient-reported measures that you can use for inflammation.”
To evaluate the predictive value of MRI-assessed vs. patient-reported knee OA in a cohort of 407 high-risk women, Runhaar and colleagues assessed inflammation observed on MRI using the MOAKS scoring system. The other measures of inflammation included effusion synovitis of grade 1 or higher, or HOFFA synovitis of grade 1 or higher.
For the survey component of the study, participants answered questions from the KOOS questionnaire about swelling, inflammation and morning stiffness. Eligible participants were free of knee complaints or radiographic evidence of knee OA at baseline.
The initial follow-up period was 2.5 years, and then the researchers followed patients for another 4 years after that. The final cohort included women aged 55 years with a BMI of 31. Baseline data showed that inflammation was reported in 15%, while swelling was reported in 12% and morning stiffness in 14%.
According to study results, at 2.5 years, clinical OA occurred in 7% of the cohort, while radiographic OA — defined as a KL score of 2 or higher — occurred in 5% of patients. “We saw that inflammation on MRI was associated to the morning stiffness,” Runhaar said. He added that patient-reported swelling also carried an association with inflammation on MRI.
By 6.5 years, the rates of inflammation were 12% for clinical OA and 16% for radiographic OA. Runhaar noted that the association between inflammation and morning stiffness persisted through this time point.
Pre-study probability estimates showed that one out of 14 knees were likely to develop incident clinical OA after 2.5 years, according to Runhaar.
At 2.5 years, results showed that clinical inflammation occurred in one out of 12 knees, while swelling occurred in one out of nine knees and morning stiffness occurred in one in six.
Can we use synovitis-related clinical questions instead of synovitis on mri to predict incident knee OA? M. L. Landsmeer,1 J. Runhaar,1 M. van Middelkoop,1 P. van der Plas,2 D. Vroegindeweij,3 E. H. Oei1, P. J. Bindels,1 S. M. Bierma-Zeinstra,1 1. Erasmus MC, Univ. Med. Ctr. Rotterdam, Rotterdam, Netherlands, 2. Spijkenisse Med. Ctr., Spijkenisse, Netherlands, 3. Maasstad Hosp., Rotterdam, Netherlands. Abstract #44. OARSI 2019 World Congress on Osteoarthritis May 2-5. Toronto, Canada
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