We are the first to report different possible lumbar disc degeneration definitions and their associations with LBP. Disc space narrowing at 2 or more levels appeared more strongly associated with LBP than other radiographic features, especially after excluding level L5-S1.

BackgroundGPs have high consultation rates for symptoms related to knee osteoarthritis (OA). Many risk factors for symptomatic knee OA progression remain unknown. AimTo define distinct knee pain trajectories in individuals with early symptomatic knee OA and determine the risk factors for these pain trajectories. Design and settingData were obtained from the multicentre prospective Cohort Hip and Cohort Knee study in the Netherlands. Participants with knee OA, according to the clinical criteria of the American College of Rheumatology, and a completed 5-year follow-up were included. MethodBaseline demographic, anamnestic, and physical examination characteristics were assessed. Outcome was annually assessed by the Numeric Rating Scale for pain. Pain trajectories were retrieved by latent class growth analysis. Multinomial logistic regression was used to calculate relative risk ratios. ResultsIn total, 705 participants were included. Six distinct pain trajectories were identified with favourable and unfavourable courses. Statistically significant differences were found in baseline characteristics, including body mass index (BMI), symptom severity, and pain coping strategies between the different trajectories. Higher BMI, lower level of education, greater comorbidity, higher activity limitation scores, and joint space tenderness were more often associated with trajectories characterised by more pain at first presentation and pain progression -compared with the reference group with a mild pain trajectory. No association was found for baseline radiographic features. ConclusionThese results can help differentiate those patients who require more specific monitoring in the management of early symptomatic knee OA from those for whom a 'wait-and-see' policy seems justifiable. Radiography provided no additional benefit over clinical diagnosis of early symptomatic knee OA in general practice.Keywords disease progression; knee osteoarthritis; knee pain; pain trajectories; primary health care.e32 British Journal of General Practice, January 2016• aged 45-65 years; and• never consulted a physician for these symptoms, or had done so <6 months prior to recruitment to the study.Participants were excluded from the CHECK study if they had:• other pathological conditions that could explain the existing complaints (for example, other rheumatic disease, previous hip or knee joint replacement, congenital dysplasia, osteochondritis dissecans, intraarticular fractures, septic arthritis, Perthes disease, ligament or meniscus injury, plica syndrome, Baker's cyst);• comorbidity that would not allow physical evaluation during 10 years' follow-up;• malignancy in the past 5 years; and• inability to understand Dutch.For the analyses of the current study participants were included if, at baseline, they:• reported knee pain; and• were considered to have knee OA according to the clinical criteria of the American College of Rheumatology. 4,11If a participant had two affected knees, the knee with the worse score based on pain, Kellgren-Lawrenc...

These results suggest that OA is more likely to start in the patellofemoral joint and then progress to COA in individuals with symptoms of early knee OA. No differences in TFOA and PFOA phenotypes were determined with respect to signs and symptoms.

BackgroundWe aimed to evaluate the prevalence of hip and knee osteoarthritis (HOA and KOA) according to American College of Rheumatology (ACR) criteria among participants with suspected early symptomatic osteoarthritis (OA) in the CHECK cohort. We also assessed whether participants not fulfilling ACR criteria at baseline develop ACR-defined OA at 2-year and/or 5-year follow up, and which baseline factors are associated with this development.MethodsThe CHECK cohort included 1002 subjects with first presentation of knee and/or hip complaints. The primary outcome was onset of HOA and/or KOA according to the ACR criteria, including the clinical classification criteria and the combined clinical and radiographic classification criteria at 2-year and/or 5-year follow up.ResultsOf the participants with hip complaints, 63% (n = 370) were classified as having HOA at baseline according to the ACR criteria. Of those not classified with HOA at baseline, 40% developed HOA according to the clinical or combined clinical/radiographic ACR criteria after 2 and/or 5 years. Up to 92% of participants (n = 829) with knee complaints were classified as having KOA at baseline; of those not classified with KOA at baseline, 55% developed KOA according to the clinical ACR criteria or the clinical/radiographic ACR criteria after 2 and/or 5 years. The following factors were associated with development of HOA: morning stiffness (OR 2.39; 95% CI 1.14–4.98), painful internal rotation (OR 2.53; 95% CI 1.23–5.19), hip flexion < 115° (OR 2.33; 95% CI 1.17–4.64) and erythrocyte sedimentation rate (ESR) < 20 mm/h (OR 2.94; 95% CI 1.13–7.61). No variables were associated with development of KOA at 2-year and/or 5-year follow up.ConclusionsA large proportion of persons with hip complaints not fulfilling the ACR criteria at baseline develop HOA after 2 and/or 5 years of follow up. Almost all persons with knee complaints already fulfill the clinical and/or radiographic ACR criteria for OA, and half of the persons not fulfilling criteria at baseline will do so after 5 years of follow up. Several individual ACR criteria for HOA at baseline were associated with the development of HOA at follow up. This association was not proven for KOA, probably because of the small number of subjects developing KOA in this study.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1785-7) contains supplementary material, which is available to authorized users.