Defining radiographic osteoarthritis for the whole knee

Felson, David T.; McAlindon, Timothy E.; Anderson, Jennifer J.; Weissman, Barbara; Aliabadi, Piran; Evans, Stephen; Levy, Daniel; LaValley, Michael P.

doi:10.1016/s1063-4584(97)80020-9

Cited by 147 publications

(140 citation statements)

References 4 publications

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“…I considered JSN grade 1 and a single grade 1 osteophyte within the same compartment as a suffi cient criterion, consistent with K/L grade ~2. In addition, a sum osteophyte compartment score ≥ 2 in the absence of JSN was defi ned as radiographic OA, which is consistent with previous suggestions (Spector et al 1993, Felson et al 1997a). Thus, I have slightly adjusted the criteria for radiographic OA compared with previous studies from the department (Roos H et al 1998.…”

Section: Oa Scoringsupporting

confidence: 80%

“…These features can thus be studied independently. However, an OA defi nition incorporating both JSN and osteophytes has been proven to offer the most precise estimation of the association of risk factors with disease worsening and clinical OA (Felson et al 1997a, LaValley et al 2001. This was verifi ed in the present work (Paper II).…”

Section: Short-form 36-item Health Surveysupporting

confidence: 65%

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Meniscal tear - a feature of osteoarthritis

Englund¹

2004

SORT

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Meniscectomy is recognized as an important risk factor for the development of knee osteoarthritis (OA), a disease that traditionally has been considered as a simple "wear and tear" phenomenon. However, despite numerous reports, little evidence has been presented that a limited meniscal resection, compared with a more extensive resection, reduces the risk of OA by preserving meniscal function. Why? This thesis provides one possible answer to that question.Patients, who had undergone isolated meniscal resection in 1973, 1978, or between 1983 and 1985 at Lund University Hospital, Sweden, were reviewed clinically and radiographically 15-22 years after the surgical procedure.Of the subjects (n = 317) almost 50% had developed radiographic OA in their operated knee, but just over half of these patients were symptomatic. An additional 20% of the patients had knee symptoms, but did not have radiographic knee OA. These results confi rm a limited correlation between radiographic features of the disorder and symptoms.A degenerative type of meniscal tear and obesity were the factors most strongly associated with both radiographic knee OA and symptomatic radiographic knee OA.Partial meniscal resection induced less radiographic changes related to knee OA compared with total meniscectomy, but the patient-relevant outcomes remained essentially the same.If radiographic hand OA was present there was an increased likelihood of the patient also having knee OA following meniscectomy. This fi nding was independent of age, and therefore an inherited susceptibility to the disease contributes to the risk of knee OA after meniscal tear. Genetic and environmental risk factors interact in OA development.A degenerative meniscal lesion is often associated with early-stage knee OA, a disorder also involving the meniscal tissue. The tear may thus represent the fi rst "signal" feature of OA. The challenge for the health professional is to discriminate between symptoms caused by a meniscal tear and those caused by OA. Meniscal resection may not benefi t the patient with early-stage knee OA. The intervention merely removes evidence of the disorder, while the OA joint degradation proceeds.

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Section: Oa Scoringsupporting

confidence: 80%

Section: Short-form 36-item Health Surveysupporting

confidence: 65%

Meniscal tear - a feature of osteoarthritis

Englund¹

2004

SORT

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“…A single bone and joint radiologist (PA), who is the reader for the Framingham OA Study, read all knee films, including the AP and skyline views, using the Kellgren/Lawrence (K/L) scale (15) and by identifying individual radiographic features of OA. Joint space narrowing (JSN) on the AP view was read in the medial and lateral compartments and scored on a 0-3 scale using the Osteoarthritis Research Society International Atlas (16). The weighted kappa for the K/L grade (scale 0-4) for intrareader reliability was 0.79 (95% confidence interval [95% CI] 0.73-0.84).…”

Section: Methodsmentioning

confidence: 99%

“…Lateral OA in the tibiofemoral joint was also defined as a K/L grade of Ն2 and lateral JSN score of Ն1. For the skyline view, we adopted the scoring criteria previously described by one of the authors (DTF) and his colleagues (16). Briefly, individual radiographic features and overall grades of OA in the patellofemoral compartment on the skyline view were read according to the following schemes: osteophytes on a 0-3 scale, JSN on a 0-3 scale, sclerosis on a 0-3 scale, and cysts as present or absent.…”

Section: Methodsmentioning

confidence: 99%

Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: The Beijing Osteoarthritis Study

Hunter¹,

Nevitt²,

Xu³

et al. 2004

Arthritis & Rheumatism

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118

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Objective. To examine the association between squatting, a common daily posture in China, and the prevalence of radiographic osteoarthritis (OA) in different knee compartments among Chinese subjects from Beijing, and to estimate how much of the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in Framingham, Massachusetts is accounted for by the impact of squatting.Methods. We recruited a random sample of Beijing residents age >60 years. Subjects answered questions on joint symptoms, and knee radiographs were obtained. Subjects were also asked to recall the average amount of time spent squatting each day at age 25 years. Radiographic films (weight-bearing anteroposterior and skyline views) were read for Kellgren/Lawrence (K/L) grade and individual radiographic features. Medial disease was defined when radiographs showed a K/L grade of >2 at the tibiofemoral joint and a medial joint space narrowing score of >1, and lateral disease was assessed in a comparable manner in the lateral compartments. We examined the association of squatting with the prevalence of tibiofemoral OA as well as with the prevalence of patellofemoral knee OA, while adjusting for age and other potential confounding factors. We used the same approach to assess the relationship between squatting and tibiofemoral OA in the medial compartment and in the lateral compartment. Finally, we estimated the impact of squatting at age 25 on the difference in prevalence of knee OA between Chinese subjects in Beijing and white subjects in the Framingham OA Study.Results. Squatting was very common among the Chinese subjects: ϳ40% of men and ϳ68% of women reported squatting >1 hour per day at age 25. The prevalence of tibiofemoral OA increased as the time spent squatting at age 25 increased in both the men and the women. Compared with subjects who squatted <30 minutes per day at age 25, the multivariable-adjusted prevalence odds ratios of tibiofemoral OA were 1.1 for time spent squatting of 30-59 minutes/day, 1.0 for 60-119 minutes/day, 1.7 for 120-179 minutes/day, and 2.0 for >120 minutes/day among the men (P for trend ‫؍‬ 0.074), and the respective odds ratios among the women were 1.4, 1.3, 1.2, and 2.4 (P for trend ‫؍‬ 0.077). A weaker association with patellofemoral OA was found. Prolonged squatting in daily life was more strongly associated with medial knee OA than with lateral disease in the men, but had a similar effect on both knee compartments in the women. After adjusting for the impact of squatting, the age-adjusted difference in prevalence of tibiofemoral OA was reduced from an excess of 14.4% to 9.5% in the Chinese women, but the difference in prevalence of tibiofemoral OA in the Chinese men increased after adjustment for age and squatting, from 2.9% lower to 7.0% lower as compared with their white counterparts.Conclusion. Prolonged squatting is a strong risk factor for tibiofemoral knee OA among elderly Chinese subjects in Beijing, and accounts for a substantial Supported by NIH grants AR-43873 and AR-47785.

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“…Each distal interphalangeal, proximal interphalangeal, metacarpophalangeal, interphalangeal, carpometacarpophalangeal, wrist, and knee joint was graded using the Framingham OA atlas for Kellgren/Lawrence (K/L) grade (0-4), largest osteophyte (grade 0-3), and joint space narrowing (JSN) (grade 0-3) (28,29). All radiographs were read in a blinded manner by a board-certified musculoskeletal radiologist.…”

Section: Radiographsmentioning

confidence: 99%

Low vitamin K status is associated with osteoarthritis in the hand and knee

Neogi

Booth

Zhang

et al. 2006

Arthritis & Rheumatism

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146

101

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Objective. Poor intake of vitamin K is common. Insufficient vitamin K can result in abnormal cartilage and bone mineralization. Furthermore, osteophyte growth, seen in osteoarthritis (OA), may be a vitamin K-dependent process. We undertook this study to determine whether vitamin K deficiency is associated with radiographic features of OA.Methods. We conducted an analysis among 672 participants (mean age 65.6 years, 358 women) in the Framingham Offspring Study, a population-based prospective observational cohort. Levels of plasma phylloquinone (the primary form of vitamin K) had previously been measured in these participants, for whom we also had bilateral hand and knee radiographs. The main outcomes were 1) prevalence ratios (PRs) of OA, osteophytes, and joint space narrowing (JSN) per quartile of plasma phylloquinone level for each joint, adjusting for correlated joints using generalized estimating equations, and 2) adjusted mean number of joints with each feature per quartile of plasma phylloquinone level. Analyses were conducted in hands and knees separately and adjusted for age, sex, body mass index, total energy intake, plasma vitamin D, and femoral neck bone mineral density.Results. The PRs for OA, osteophytes, and JSN and adjusted mean number of joints with all 3 features in the hand decreased significantly with increasing plasma phylloquinone levels (P < 0.03 for all). For example, as plasma phylloquinone levels rose, the PR for hand OA decreased from 1.0 to 0.7 (P ‫؍‬ 0.005). For the knee, only the PR for osteophytes and the adjusted mean number of knee joints with osteophytes decreased significantly with increasing plasma phylloquinone levels (PR decreased from 1.0 to 0.6, P ‫؍‬ 0.01).Conclusion. These observational data support the hypothesis of an association between low plasma levels of vitamin K and increased prevalence of OA manifestations in the hand and knee.

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Defining radiographic osteoarthritis for the whole knee

Cited by 147 publications

References 4 publications

Meniscal tear - a feature of osteoarthritis

Meniscal tear - a feature of osteoarthritis

Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: The Beijing Osteoarthritis Study

Low vitamin K status is associated with osteoarthritis in the hand and knee

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