Early knee osteoarthritis prevalence is highest among middle-aged adult females with obesity based on new set of diagnostic criteria from a large sample cohort study in the Japanese general population

Sasaki, Eiji; Ota, Seiya; Chiba, Daisuke; Kimura, Yuka; Sasaki, Shizuka; Yamamoto, Yuji; Tsuda, Eiichi; Nakaji, Shigeyuki; Ishibashi, Yasuyuki

doi:10.1007/s00167-019-05614-z

Cited by 45 publications

(54 citation statements)

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“…Whilst EKOA is solely diagnosed based on mild knee pain and disabilities, it can be clearly distinguished from both normal and symptomatically abnormal knees. In their cohort study, Sasaki et al reported that the highest prevalence of EKOA was www.nature.com/scientificreports/ observed in females aged ≥ 50 years, who had reduced knee function and QOL; the risk factors for EKOA were age, female sex, obesity, and previous knee injury, similar to those of definitive knee OA 6 . The association of serum biomarkers and EKOA has not been well established.…”

Section: Discussionmentioning

confidence: 99%

“…Early identification of changes to the knee at an early phase of OA may help prevent the progression to definitive OA. Although many studies had reported the features of early phase of knee OA 1,6,17,18 , there was no clear definition for early phase of knee OA; however, Luyten et al defined the new criteria 5 . Whilst EKOA is solely diagnosed based on mild knee pain and disabilities, it can be clearly distinguished from both normal and symptomatically abnormal knees.…”

Section: Discussionmentioning

confidence: 99%

“…Participants answered questionnaires regarding their past and present medical history, lifestyle, occupation, family history, onset of menopause, health-related QOL, and disease-specific information, such as knee symptoms. We focused on female participants aged 30 to 70 years with no radiographic abnormalities because the prevalence of EKOA is higher in middle-aged women 6 . We excluded 15, 31, 10, 15, 14 and 428 participants who had undergone knee arthroplasty, who did not undergo radiographs, with history of knee ligament injury or fracture, diagnosed rheumatoid arthritis, with positive anti-cyclic citrullinated peptide antibody, and who were male participants, respectively.…”

Section: Methodsmentioning

confidence: 99%

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Detection of synovitis in early knee osteoarthritis by MRI and serum biomarkers in Japanese general population

Ishíbashi

Sasaki

Ota

et al. 2020

Sci Rep

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To investigate synovitis' influence on early knee osteoarthritis (EKOA) by serum biomarkers and magnetic resonance imaging (MRI) findings in Japanese women. We enrolled 255 women aged 30-70 without radiographic abnormalities (Kellgren-Lawrence grade ≥ 2). Knee injury, OA outcome scores (KOOS), clinical examinations, and standing radiograph were used for classification criteria of EKOA. Participants were classified into normal knee group and EKOA group. All participants underwent MRIs of their right knee. The amount of effusion-synovitis volume was quantified. We compared serum matrix metalloproteinases-3 levels (MMP-3), high-sensitivity C-reactive protein, interleukin-6, and adiponectin between the groups. The relationship between synovitis and EOKA was investigated using multiple linear regression. Fifty-four participants (21%) were classified as EKOA. Serum MMP-3 concentration and effusion-synovitis volume were higher in patients with EKOA (p = 0.025 and p = 0.001, respectively). Effusion-synovitis volume negatively correlated with all KOOS subscales and positively correlated with serum MMP-3 concentration. Serum MMP-3 concentration was associated with effusion-synovitis volume β = 0.60, p < 0.001). There was mildly active but definitive synovitis in EKOA. This was an observational study so that no conclusions can be drawn regarding cause-effect for synovitis and symptoms. Future studies should conduct follow-up of participants with synovitis to assess the progression of knee OA. Knee osteoarthritis (OA) is a major joint disease that causes chronic pain, stiffness, and disability, especially in the aging population 1,2. It requires high-cost treatment, such as arthroplasty, decreases productivity, and creates absence from work; therefore, knee OA imposes a substantial and growing burden on society 3. Although early intervention or preventive approaches are needed, the timing and identifying methodology are not established, as conventional standard diagnosis and assessment are conducted mainly based on the Kellgren-Lawrence (KL) grading on radiographs 4 , thus making it difficult to detect early and minute changes. Recently, new criteria for detecting early knee OA were proposed by the first international EKOA workshop (EKOA) without radiographic abnormalities 5 ; they allow identification of people with moderate knee symptoms who have same risk factors as those with definitive knee OA. EKOA prevalence was 9.5% in men and 15.0% in women, and the highest prevalence was noted in middle-aged females 6. Nevertheless, EKOA's etiology has not been well studied. Several biomarkers are frequently used to assess disease activity precisely and quantitatively. There are reports regarding the availability of serum biomarkers to evaluate synovitis at an early phase and to predict OA progression. Interleukin-6 (IL-6) and keratan sulfate levels increase in the early phase of knee OA accompanied by knee pain 7,8. Magnetic resonance imaging (MRI) is a useful imaging biomarker for assessing early phase of knee OA. The Framingham ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Detection of synovitis in early knee osteoarthritis by MRI and serum biomarkers in Japanese general population

Ishíbashi

Sasaki

Ota

et al. 2020

Sci Rep

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“…Knee osteoarthritis (KOA) is a major public health problem in the middle-aged to elderly population and negatively affects patients' activities of daily living (ADL) and quality of life (QOL) [1][2][3] . Early diagnosis and treatment of KOA are required to reduce its health care burden 4 , by preventing disease development and progression [5][6][7][8] . The concept of early KOA is characterized by the presence of knee symptoms in the absence of de nitive radiographic abnormalities (Kellgren-Lawrence [KL] grade 0-1).…”

Section: Introductionmentioning

confidence: 99%

Relationship between magnetic resonance imaging lesions and knee symptoms in early knee osteoarthritis: A cross-sectional Japanese population study

Ota

Sasaki

et al. 2020

Preprint

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Background: The prevalence of minute structural abnormalities in early knee osteoarthritis (KOA) and their association with knee symptoms remains unclear. We investigated the prevalence of abnormalities detected by magnetic resonance imaging (MRI) and their relation to knee symptoms in women without radiographic evidence of KOA.Methods: This cross-sectional cohort study in a Japanese population included 261 women without radiographic evidence of KOA, which was defined as a Kellgren‒Lawrence grade < 2. All participants underwent T2-weighted fat-suppressed MRI of their right knee. Structural abnormalities (cartilage damage, bone marrow lesions [BMLs], subchondral cysts, bone attrition, osteophytes, meniscal lesions, and synovitis) were scored according to the Whole-Organ MRI Scoring method. Knee symptoms were evaluated by the Knee injury and Osteoarthritis and Outcome Score (KOOS). Participants were divided into early KOA and non-KOA groups based on early KOA classification criteria. Logistic regression analysis was performed to evaluate the relationship between MRI abnormalities and knee symptoms.Results: Cartilage damage were the most common abnormality (53%), followed by osteophytes (43%), and BMLs (33%). The prevalence of BMLs (47%), meniscal lesions (26%), and synovitis (37%) was higher in early KOA than in non-KOA. On logistic regression analysis, synovitis (odds ratio [OR] = 1.901, P = 0.013) and meniscal lesions (OR = 1.410, P = 0.045) were positively associated with the presence of early KOA.Conclusions: The prevalence of BMLs, meniscal lesions, and synovitis was higher in symptomatic knees. Synovitis was most strongly associated with knee pain and might be a therapeutic target in patients with early KOA.

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“…Disadvantages of progressed KOA include high treatment costs, decreased productivity, and absence from work 3 ; therefore, early diagnosis is crucial for early treatment and preventative interventions 4 . A recent epidemiological study revealed that the highest prevalence of early KOA (EKOA) was observed in females aged ≥ 50 years, owing to factors such as age, female sex, obesity, and previous knee injury 5 . The major causal factor of EKOA and de nitive KOA (DKOA) was sex 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Epidemiological study on the relationship among menopausal condition, bone fragility, and knee osteoarthritis

Sasaki¹,

Chiba²,

Ota³

et al. 2020

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Background: Knee osteoarthritis (KOA) occurs more often in middle-aged females. While this age-group experiences comorbid osteoporosis with menopause, its influence on KOA has not been clarified. This epidemiological study aimed to investigate the relationship between menopausal conditions, bone mineral density (BMD), and KOA. Methods: A total of 518 female volunteers who participated in the Iwaki cohort study were enrolled and divided into groups (pre- and post-menopause). Antimullerian hormone (AMH) was measured as a predictive marker for menopause in the pre-menopausal subjects. Weight-bearing anterior-posterior knee radiographs were classified by Kellgren-Lawrence grade, and grade ≥ 2 was defined as definitive KOA (DKOA). Early KOA (EKOA) was defined by Luyten’s criteria, and BMD was measured at a distal radius. The relationship between menopausal condition, BMD, and KOA was analyzed by ROC and regression analysis. Results: Fifty-two participants (10.0%) were diagnosed with EKOA and 204 (39.4%) with DKOA. A total of 393 (75.9%) females began menopause, and the prevalence of DKOA was up to 48.1% and >12.0% in pre-menopause females (p < 0.001, Odds ratio: 6.79). From the ROC analysis in pre-menopausal females, cut-off value of AMH for detecting EKOA was 0.08 ng/ml (AUC: 0.712, p5%CI: 0.527 to 0.897, p-value: 0.025, Odds ratio: 8.28). Regression analysis showed that lower AMH was related to EKOA (p=0.035, Odds ratio: 5.55) and DKOA (p=0.032, Odds 1.59), and lower BMD and high turnover bone metabolism were correlated with DKOA. Conclusions: KOA increased after menopause and was correlated with lower BMD. Furthermore, reduction in AMH was a valuable biomarker for the detection of EKOA.

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Early knee osteoarthritis prevalence is highest among middle-aged adult females with obesity based on new set of diagnostic criteria from a large sample cohort study in the Japanese general population

Cited by 45 publications

References 53 publications

Detection of synovitis in early knee osteoarthritis by MRI and serum biomarkers in Japanese general population

Detection of synovitis in early knee osteoarthritis by MRI and serum biomarkers in Japanese general population

Relationship between magnetic resonance imaging lesions and knee symptoms in early knee osteoarthritis: A cross-sectional Japanese population study

Epidemiological study on the relationship among menopausal condition, bone fragility, and knee osteoarthritis

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