The incident tibiofemoral osteoarthritis with rapid progression phenotype: development and validation of a prognostic prediction rule

Abstract

Objectives No clinical prediction rules were found for estimating the likelihood of developing incident radiographic tibiofemoral osteoarthritis with rapid progression. Such a tool would enhance prognostic capability for clinicians and researchers. Design We used two longitudinal datasets to independently derive (Multicenter Osteoarthritis Study) and validate (Osteoarthritis Initiative) a prognostic clinical prediction rule for estimating the probability of incident rapidly progressing radiographic knee OA in the following 4-5 years. Eligible subjects had at least one knee with a Kellgren and Lawrence (K&L) graded tibiofemoral joint of 0 or 1. Several potential risk factors were examined including obesity, age, knee alignment, frequent knee symptoms, contralateral knee osteoarthritis and knee injury history. Multiple logistic regression was used to identify significant predictors and area under the receiver operating characteristic curve (AUC) was used to assess discrimination. Results A total of 1,690 subjects participated in the derivation and 2,422 subjects participated in the validation of the clinical prediction rule. The multivariable model displayed good discrimination with AUC of 0.79 in the derivation dataset and 0.81 in the validation dataset. Conclusions Persons with contralateral knee OA, a baseline index knee OA grade of 1, higher BMI and higher baseline WOMAC Total scores were more likely to develop K&L grades of 3 or 4 within 5 years. Frequent knee symptoms at baseline was not a significant predictor. The prediction rule and nomogram can assist clinicians in estimating the probability of rapidly progressing radiographic knee OA and the nomogram can assist researchers conducting epidemiologic studies and clinical trials.

A single recent injury is a potent risk factor for the development of accelerated knee osteoarthritis: data from the osteoarthritis initiative

“…These results confirm and expand our understanding that adults with greater BMI are more likely to develop AKOA, which has been previously reported to be a significant risk factor during the first four years of the OAI [3,11]. This is the first instance where it is shown that BMI is also associated with the onset of AKOA at least 4 to 8 years later.…”

“…While numerous studies have evaluated AKOA with data from the OAI [1,5,6,3,2,4,10,11] they have all focused on the first four years of the cohort. By studying people with AKOA after the 48-month visit of the OAI, we could explore which modifiable risk factors are consistently present and which risk factors are unique to the timing of incident AKOA.…”

Knee symptoms among adults at risk for accelerated knee osteoarthritis: data from the Osteoarthritis Initiative

“…Furthermore, baseline total WOMAC score (averaged from both knees) helped predict who would develop accelerated KOA in the Osteoarthritis Initiative and Multicenter Osteoarthritis Study [11]. When looking at specific symptoms, we found that people who developed accelerated KOA were more likely to report a greater symptom severity compared with those who developed common KOA in 3 symptoms: difficulty lying down, pain straightening the knee fully, and pain walking.…”

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

“…Knee osteoarthritis (KOA) is typically a slowly progressive disorder. However, a subset of individuals may develop accelerated KOA, which is defined by the rapid onset and progression of disease within 4 years (from preradiographic disease to advanced‐stage disease) . Two of 3 adults with accelerated KOA transition from developing KOA to accelerated KOA in fewer than 12 months .…”

“…However, a subset of individuals may develop accelerated KOA, which is defined by the rapid onset and progression of disease within 4 years (from preradiographic disease to advanced‐stage disease) . Two of 3 adults with accelerated KOA transition from developing KOA to accelerated KOA in fewer than 12 months . Individuals with accelerated KOA have substantially greater pain and disability when compared to their peers without accelerated KOA, and this becomes evident prior to radiographic onset of the disease .…”