Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis

143

Objective. Using radiography to assess the efficacy of a disease-modifying osteoarthritis (OA) drug on joint structure is challenging. Subchondral bone marrow abnormalities determined by magnetic resonance imaging (MRI) and urinary excretion of C-terminal crosslinking telopeptide of type II collagen (CTX-II) have recently been shown to be predictors of radiographic progression in patients with knee OA, suggesting that these may represent valuable biomarkers with increased sensitivity compared with findings on radiography. The aims of this investigation were to analyze, in patients with knee OA, whether the values associated with these 2 OA biomarkers can change within 3 months, and to investigate the relationships between bone marrow abnormalities and CTX-II.Methods. Knee MRI scans were obtained in 377 patients with painful knee OA (76% women, mean age 63 years, mean disease duration 6.6 years) at both baseline and 3 months. The femoral and tibial condyles and the patella were divided into 8 sites for the scoring of bone marrow abnormalities. A bone marrow abnormality was defined as an area of increased signal on T2-weighted images of the subchondral bone. All scans were reviewed centrally and scored by a single trained radiologist using a validated 4-point scoring method. Fasting urine and serum samples were also collected from all patients at baseline, month 1, month 2, and month 3, in order to measure the levels of urinary CTX-II and serum CTX-I, a biochemical marker of bone resorption.Results. At baseline, 82% of patients had MRI evidence of bone marrow abnormalities. Bone marrow abnormality scores correlated significantly with CTX-II levels (P < 0.0001). Within 3 months, the bone marrow abnormality score decreased in 37 patients (9.8%), increased in 71 patients (18.8%), and did not change in the majority of patients (71.4%). Patients with baseline urinary CTX-II levels in the highest tertile had a relative risk of 2.4 (95% confidence interval 1.1-5.0) of worsening bone marrow abnormalities at 3 months compared with patients with levels in the lowest tertile, after adjustment for age, sex, and body mass index. In patients who showed a decrease in the bone marrow abnormality score at 3 months, urinary CTX-II levels decreased significantly (mean ؊75 ng/mmole creatinine), whereas levels increased (mean ؉23 ng/mmole creatinine) in patients showing an increase in the bone marrow abnormality score (P ‫؍‬ 0.01 between the 2 groups). No significant association between bone marrow abnormalities and serum CTX-I was observed.Conclusion. In patients with painful knee OA, bone marrow abnormalities on MRI can change within only 3 months in ϳ30% of patients. Reduction in the extent of bone marrow abnormalities is associated with a decrease in cartilage degradation.Osteoarthritis (OA) of the knee frequently affects the elderly population and is characterized by cartilage loss, osteophytes, and subchondral sclerosis and cysts (1). Radiography is currently the only method accepted by regulatory agencies for assessing progress...

Section: Methodsmentioning

confidence: 99%

Bone marrow abnormalities on magnetic resonance imaging are associated with type II collagen degradation in knee osteoarthritis: A three‐month longitudinal study

Garnero¹,

Peterfy²,

Zaim³

et al. 2005

143

“…Cartilage morphology was assessed by musculoskeletal radiologists (led by AG) using a semiquantitative, multifeature scoring method, the Whole-Organ Magnetic Resonance Imaging Score (WORMS), for whole-organ evaluation of the knee that is applicable to MRI readings obtained with conventional techniques (17). Intraclass correlation coefficients of agreement in scoring cartilage readings ranged from 0.72 to 0.97.…”

Section: Study Populations Framingham Offspring Cohort Thementioning

confidence: 99%

Low levels of vitamin D and worsening of knee osteoarthritis: Results of two longitudinal studies

Felson

Niu

Clancy

et al. 2007

161

122

Objective. To confirm reports that 25-hydroxyvitamin D (25[OH]D) deficiency is associated with an increased risk of joint space narrowing or cartilage loss in osteoarthritis (OA). Methods. We measured 25(OH)D levels in sub-Osteoarthritis (OA) is characterized by loss of cartilage and concurrent changes in subchondral bone, and there is evidence that subchondral bone has a major influence on the development of OA and its worsening

“…Baseline and 15-month MRI scans were obtained with a 1.0T MR system (OrthOne; ONI Medical Systems, Wilmington, MA) equipped with a circumferential transmit-receive extremity coil and included sagittal and axial Two musculoskeletal radiologists (AG and FWR) who were blinded to the case/control status and clinical data read paired images (with knowledge of the time sequence). Meniscal tears, maceration, and/or resection (referred to in this study as meniscal damage) were graded using the Whole-Organ MRI Score (WORMS) (22). The anterior horn, body segment, and posterior horn of the medial and lateral menisci were graded separately on a scale from 0 to 4, as follows: 0 ϭ intact, 1 ϭ minor radial tear or parrot-beak tear, 2 ϭ nondisplaced tear or prior surgical repair, 3 ϭ displaced tear or partial resection, and 4 ϭ complete maceration/destruction or complete resection (interrater weighted ϭ 0.80).…”

Section: Study Design the Multicenter Osteoarthritis (Most)mentioning

confidence: 99%

“…A meniscal score (range 0-3) was determined for each of the medial and lateral menisci ( Table 2). We used a collapsed version of the original 7-item WORMS total meniscal score (22) because of low numbers of subjects with higher grades. The highest score from the medial or lateral side was used for analysis.…”

Section: Study Design the Multicenter Osteoarthritis (Most)mentioning

confidence: 99%

Effect of meniscal damage on the development of frequent knee pain, aching, or stiffness

Englund¹,

Niu²,

Guermazi³

et al. 2007

132

Objective. To evaluate the effect of meniscal damage on the development of frequent knee pain, aching, or stiffness in middle-aged and older adults.Methods. The Multicenter Osteoarthritis Study is a prospective study of 3,026 individuals 50 years of age or older who have or are at high risk of developing knee osteoarthritis (OA). We investigated knees at baseline and at 15 months. Case knees (n ‫؍‬ 110) were those with no pain, aching, or stiffness on most days at baseline, but that had developed frequent pain, aching, or stiffness at 15 months. Control knees (n ‫؍‬ 220) were drawn randomly from knees with no frequent symptoms at baseline that did not become case knees. Using 1.0T magnetic resonance imaging performed at baseline and at followup, 2 musculoskeletal radiologists blinded to the case-control status assessed the meniscal damage using the following scale: 0 ‫؍‬ intact, 1 ‫؍‬ minor tear, 2 ‫؍‬ nondisplaced tear or prior surgical repair, and 3 ‫؍‬ displaced tear, resection, maceration, or destruction. The effect of meniscal damage was analyzed by contingency tables and logistic regression.Results. Meniscal damage was common at baseline both in case knees (38%) and in control knees (29%). Although there was a modest association between the meniscal damage score (range 0-3) and the development of frequent knee pain, aching, or stiffness (odds ratio [OR] 1.21, 95% confidence interval [95% CI] 0.96-1.51, adjusted for age, sex, and body mass index), meniscal damage was mostly present in knees with OA. When considering the co-occurrence of OA, we found no independent association between meniscal damage and the development of frequent knee symptoms (OR 1.05, 95% CI 0.80-1.37).Conclusion. In middle-aged and older adults, any association between meniscal damage and the development of frequent knee pain seems to be present because both pain and meniscal damage are related to OA and not because of a direct link between the two.