Logo image
Back
Two-year vs. Four-year Structural Progressors of Knee Osteoarthritis Suggest Distinct Clinical Phenotypes
Abstract   Peer reviewed

Two-year vs. Four-year Structural Progressors of Knee Osteoarthritis Suggest Distinct Clinical Phenotypes

A. Mahmoudian, J.H. van Dieën, I.A. Baert, S.M. Bruijn, G.S. Faber, F.P. Luyten and S.M. Verschueren
Osteoarthritis and Cartilage, Vol.25
Liverpool, United Kingdom, 04/2017
04/2017

Metrics

1 Record Views

Abstract

Purpose: Osteoarthritis (OA) of the knee has become one of the leading causes of pain and disability worldwide. The need to identify subjects at higher risk of progression is of clinical relevance, as they could be targeted for more specific management strategies, to improve their prognosis and possibly delay or avoid knee replacement surgery. Our objective was to identify clinical phenotypes in women with medial knee OA based on structural progression after 2 and 4 years. Methods: Fifty-seven patients with either early or established medial knee OA were included. Structural, clinical, functional, and gait characteristics of all patients were assessed at the time of study entry. All patients were structurally assessed after 2, as well as 4 years. Medial tibiofemoral OA progression was defined based on structural changes, meaning any worsening in the grade for radiographic medial joint space on the K&L grading system between baseline and 2 years (fast progressors), and 4 years (slow progressors). Next, we compared the baseline characteristics between fast and slow progressors. Results: Fourteen subjects (24 %) with early or established medial knee OA progressed over 2 years, as assessed by K&L scoring system. Furthermore, eleven additional subjects (19%) with medial knee OA worsened in the K&L score only after 4 years. Fast progressors showed significantly higher knee pain and symptoms compared to slow progressors at the time of entry, as measured with KOOS pain and symptoms subscales (p = 0.003 and p = 0.005, respectively). Fast progressors also reported significantly worse Activity Daily living and Quality of Life, at baseline, compared to the slow progressors (p = 0.006 and p = 0.007, respectively). Remarkably, patients in the fast progression group showed significantly more kinesiophobia (p = 0.035) at the time of entry. Furthermore, fast progressors showed significantly weaker quadriceps and hamstrings, compared to the slow progressors, at the time of entry (all p ˂ 0.016). Regarding structural differences as detected on MRI, fast progressors demonstrated a trend towards significantly higher meniscal degeneration compared to the slow progressors, at the time of entry (p = 0.076). Conclusions: These data identify clinical differences for fast structural progressors compared to the slow progressors with higher kinesiophobia, more pain and symptoms as well as worse self-reported function, and weaker knee musculature. Current results suggest that specific patient profiles might be better determinants for progression of medial knee OA, rather than the disease severity per se at baseline.

Details

Logo image