Nottingham knee osteoarthritis risk prediction models

Abstract

Objectives (1) To develop risk prediction models for knee osteoarthritis (OA) and (2) to estimate the risk reduction that results from modifi cation of potential risk factors. Method This was a 12-year retrospective cohort study undertaken in the general population in Nottingham, UK. Baseline risk factors were collected by questionnaire. Incident radiographic knee OA was defi ned by Kellgren and Lawrence (KL) score ≥2. Incident symptomatic knee OA was defi ned by KL ≥2 plus knee pain. Progression of knee OA was defi ned by KL ≥1 grade increase from baseline. A logistic regression model was used for prediction. Calibration and discrimination of the models were tested in the Osteoarthritis Initiative (OAI) population and Genetics of Osteoarthritis and Lifestyle (GOAL) population. ORs of the models were compared with those obtained from meta-analysis of existing literature.Results From a community sample of 424 people aged over 40, 3 risk prediction models were developed. These included incidence of radiographic knee OA, incidence of symptomatic knee OA and progression of knee OA. All models had good calibration and moderate discrimination power in OAI and GOAL. The ORs lied within the 95% CIs of the published studies. The risk reduction due to modifying obesity at the individual and the population levels were demonstrated. Conclusions Risk prediction of knee OA based on the well established, common modifi able risk factors has been established. The models may be used to predict the risk of knee OA, and risk reduction due to preventing a specifi c risk factor.Knee osteoarthritis (OA) is the most common form of chronic joint disease and the leading cause of lower limb disability in older patients. 1 Although there are more than 50 treatments for symptomatic relief, the benefi ts of these treatments are only marginal over placebo, 2 -4 and often outweighed by their side effects. 2 4 Currently there is no effective treatment for structure modifi cation. The majority of patients have to cope with the disease for most of their lives, and even of those who undergo total joint replacement, 6% to 30% still have persistent knee pain after the surgery. 5 -8 At present, established symptomatic OA is a chronic, disabling and incurable condition.In contrast, research in the past two decades into the epidemiology of knee OA has identifi ed opportunities for primary and secondary disease prevention. 9 A number of risk factors for development of knee OA have been confi rmed. 10 For the purpose of prevention, they may be classifi ed into nonmodifi able (eg, age, gender, genetic susceptibility/ family history) and potentially modifi able risk factors (eg, body mass index (BMI), occupational risk, joint injury, quadriceps weakness, nutrients, bone mineral density and oestrogen defi ciency). 9 Some new risk factors have been recently identifi ed such as the longer ring fi nger (2D:4D ratio), 11 12 varus/valgus mal-alignment 13 14 and genetic predisposition 15 16 but many of these have yet to be ratifi ed.This project aimed to...

Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis

“…Kneeling was investigated by four studies 18,21,32,34 and found to be significantly related to knee OA by three 18,21,32 , suggesting that it is an important element of physical work that can be classed as a risk factor for knee pain and knee OA. Lifting was also assessed by three studies 21,32,34 and was significantly related to knee OA by one 32 .…”

“…One paper did not include enough information to be included in the meta-analysis 32 . There was consistent evidence that females were at higher risk of knee OA.…”

Predictive value of semi-quantitative MRI-based scoring systems for future knee replacement: data from the osteoarthritis initiative

“…Adjustments were performed for well-known (HR-1) and proposed predictors (HR-2) of KR in OA. Choices of confounders were made according to the prediction models proposed by Kerkhof et al and in line with other similar reports [5][6][7]22]. The first model (HR-1) includes adjustments for age, gender and BMI.…”

Personalized medicine for osteoarthritis: where are we now?

“…A potential solution to this limitation has been provided by another group: the 'Nottingham knee prediction models' are mathematical models designed to apply what we know about key OA risk factors to predict incident, symptomatic or progressive (increase by K/L grade 1) OA of the knee [Zhang et al 2011]. For example, the equation for incidence of symptomatic OA is Logit = −7.733 + 0.56 age + 0.29 female + 0.089 BMI + 0.245 occupational risks + 0.543 family history + 0.87 knee injury.…”