Prevalence of radiographic osteoarthritis—it all depends on your point of view

Duncan, Rachel; Hay, Elaine M; Saklatvala, J.; Croft, Peter

doi:10.1093/rheumatology/kei270

Cited by 240 publications

(202 citation statements)

References 9 publications

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“…Contrary to common belief, the PF joint may be a more common site of OA (1,2) and source of symptoms (3,4) than the TF joint. PF joint OA also predicts the incidence of TF joint OA (5,6).…”

Section: Introductionmentioning

confidence: 68%

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

Stefanik

Duncan

Felson

et al. 2017

Arthritis Care & Research

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ObjectiveTo assess the diagnostic performance of a comprehensive set of tests and measures to discriminate patellofemoral (PF) from tibiofemoral (TF) osteoarthritis (OA).MethodsThe Clinical Assessment of the Knee Study is a study of knee pain in the general population. The presence of PF crepitus and pain with PF compression were assessed. Anterior knee pain was determined using a knee pain map. Pain with climbing/descending stairs and walking on level ground were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index. Radiographs were used to define the compartment(s) of the knee affected by OA (no OA, isolated/predominant PF joint OA, and isolated/predominant TF joint OA). In knees with mixed OA, knees with more severe PF joint OA were included in the isolated/predominant PF group (the same was done for TF joint OA). We determined the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and positive likelihood ratio (LR+) for each test and measure individually, and the combination of these measures, in distinguishing knees with PF joint OA from knees with TF joint OA or no OA.ResultsThere were 745 knees included in the study. No measure had high sensitivity and specificity. Pain with climbing/descending stairs had the greatest sensitivity (90%) but poor specificity (15%). The combination of definite crepitus with no pain on walking had the greatest specificity (96%), PPV (53%), and LR+ (1.8), but poor sensitivity (7%).ConclusionTypical clinical examination findings and knee pain patterns commonly thought to represent underlying PF joint pathology do not discriminate knees with PF joint OA from knees without OA or TF joint OA.

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“…Contrary to common belief, the PF joint may be a more common site of OA (1,2) and source of symptoms (3,4) than the TF joint. PF joint OA also predicts the incidence of TF joint OA (5,6).…”

Section: Introductionmentioning

confidence: 68%

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

Stefanik

Duncan

Felson

et al. 2017

Arthritis Care & Research

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“…In a subsample of 50 participants, both intra-and interreader reliability for PA K/L score, skyline K/L score, and lateral osteophytes were very good ( ϭ 0.81-0.98 and 0.49 -0.76, respectively). Definite radiographic osteoarthritis was defined as K/L grade 2 or higher for the PA view, K/L grade 2 or higher for the skyline view, the presence of superior or inferior patella osteophytes (lateral view), and/or posterior tibial osteophytes (lateral view) (24). Our definition of radiographic osteoarthritis essentially applied the same principle as earlier studies (i.e., definite osteophyte [25]) but extended this to all 3 views of the knee.…”

Section: Methodsmentioning

confidence: 99%

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

Peat

Thomas

Duncan

et al. 2007

Arthritis & Rheumatism

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Objective. To determine whether clinical information can practically rule in or rule out the presence of radiographic osteoarthritis in older adults with knee pain. Methods. We conducted a cross-sectional diagnostic study involving 695 adults ages >50 years reporting knee pain within the last year identified by postal survey and attending a research clinic. Potential indicators of radiographic osteoarthritis were gathered by self-complete questionnaires, clinical interview, and physical examination. Participants underwent plain radiography (posteroanterior, skyline, and lateral views). Radiographic osteoarthritis was defined as the presence of definite osteophytes in at least 1 joint compartment of the index knee. Results. Independent predictors of radiographic osteoarthritis were age, sex, body mass index, absence of whole leg pain, traumatic onset, difficulty descending stairs, palpable effusion, fixed-flexion deformity, restricted-flexion range of motion, and crepitus. Using this model, 245 participants had a predicted probability >80% (practical rule in), of whom 231 (94%) actually had radiographic osteoarthritis (specificity 93%). Twenty-one participants had a predicted probability <20% (practical rule out), of whom only 2 (10%) had radiographic osteoarthritis (sensitivity 99.6%). The predicted probability of radiographic osteoarthritis for the remaining 429 participants fell into an intermediate category (20 -79%). Conclusion. Simple clinical information can be used to estimate the probability of radiographic osteoarthritis in individual patients. However, for the majority of community-dwelling older adults with knee pain this method enables the presence of radiographic osteoarthritis to be neither confidently ruled in nor ruled out. Prospective validation and updating of these findings in an independent sample is required.

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“…36,130 Based on the current evidence, a multicompartmental approach to treatment of knee OA is warranted, as the combined radiographic disease pattern of tibiofemoral and patellofemoral OA is found in up to 40% of older adults with knee pain. 37 In addition, knees with structural damage in both the tibiofemoral and patellofemoral compartments are more likely to be painful and are associated with greater loss of function compared with isolated compartmental disease.…”

Section: Patellofemoral Joint Loading and Oamentioning

confidence: 99%

A Biomechanical Perspective on Physical Therapy Management of Knee Osteoarthritis

Farrokhi¹,

Voycheck²,

Tashman³

et al. 2013

J Orthop Sports Phys Ther

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Prevalence of radiographic osteoarthritis—it all depends on your point of view

Cited by 240 publications

References 9 publications

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

A Biomechanical Perspective on Physical Therapy Management of Knee Osteoarthritis

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