Radiological Assessment of Rheumatoid Arthritis

250

171

Objective. To determine whether chondroitin sulfate (CS) is effective in inhibiting cartilage loss in knee osteoarthritis (OA).Methods. In this randomized, double-blind, placebo-controlled trial, 300 patients with knee OA were recruited from an outpatient clinic, from private practices, and through advertisements. Study patients were randomly assigned to receive either 800 mg CS or placebo once daily for 2 years. The primary outcome was joint space loss over 2 years as assessed by a posteroanterior radiograph of the knee in flexion; secondary outcomes included pain and function.Results. Of 341 patients screened, 300 entered the study and were included in the intent-to-treat analysis. The 150 patients receiving placebo had progressive joint space narrowing, with a mean ؎ SD joint space loss of 0.14 ؎ 0.61 mm after 2 years (P ‫؍‬ 0.001 compared with baseline). In contrast, there was no change in mean joint space width for the 150 patients receiving CS (0.00 ؎ 0.53 mm; P not significant compared with baseline). Similar results were found for minimum joint space narrowing. The differences in loss of joint space between the two groups were significant for mean joint space width (0.14 ؎ 0.57 mm; P ‫؍‬ 0.04) and for minimum joint space width (0.12 ؎ 0.52 mm; P ‫؍‬ 0.05). CS was well tolerated, with no significant differences in rates of adverse events between the two groups. Conclusion.While there was no significant symptomatic effect in this study, long-term treatment with CS may retard radiographic progression in patients with OA of the knee. However, the clinical relevance of the observed structural results has to be further evaluated, and further studies are needed to confirm the structural effects of CS.

Section: Methodsmentioning

confidence: 99%

Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: A randomized, controlled trial

Michel

Stucki²,

Frey

et al. 2005

250

171

“…Other inclusion criteria were a predominance of pain/tenderness over the medial region of the knee and medial radiographic OA (defined as at least grade 1 medial joint space narrowing [more narrowing in the medial than in the lateral compartment] and grade 1 medial tibial or femoral osteophytes) (21). The exclusion criteria were as follows: questionable presence of or advanced radiographic knee OA (Kellgren/Lawrence [K/L] score of 1 or 4, respectively) (22), predominant patellofemoral joint symptoms based on clinical examination, knee surgery or intraarticular corticosteroid injection within the past 6 months, current or past (within 4 weeks) oral corticosteroid use, systemic arthritic conditions, a history of tibiofemoral/patellofemoral joint replacement or tibial osteotomy, or taking medication or having any condition that could affect bone density. Participants with either unilateral and bilateral disease were included, with the more painful knee studied.…”

Section: Methodsmentioning

confidence: 99%

“…In patients with knee OA, standardized semiflexed posteroanterior knee radiographs were obtained with the participant standing barefoot. Radiographic severity of tibiofemoral OA was assessed using the K/L scale, where 0 ϭ normal, 1 ϭ possible osteophytes, 2 ϭ minimal osteophytes and possible joint space narrowing, 3 ϭ moderate osteophytes, some narrowing, and possible sclerosis, and 4 ϭ large osteophytes, definite joint space narrowing, and severe sclerosis (21,22). The radiographs were assessed by an experienced musculoskeletal researcher and physiotherapist (KLB) whose intrarater reliability was 0.87 (linearly incremental weighted kappa statistic).…”

Section: Methodsmentioning

confidence: 99%

Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology

Bennell¹,

Creaby²,

Wrigley³

et al. 2008

Objective. Knee osteoarthritis (OA) is an organlevel failure of the joint involving pathologic changes in articular cartilage and bone. This cross-sectional study compared apparent volumetric bone mineral density (vBMD) of proximal tibial subchondral trabecular bone in people with and without knee OA, using peripheral quantitative computed tomography (pQCT).Methods. Seventy-five individuals with mild or moderate medial compartment knee OA and 41 asymptomatic controls were recruited. Peripheral QCT was used to measure vBMD of trabecular bone beneath medial and lateral tibiofemoral compartments at levels of 2% and 4% of tibial length, distal to the tibial plateau.Results. There was no significant difference in vBMD beneath the overall medial and lateral compartments between the 3 groups. However, in the affected medial compartment of those with moderate OA, lower vBMD was seen in the 2 posterior subregions compared with controls and those with mild knee OA, while higher vBMD was seen in the anteromedial subregion. Beneath the unaffected or lesser affected lateral compartment, significantly lower vBMD was seen at the 2% level in the anterior and lateral subregions of those with moderate disease. Volumetric BMD ratios showed relatively higher vBMD in the medial compartment compared with the lateral compartment, but these ratios were not influenced by disease status.Conclusion. Subregional vBMD changes were evident beneath the medial and lateral compartments of those with moderate medial knee OA. Of import, the posterior subchondral trabecular regions of the medial tibial plateau have markedly lower vBMD.

“…One rheumatologist (DTF) and one musculoskeletal radiologist who were both experienced in reading study films graded all baseline posteroanterior view radiographs according to the Kellgren/Lawrence (K/L) scale (25), under blinded conditions with regard to case/control status and clinical data. Radiographic OA was considered to be present if the K/L grade was Ն2.…”

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

143

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.