Rapidly Progressive Osteoarthritis: a Review of the Clinical and Radiologic Presentation

Flemming, Donald J.; French, Cristy

doi:10.1007/s11926-017-0665-5

Cited by 59 publications

(48 citation statements)

References 35 publications

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“…Our findings that accelerated KOA is characterized by destabilizing meniscal tear or miscellaneous pathology, especially subchondral bone damage, supports prior evidence that certain types of meniscal pathology (e.g., root tears) may increase the risk for accelerated progression , and that other more aggressive forms of rapidly progressive OA progression may be defined by significant subchondral bone damage . It is important to acknowledge that it remains unclear if accelerated KOA has any relation to type 2, rapidly progressive OA, which is characterized by a more dramatic joint space narrowing (≥2 mm within 1 year) and greater abnormal bone loss/destruction .…”

Section: Discussionsupporting

confidence: 83%

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

Driban

Davis

Lü

et al. 2019

Arthritis & Rheumatology

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Objective. To determine whether accelerated knee osteoarthritis (KOA) is preceded by, and characterized over time by, destabilizing meniscal tears or other pathologic changes.Methods. We selected 3 sex-matched groups of subjects from the first 48 months of the Osteoarthritis Initiative, comprising adults who had a knee without KOA (Kellgren/Lawrence [K/L] radiographic grade <2) at baseline. Subjects in the accelerated KOA group developed KOA of K/L grade ≥3, those with typical KOA showed increased K/L radiographic scores, and those with no KOA had the same K/L grade over time. An index visit was the visit when the radiographic criteria for accelerated KOA and typical KOA were met (the no KOA group was matched to the accelerated KOA group). The observation period was up to 2 years before and after an index visit. Radiologists reviewed magnetic resonance (MR) images of the index knee and identified destabilizing meniscal tears (root tears, radial tears, complex tears), miscellaneous pathologic features (acute ligamentous or tendinous injuries, attrition, subchondral insufficiency fractures, other incidental findings), and meniscal damage in >2 of 6 regions (3 regions per meniscus: anterior horn, body, posterior horn). In addition, bone marrow lesions (BMLs) and cartilage damage on MR images were quantified. Linear mixed regression models were performed to analyze the results.Results. At 1 year before the index visit, >75% of adults with accelerated KOA had meniscal damage in ≥2 regions (odds ratio 3.19 [95% confidence interval 1.70-5.97] versus adults with typical KOA). By the index visit, meniscal damage in ≥2 regions was ubiquitous in adults with accelerated KOA, including 42% of subjects having evidence of a destabilizing meniscal tear (versus 14% of subjects with typical KOA). These changes corresponded to findings of larger BMLs and greater cartilage loss in the accelerated KOA group.Conclusion. Accelerated KOA is characterized by destabilizing meniscal tears in a knee compromised by meniscal damage in >2 regions, and also characterized by the presence of large BMLs and greater cartilage loss.

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Section: Discussionsupporting

confidence: 83%

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

Driban

Davis

Lü

et al. 2019

Arthritis & Rheumatology

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“…For example, no one with AKOA in the Osteoarthritis Initiative experienced more than 2 mm of loss in joint space width in less than one year nor abnormal bone loss or destruction. Furthermore, rapid progressive osteoarthritis is often described in knees, hips, or shoulders [46,50,53,55,56]. However, accelerated osteoarthritis is primarily observed in the knee and, to a lesser extent, the hand.…”

Section: Classifying Adults At Risk For Accelerated Knee Osteoarthritismentioning

confidence: 99%

Risk factors and the natural history of accelerated knee osteoarthritis: a narrative review

Driban

Harkey

Barbe

et al. 2020

BMC Musculoskelet Disord

108

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Background: Osteoarthritis is generally a slowly progressive disorder. However, at least 1 in 7 people with incident knee osteoarthritis develop an abrupt progression to advanced-stage radiographic disease, many within 12 months. We summarize what is knownprimarily based on findings from the Osteoarthritis Initiativeabout the risk factors and natural history of accelerated knee osteoarthritis (AKOA)defined as a transition from no radiographic knee osteoarthritis to advanced-stage disease < 4 yearsand put these findings in context with typical osteoarthritis (slowly progressing disease), aging, prior case reports/series, and relevant animal models. Summary: Risk factors in the 2 to 4 years before radiographic manifestation of AKOA (onset) include older age, higher body mass index, altered joint alignment, contralateral osteoarthritis, greater pre-radiographic disease burden (structural, symptoms, and function), or low fasting glucose. One to 2 years before AKOA onset people often exhibit rapid articular cartilage loss, larger bone marrow lesions and effusion-synovitis, more meniscal pathology, slower chair-stand or walking pace, and increased global impact of arthritis than adults with typical knee osteoarthritis. Increased joint symptoms predispose a person to new joint trauma, which for someone who develops AKOA is often characterized by a destabilizing meniscal tear (e.g., radial or root tear). One in 7 people with AKOA onset subsequently receive a knee replacement during a 9-year period. The median time from any increase in radiographic severity to knee replacement is only 2.3 years. Despite some similarities, AKOA is different than other rapidly progressive arthropathies and collapsing these phenomena together or extracting results from one type of osteoarthritis to another should be avoided until further research comparing these types of osteoarthritis is conducted. Animal models that induce meniscal damage in the presence of other risk factors or create an incongruent distribution of loading on joints create an accelerated form of osteoarthritis compared to other models and may offer insights into AKOA. Conclusion: Accelerated knee osteoarthritis is unique from typical knee osteoarthritis. The incidence of AKOA in the Osteoarthritis Initiative and Chingford Study is substantial. AKOA needs to be taken into account and studied in epidemiologic studies and clinical trials.

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“…We did note a significantly higher use of NSAIDs in the RPO cohort (P < .001). Some studies have implicated these drugs in the formation of RPO, suggesting they impair bone turnover [1,20]; however, this has been challenged by other literature [21]. Intraarticular steroid injections have also been linked to RPO [2].…”

Section: Current Controversies and Future Considerationsmentioning

confidence: 99%

Rapidly Progressive Osteoarthritis and Acetabular Bone Loss Outcomes for Patients Undergoing Primary Total Hip Replacement

et al. 2020

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Rapidly progressive osteoarthritis (RPO) is a rare condition which is poorly understood. Limited published literature is available. Reported here is a cohort of patients with RPO and acetabular bone loss who underwent primary THA. Risk factors, degree of acetabular bone loss and outcomes are presented. A typical case of RPO is described and investigations discussed. A retrospective audit was undertaken. 49 patients over an 18-year period were included. RPO patients were significantly older (P < 0.01) and had a lower BMI (P ¼ 0.03). The mean acetabular bone loss in this cohort was 10.0 mm. Pathogenesis and risk factors for developing RPO remain unclear and future research is necessary. Repeat imaging in patients with deteriorating symptoms is important and urgent surgery is required maintain bone stock.

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Rapidly Progressive Osteoarthritis: a Review of the Clinical and Radiologic Presentation

Cited by 59 publications

References 35 publications

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden

Risk factors and the natural history of accelerated knee osteoarthritis: a narrative review

Rapidly Progressive Osteoarthritis and Acetabular Bone Loss Outcomes for Patients Undergoing Primary Total Hip Replacement

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