The Bristol ‘OA500’ Study: progression of osteoarthritis (OA) over 3 years and the relationship between clinical and radiographic changes at the knee joint

Abstract

Five hundred patients with established, symptomatic limb joint OA have been recruited into an on-going prospective study of the natural history of the condition. Four hundred and fifteen patients (mean age 65.6 years, female to male ratio 2.05:1) were available for a full clinical and radiographic review 3 years after entry (mean entry to follow-up interval 37.6 months, range 31-41). The majority reported an overall worsening of their condition, although pain severity did not change. There was an overall increase in disability (Steinbrocker) and the use of walking aids in the group but 57 patients (13.7%) improved, 38 of whom had undergone joint surgery. There was a strong correlation between changes in different clinical outcome measures, but none of the baseline variables predicted change over 3 years with the exception of an association between pain severity and subsequent surgery. One hundred and ninety-three of the 415 patients had knee joint disease at entry. One hundred and forty-five of these patients had knee radiographs and full clinical data available from both time points. Some change was seen in 85 of 276 evaluable tibiofemoral joints (30.1%), but only 10 patellofemoral joints. There was a strong correlation between changes in joint space, osteophyte and subchondral bone scelerosis. However, there was no correlation between radiographic and clinical changes. It is concluded that radiographic change may not be a good surrogate for clinical outcome in established OA. This has implications for the design of long-term studies of possible structure modifying agents in OA.

Prognostic factors of progression of osteoarthritis of the knee: A systematic review of observational studies

“…In contrast to the review on prognostic factors of progression of hip OA by Lievense et al (5), we found only 4 studies (15%) that also used a clinical outcome for progression of knee OA (11,19,23,24,45). The study by Dieppe et al (11) did not include persons with a total knee replacement in the analysis; the other 4 studies used either a radiologic change or a total knee replacement in their definition for progression of knee OA (19,23,24,45).…”

“…Progression was defined as radiologic progression in almost all studies. Only 4 studies (11,19,23,24,45) (15%) also reported on a clinical outcome (total knee replacement).…”

“…Ledingham et al (21) found a significant association with the change in attrition; in their study, no association was found between radiologic severity and change in the K/L score or JSN. Contradictory associations were found in the relationship between clinical severity and progression of knee OA (11,45).…”

“…The study by Dieppe et al (11) did not include persons with a total knee replacement in the analysis; the other 4 studies used either a radiologic change or a total knee replacement in their definition for progression of knee OA (19,23,24,45). The numbers of patients with a total knee replacement in another study by Dieppe et al (11) (n ϭ 415) and 2 studies by Sharif et al (23,24) (n ϭ 75) were 12 and 14, respectively.…”

Identifying common trajectories of joint space narrowing over two years in knee osteoarthritis

“…In the Glucosamine/Chondroitin Arthritis Intervention Trial, over 2 years only 19 -22% of participants had JSN Ͼ0.48 mm (15). Over 3 years, in an older group of 68 individuals in Japan, JSN was evident in 32% of knees (16); this was similar to the proportion (31%) of those exhibiting JSN Ͼ2 mm over 3 years in the Bristol OA500 study (17). Sahlstrom et al reevaluated 110 (of 256 individuals) who had radiographs for knee pain between 1970 and 1973 at a university hospital and who remained untreated or conservatively treated.…”