What Comes First? Multitissue Involvement Leading to Radiographic Osteoarthritis: Magnetic Resonance Imaging–Based Trajectory Analysis Over Four Years in the Osteoarthritis Initiative

Abstract

Background To assess whether presence of structural osteoarthritis features over up to 4 years prior incident radiographic (ROA) increases risk for ROA in a nested, case-control design. Methods 355 knees from the Osteoarthritis Initiative cohort that developed ROA before the 48-month visit were studied. They were matched one-to-one by gender, age and radiographic status with a control knee. MR images were read for bone marrow lesions (BMLs), cartilage, meniscus (including tears and extrusion), Hoffa- and effusion-synovitis. Conditional logistic regression was applied to assess risk of ROA in regard to presence of BMLs (≥2), cartilage lesions (≥1.1), meniscal damage (any) and extrusion (≥3 mm), Hoffa- and effusion-synovitis (any). Time points were defined as P0 = incident ROA visit; P-1 = visit prior reported incidence; P-2 = two visits prior etc. Results The presence of Hoffa-synovitis (OR 1.76, 95% CI [1.18,2.64]), effusion-synovitis (OR 1.81, 95% CI [1.18,2.78]), and medial meniscal damage (OR 1.83 95% CI [1.17,2.89]) at P-2 predicted ROA incidence. At P-1, all features but meniscal extrusion predicted ROA, with highest odds for medial BMLs (OR 6.50 95% CI [2.27,18.62]) and effusion-synovitis (OR 2.50 95% CI [1.76,3.54]). The findings at P-3 and P-4 did not reach statistical significance. Conclusion Presence of specific structural features of MRI-detected joint damage two years prior incident ROA increases the risk of incident ROA. However, one year prior ROA, the presence of almost any abnormal morphologic feature increases risk of ROA in the subsequent year.

The prevalence of radiographic and MRI-defined patellofemoral osteoarthritis and structural pathology: a systematic review and meta-analysis

“…However, it is unclear whether these findings represent PF OA, as there is no accepted and validated MRI definition of OA. MRI features such as cartilage damage and BMLs can predict incident radiographic OA,107 development of knee pain108 and future total knee replacement 109. Thus, it is plausible that these MRI findings may represent early stages of the PF OA disease process.…”

Recent advances in the understanding of molecular mechanisms of cartilage degeneration, synovitis and subchondral bone changes in osteoarthritis

“…The clinical importance of the meniscus in OA development is well documented (126)(127)(128). However, meniscus pathology in OA is largely attributed to mechanically mediated loss of structural integrity.…”

Measuring Disease Progression in Osteoarthritis

“…Meniscal alterations are associated with increased risk of developing radiographic knee OA in middle-aged and elderly individuals, with meniscal tears increasing the odds by 5.7 in one study [90] and meniscal damage increasing the hazard ratio of radiographic OA in 2 years by 1.81 in another [85]. Meniscal extrusion independently predicts knee cartilage volume loss at about 2 years [54,91], as do meniscal tears [92].…”

“…Data from the Osteoarthritis Initiative demonstrate that presence of either effusion or Hoffa synovitis predicts incident radiographic knee OA over 2 years [85]. Longitudinal observational data demonstrates that knee effusion/synovitis in the suprapatellar pouch predicts cartilage defects, BMLs and increased cartilage loss over 2.6 years, in a dose-response manner [86].…”