Clinical risk factors associated with radiographic osteoarthritis progression among people with knee pain: a longitudinal study

Milena Simic, Alison R Harmer, Maria Agaliotis, Lillias Nairn, Lisa Bridgett, Lyn March, Milana Votrubec, John Edmonds, Mark Woodward, Richard Day, Marlene Fransen, Milena Simic, Alison R Harmer, Maria Agaliotis, Lillias Nairn, Lisa Bridgett, Lyn March, Milana Votrubec, John Edmonds, Mark Woodward, Richard Day, Marlene Fransen

Abstract

Background: The aim of this study was to identify modifiable clinical factors associated with radiographic osteoarthritis progression over 1 to 2 years in people with painful medial knee osteoarthritis.

Methods: A longitudinal study was conducted within a randomised controlled trial, the "Long-term Evaluation of Glucosamine Sulfate" (LEGS study). Recruitment occurred in 2007-2009, with 1- and 2-year follow-up assessments by blinded assessors. Community-dwelling people with chronic knee pain (≥4/10) and medial tibiofemoral narrowing (but retaining >2mm medial joint space width) on radiographs were recruited. From 605 participants, follow-up data were available for 498 (82%, mean [sd] age 60 [8] years). Risk factors evaluated at baseline were pain, physical function, use of non-steroidal anti-inflammatory drugs (NSAIDs), statin use, not meeting physical activity guidelines, presence of Heberden's nodes, history of knee surgery/trauma, and manual occupation. Multivariable logistic regression analysis was conducted adjusting for age, sex, obesity, high blood pressure, allocation to glucosamine and chondroitin treatment, and baseline structural disease severity (Kellgren and Lawrence grade, joint space width, and varus alignment). Radiographic osteoarthritis progression was defined as joint space narrowing ≥0.5mm over 1 to 2 years (latest follow-up used where available).

Results: Radiographic osteoarthritis progression occurred in 58 participants (12%). Clinical factors independently associated with radiographic progression were the use of NSAIDs, adjusted odds ratios (OR) and 95% confidence intervals (CI) 2.05 (95% CI 1.1 to 3.8), and not meeting physical activity guidelines, OR 2.07 (95% CI 0.9 to 4.7).

Conclusions: Among people with mild radiographic knee osteoarthritis, people who use NSAIDs and/or do not meet physical activity guidelines have a greater risk of radiographic osteoarthritis progression.

Trial registration: ClinicalTrials.gov , NCT00513422 . This original study trial was registered a priori, on August 8, 2007. The current study hypothesis arose before inspection of the data.

Keywords: Disease progression; Epidemiology; Knee osteoarthritis; Non-steroidal anti-inflammatory drugs; Risk factors.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage (95% confidence interval) of participants with radiographic OA progression (JSN ≥ 0.5mm) based on the number of positive risk factors

References

    1. Safiri S, Kolahi A-A, Smith E, Hill C, Bettampadi D, Mansournia MA, Hoy D, Ashrafi-Asgarabad A, Sepidarkish M, Almasi-Hashiani A, Collins G, Kaufman J, Qorbani M, Moradi-Lakeh M, Woolf AD, Guillemin F, March L, Cross M. Global, regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the global burden of disease study 2017. Ann Rheum Dis. 2020;79(6):819–828. doi: 10.1136/annrheumdis-2019-216515.
    1. Wise BL, Niu J, Yang M, Lane NE, Harvey W, Felson DT, Hietpas J, Nevitt M, Sharma L, Torner J, Lewis CE, Zhang Y, Multicenter Osteoarthritis (MOST) Group Patterns of compartment involvement in tibiofemoral osteoarthritis in men and women and in whites and African Americans. Arthritis Care Res. 2012;64(6):847–852. doi: 10.1002/acr.21606.
    1. Silverwood V, Blagojevic-Bucknall M, Jinks C, Jordan JL, Protheroe J, Jordan KP. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthr Cartil. 2015;23(4):507–515. doi: 10.1016/j.joca.2014.11.019.
    1. Biswal S, Hastie T, Andriacchi TP, Bergman GA, Dillingham MF, Lang P. Risk factors for progressive cartilage loss in the knee. Arthritis Rheum. 2002;46(11):2884–2892. doi: 10.1002/art.10573.
    1. Chapple CM, Nicholson H, Baxter GD, Abbott JH. Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies. Arthritis Care Res. 2011;63(8):1115–1125. doi: 10.1002/acr.20492.
    1. Cooper C, Snow S, McAlindon TE, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000;43(5):995–1000. doi: 10.1002/1529-0131(200005)43:5<995::AID-ANR6>;2-1.
    1. Crema MD, Nevitt MC, Guermazi A, Felson DT, Wang K, Lynch JA, Marra MD, Torner J, Lewis CE, Roemer FW. Progression of cartilage damage and meniscal pathology over 30 months is associated with an increase in radiographic tibiofemoral joint space narrowing in persons with knee OA – the MOST study. Osteoarthr Cartil. 2014;22(10):1743–1747. doi: 10.1016/j.joca.2014.07.008.
    1. Muraki S, Akune T, En-yo Y, Yoshida M, Suzuki T, Yoshida H, Ishibashi H, Tokimura F, Yamamoto S, Tanaka S, Nakamura K, Kawaguchi H, Oka H, Yoshimura N. Joint space narrowing, body mass index, and knee pain: the ROAD study. Osteoarthr Cartil. 2015;23(6):874–881. doi: 10.1016/j.joca.2015.01.011.
    1. Bruyere O, Richy F, Reginster J-Y. Three year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study. Ann Rheum Dis. 2005;64(12):1727–1730. doi: 10.1136/ard.2005.037309.
    1. Leyland KM, Hart DJ, Javaid MK, Judge A, Kiran A, Soni A, Goulston LM, Cooper C, Spector TD, Arden NK. The natural history of radiographic knee osteoarthritis: a fourteen-year population-based cohort study. Arthritis Rheum. 2012;64(7):2243–2251. doi: 10.1002/art.34415.
    1. Bastick A, Belo J, Runhaar J, Bierma-Zeinstra SMA. What are the prognostic factors for radiographic progression of knee osteoarthritis? A meta-analysis. Clin Orthop Relat Res. 2015;473(9):2969–2989. doi: 10.1007/s11999-015-4349-z.
    1. Schouten JS, van den Ouweland FA, Valkenburg HA. A 12 year follow up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee. Ann Rheum Dis. 1992;51(8):932–937. doi: 10.1136/ard.51.8.932.
    1. Fransen M, Agaliotis M, Nairn L, Votrubec M, Bridgett L, Su S, Jan S, March L, Edmonds J, Norton R, Woodward M, Day R, LEGS study collaborative group Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis. 2015;74(5):851–858. doi: 10.1136/annrheumdis-2013-203954.
    1. Buckland-Wright JC, Wolfe F, Ward RJ, Flowers N, Hayne C. Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a comparative radiographic study, without fluoroscopy, of standing extended, semiflexed (MTP), and schuss views. J Rheumatol. 1999;26(12):2664–2674.
    1. Conrozier T, Mathieu P, Piperno M, Favret H, Colson F, Vignon M, Conrozier S, Vignon E. Selection of knee radiographs for trials of structure-modifying drugs in patients with knee osteoarthritis: a prospective, longitudinal study of Lyon schuss knee radiographs with the definition of adequate alignment of the medial tibial plateau. Arthritis Rheum. 2005;52(5):1411–1417. doi: 10.1002/art.21024.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation-study of WOMAC - a health-status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug-therapy in patients with osteo-arthritis of the hip or knee. J Rheumatol. 1988;15(12):1833–1840.
    1. Armstrong T, Bauman A, Davies J. Physical activity patterns of Australian adults. results of the 1999 national physical activity survey. Canberra: Australian Institute of Health and Welfare; 2000.
    1. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP, American College of Sports Medicine Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359. doi: 10.1249/MSS.0b013e318213fefb.
    1. Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Care Res. 2003;49(2):156–163. doi: 10.1002/art.10993.
    1. Gandhi SK, Warren Salmon J, Zhao SZ, Lambert BL, Gore PR, Conrad K. Psychometric evaluation of the 12-item short-form health survey (SF-12) in osteoarthritis and rheumatoid arthritis clinical trials. Clin Ther. 2001;23(7):1080–1098. doi: 10.1016/S0149-2918(01)80093-X.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):485–493. doi: 10.1136/ard.16.4.485.
    1. Hellio Le Graverand M-P, Vignon EP, Brandt KD, et al. Head-to-head comparison of the Lyon Schuss and fixed flexion radiographic techniques. Long-term reproducibility in normal knees and sensitivity to change in osteoarthritic knees. Ann Rheum Dis. 2008;67(11):1562–1566. doi: 10.1136/ard.2007.077834.
    1. Hinman RS, May RL, Crossley KM. Is there an alternative to the full-leg radiograph for determining knee joint alignment in osteoarthritis? Arthritis Care Res. 2006;55(2):306–313. doi: 10.1002/art.21836.
    1. Moreland JR, Bassett LW, Hanker GJ. Radiographic analysis of axial alignment of the lower extremity. J Bone Joint Surg-Am Vol. 1987;69(5):745–749. doi: 10.2106/00004623-198769050-00016.
    1. Ornetti P, Brandt K, Hellio-Le Graverand MP, et al. OARSI–OMERACT definition of relevant radiological progression in hip/knee osteoarthritis. Osteoarthr Cartil. 2009;17(7):856–863. doi: 10.1016/j.joca.2009.01.007.
    1. Cooper C, Adachi JD, Bardin T, Berenbaum F, Flamion B, Jonsson H, Kanis JA, Pelousse F, Lems WF, Pelletier JP, Martel-Pelletier J, Reiter S, Reginster JY, Rizzoli R, Bruyère O. How to define responders in osteoarthritis. Curr Med Res Opin. 2013;29(6):719–729. doi: 10.1185/03007995.2013.792793.
    1. Niu J, Clancy M, Aliabadi P, Vasan R, Felson DT. Metabolic syndrome, its components, and knee osteoarthritis: the Framingham Osteoarthritis Study. Arthritis Rheum. 2017;69(6):1194–1203. doi: 10.1002/art.40087.
    1. Wasserstein RL, Lazar NA. The ASA’s statement on p-values: context, process, and purpose. Am Stat. 2016;70(2):129–133. doi: 10.1080/00031305.2016.1154108.
    1. Hawthorne G, Osborne RH, Taylor A, Sansoni J. The SF36 version 2: critical analyses of population weights, scoring algorithms and population norms. Qual Life Res. 2007;16(4):661–673. doi: 10.1007/s11136-006-9154-4.
    1. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P, American College of Rheumatology American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64(4):465–474. doi: 10.1002/acr.21596.
    1. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–388. doi: 10.1016/j.joca.2014.01.003.
    1. Bjordal JM, Ljunggren AE, Klovning A, Slørdal L. Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. Br Med J. 2004;329(7478):1317. doi: 10.1136/bmj.38273.626655.63.
    1. Day RO, Graham GG. Non-steroidal anti-inflammatory drugs (NSAIDs) BMJ. 2013;346:f3195.
    1. Tamim H, Monfared AA, LeLorier J. Application of lag-time into exposure definitions to control for protopathic bias. Pharmacoepidemiol Drug Saf. 2007;16(3):250–258. doi: 10.1002/pds.1360.
    1. Ding C, Cicuttini F, Jones G. Do NSAIDs affect longitudinal changes in knee cartilage volume and knee cartilage defects in older adults? Am J Med. 2009;122(9):836–842. doi: 10.1016/j.amjmed.2009.03.022.
    1. Reijman M, Bierma-Zeinstra SM, Pols HA, Koes BW, Stricker BH, Hazes JM. Is there an association between the use of different types of nonsteroidal antiinflammatory drugs and radiologic progression of osteoarthritis? The Rotterdam Study. Arthritis Rheum. 2005;52(10):3137–3142. doi: 10.1002/art.21357.
    1. Huskisson EC, Berry H, Gishen P, Jubb RW, Whitehead J. Effects of antiinflammatory drugs on the progression of osteoarthritis of the knee. LINK Study Group. Longitudinal Investigation of Nonsteroidal Antiinflammatory Drugs in Knee Osteoarthritis. J Rheumatol. 1995;22(10):1941–1946.
    1. Lapane KL, Yang S, Driban JB, Liu SH, Dubé CE, McAlindon TE, Eaton CB. Effects of prescription nonsteroidal antiinflammatory drugs on symptoms and disease progression among patients with knee osteoarthritis. Arthritis Rheum. 2015;67(3):724–732. doi: 10.1002/art.38933.
    1. Wluka AE, Ding C, Wang Y, Jones G, Urquhart DM, Cicuttini FM. Aspirin is associated with reduced cartilage loss in knee osteoarthritis: data from a cohort study. Maturitas. 2015;81(3):394–397. doi: 10.1016/j.maturitas.2015.04.015.
    1. Maly MR. Abnormal and cumulative loading in knee osteoarthritis. Curr Opin Rheumatol. 2008;20(5):547–552. doi: 10.1097/BOR.0b013e328307f58c.
    1. Timmins KA, Leech RD, Batt ME, Edwards KL. Running and knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med. 2017;45(6):1447–1457. doi: 10.1177/0363546516657531.
    1. Dean E, Gormsen HR. Prescribing optimal nutrition and physical activity as “First-Line” interventions for best practice management of chronic low-grade inflammation associated with osteoarthritis: evidence synthesis. Arthritis. 2012;2012:560634. doi: 10.1155/2012/560634.
    1. Pietrosimone B, Thomas AC, Saliba SA, Ingersoll CD. Association between quadriceps strength and self-reported physical activity in people with knee osteoarthritis. Int J Sports Phys Ther. 2014;9(3):320–328.
    1. Bennell KL, Hunt MA, Wrigley TV, Lim B-W, Hinman RS. Role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin N Am. 2008;34(3):731–754. doi: 10.1016/j.rdc.2008.05.005.
    1. Martel-Pelletier J, Roubille C, Abram F, Hochberg MC, Dorais M, Delorme P, Raynauld JP, Pelletier JP. First-line analysis of the effects of treatment on progression of structural changes in knee osteoarthritis over 24 months: data from the osteoarthritis initiative progression cohort. Ann Rheum Dis. 2015;74(3):547–556. doi: 10.1136/annrheumdis-2013-203906.
    1. Sawitzke AD, Shi H, Finco MF, Dunlop DD, Bingham CO, III, Harris CL, Singer NG, Bradley JD, Silver D, Jackson CG, Lane NE, Oddis CV, Wolfe F, Lisse J, Furst DE, Reda DJ, Moskowitz RW, Williams HJ, Clegg DO. The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the Glucosamine/Chondroitin Arthritis Intervention Trial. Arthritis Rheum. 2008;58(10):3183–3191. doi: 10.1002/art.23973.
    1. Zhang Y, Niu J, Felson DT, Choi HK, Nevitt M, Neogi T. Methodologic challenges in studying risk factors for progression of knee osteoarthritis. Arthritis Care Res. 2010;62(11):1527–1532. doi: 10.1002/acr.20287.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner