ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2753

Relationship Of Pre-Radiographic MRI Lesions With Prevalent Frequent Knee Symptoms and Incident Persistent Knee Symptoms In Persons At Higher Risk For Knee Osteoarthritis

Leena Sharma1, Joan S. Chmiel1, Orit Almagor1, Dorothy D. Dunlop2, Marc C. Hochberg3, Charles Eaton4, C. Kent Kwoh5, Rebecca D. Jackson6, Joan M. Bathon7, Ali Guermazi8, Frank Roemer9, Michel Crema8, W. Jerry Mysiw6 and Michael C. Nevitt10, 1Northwestern University, Chicago, IL, 2Northwestern University Feinberg School of Medicine, Chicago, IL, 3Medicine, University of Maryland School of Medicine, Baltimore, MD, 4Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Providence, RI, 5School of Medicine, Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, 6Ohio State University, Columbus, OH, 7Columbia University, New York, NY, 8Boston University, Boston, MA, 9Klinikum Augsburg, Augsburg, Germany, 10Epidemiology & Biostatistics, UCSF (University of California, San Francisco), San Francisco, CA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Osteoarthritis II: Risk Factors and Natural History of Osteoarthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: The clinical significance of pre-radiographic MRI lesions in persons at risk for knee OA is unclear.  Understanding whether such lesions are inconsequential or early disease will aid prevention and disease-modifying strategy design.  We hypothesized, in persons at risk but without radiographic OA, that cartilage damage, bone marrow lesions (BML), meniscal tear (MT), and meniscal extrusion (ME) are each associated with 1) prevalent frequent knee symptoms and 2) incident persistent knee symptoms.

Methods: The Osteoarthritis Initiative is a cohort study of men and women age 45-79 years with or at increased risk to develop knee OA.  850 participants were bilateral K/L 0 at 12 months.  In their 12-month right knee (left if right inadequate) MR images, we assessed cartilage, BML, MT, and ME using a modified MOAKS system, blinding readers to hypotheses and all other data.  At baseline, of the 850, 578 were without frequent knee symptoms (knee symptoms or medication use for knee symptoms most days of a month in the past 12 months).  Incident persistent knee symptoms were defined as frequent knee symptoms at 2 consecutive annual OAI visits.  Multiple logistic regression models evaluated associations between each lesion and 1) prevalent frequent symptoms and 2) incident persistent symptoms by 60 months, adjusting for age, gender, BMI, knee injury, and knee surgery.

Results: As shown in Table 1, cartilage damage, BML, and ME were each associated with prevalent frequent knee symptoms.  As shown in Table 2, cartilage damage and BML (particularly patellofemoral), and MT were each associated with incident persistent symptoms. 

Conclusion: In persons at higher risk but without any evidence of radiographic knee OA, cartilage damage, BML, ME, and BMI were associated with prevalent frequent knee symptoms, and cartilage damage, BML, MT, and BMI with the new development of persistent symptoms by 5 years.   These findings suggest that these lesions, in persons at higher risk for knee OA, are clinically significant and may represent early disease. 

Table 1.  Pre-radiographic MRI Lesions and Risk of Prevalent Frequent Knee Symptoms

n = 850 persons K/L 0 in both knees [mean age 59.6 years (8.8, SD), BMI 26.7 kg/m2 (4.2), 475 (55.9%) women]. 

(TF = tibiofemoral, PF = patellofemoral)

 

Number of knees

(1 knee per person)

Number of knees (row%) with frequent knee symptoms

OR (95% CI)

Unadjusted

OR (95% CI)

Adjusted for age, gender, BMI, previous knee injury, previous knee surgery

Cartilage damage (TF or PF)

642

178 (27.7%)

1.81 (1.21, 2.69)

1.75 (1.16, 2.63)*

Cartilage damage (TF only)

118

27 (22.9%)

0.86 (0.54, 1.36)

0.78 (0.49, 1.26)*

Cartilage damage (PF only)

257

64 (24.9%)

0.98 (0.70, 1.37)

0.95 (0.67, 1.35)*

Cartilage damage (TF and PF)

266

87 (32.7%)

1.73 (1.26, 2.40)

1.85 (1.32, 2.59)*

No cartilage damage (TF or PF)

208

36 (17.3%)

reference

reference

 

 

 

 

 

BML (TF or PF)

515

155 (30.1%)

2.00 (1.42, 2.80)

1.95 (1.38, 2.76)*

BML (TF only)

79

21 (26.6%)

1.08 (0.64, 1.82)

1.04 (0.60, 1.79)*

BML (PF only)

289

84 (29.1%)

1.34 (0.98, 1.87)

1.38 (0.99, 1.92)*

BML (TF and PF)

147

50 (34.0%)

1.68 (1.15, 2.47)

1.62 (1.09, 2.40)*

No BML (TF or PF)

335

59 (17.6%)

reference

reference

 

 

 

 

 

MT

180

51 (28.3%)

1.22 (0.84, 1.77)

1.22 (0.82, 1.81)*

No MT

670

163 (24.3%)

reference

reference

 

 

 

 

 

ME

117

39 (33.3%)

1.58 (1.04, 2.41)

1.67 (1.08, 2.59)*

No ME

733

175 (23.9%)

reference

reference

* BMI also significant

 

 

Table 2.  Pre-radiographic MRI Lesions and Risk of Incident Persistent Knee Symptoms

n = 578 persons K/L 0 in both knees and without frequent knee symptoms at baseline [mean age 59.3 years (9.0), BMI 26.6 kg/m2 (4.3), 324 (56.1%) women]. 

 

Number of knees

(1 knee per person)

Number of knees (row%) with incident persistent knee symptoms

OR (95% CI)

Unadjusted

OR (95% CI)

Adjusted for age, gender, BMI, previous knee injury, previous knee surgery

Cartilage damage (TF or PF)

423

86 (20.3%)

1.94 (1.13, 3.35)

1.72 (0.98, 3.02)*

Cartilage damage (TF only)

84

13 (15.5%)

1.39 (0.65, 3.01)

1.17 (0.51, 2.73)*

Cartilage damage (PF only)

178

38 (21.3%)

2.07 (1.12, 3.80)

1.98 (1.04, 3.75)*

Cartilage damage (TF and PF)

161

35 (21.7%)

2.11 (1.14, 3.92)

2.00 (1.04, 3.84)

No cartilage damage (TF or PF)

155

18 (11.6%)

reference

reference

 

 

 

 

 

BML (TF or PF)

337

75 (22.3%)

2.09 (1.31, 3.33)

1.90 (1.18, 3.06)*

BML (TF only)

48

9 (18.8%)

1.69 (0.74, 3.84)

1.42 (0.58, 3.45)**

BML (PF only)

197

43 (21.8%)

2.04 (1.22, 3.42)

1.82 (1.07, 3.08)

BML (TF and PF)

92

23 (25.0%)

2.44 (1.32, 4.49)

2.31 (1.24, 4.31)

No BML (TF or PF)

241

29 (12.0%)

reference

reference

 

 

 

 

 

MT

109

30 (27.5%)

2.03 (1.24, 3.30)

1.97 (1.17, 3.33)*

No MT

469

74 (15.8%)

reference

reference

 

 

 

 

 

ME

61

18 (29.5%)

2.10 (1.16, 3.81)

1.69 (0.90, 3.18)*

No ME

517

86 (16.6%)

reference

reference

*BMI also significant

**Previous surgery also significant

 

 

Disclosure:

L. Sharma,
None;

J. S. Chmiel,
None;

O. Almagor,
None;

D. D. Dunlop,
None;

M. C. Hochberg,

Abbvie, Inc,

5,

Bioiberica SA,

5,

Eli Lilly and Company,

5,

Genentech, Inc,

5,

Iroko Pharmaceuticals, LLC,

5,

Merck, Inc,

5,

Novartis Pharma AG,

5,

Pfizer, Inc,

5,

Savient Pharmaceuticals,

5;

C. Eaton,
None;

C. K. Kwoh,
None;

R. D. Jackson,

NIH,

2;

J. M. Bathon,
None;

A. Guermazi,

Boston Imaging Core Lab,

1,

Merck Serono,

5,

Sanofi-Aventis Pharmaceutical,

5,

TissueGene,

5;

F. Roemer,

BICL, LLC,

1,

BICL, LLC,

3,

Merck-Serono,

5;

M. Crema,

BICL, LLC,

1,

BICL, LLC,

3;

W. J. Mysiw,
None;

M. C. Nevitt,
None.

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