Tufts Medical Center, Boston, Massachusetts.
Tufts University and Tufts Medical Center, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2022 May;74(5):799-808. doi: 10.1002/acr.24512. Epub 2022 Mar 1.
We developed and validated a set of composite scores that combine quantitative magnetic resonance imaging (MRI)-based measurements of hyaline cartilage damage, bone marrow lesions (BMLs), and effusion-synovitis into composite scores.
We selected 300 participants (n = 100 for development cohort; n = 200 for validation cohort) from the Osteoarthritis Initiative with complete clinical, radiographic, and MRI data at baseline and 24 months. We used semiautomated programs to quantify tibiofemoral and patellar cartilage damage, BML volume, and whole-knee effusion-synovitis volume. The candidate composite scores were formed by summing changes from baseline to 24 months based on prespecified methods. We evaluated the candidate composite scores for 1) the ability to differentiate groups with and without knee osteoarthritis progression (17 radiographic and patient-reported definitions), 2) sensitivity to change (standardized response means), and 3) relative performance relating to legacy outcome measures of knee osteoarthritis progression.
Three of 13 developed composite scores qualified for testing in the validation cohort (ranked by sensitivity to change): whole-knee cumulative cartilage damage, unweighted total knee score, and BML plus effusion-synovitis volume. Change in cumulative cartilage damage associated with radiographic progression (Kellgren/Lawrence grade: odds ratio [OR] 1.84; joint space width progression: OR 2.11). Changes in the unweighted total knee score (OR 1.97) and BML plus effusion-synovitis score (OR 1.92) associated with Western Ontario and McMaster Universities Osteoarthritis Index knee pain progression.
Two composite scores emerged, reflecting discrete domains of knee osteoarthritis progression. First, cumulative damage, which is measured by a whole-knee cartilage damage score, reflects the damage accrued over time. Second, dynamic disease activity, which is measured by a BML plus effusion-synovitis score, relates to changes in a patient's state of disease and symptoms.
我们开发并验证了一套综合评分，将基于定量磁共振成像（MRI）的透明软骨损伤、骨髓病变（BML）和积液滑膜炎的测量结果结合到综合评分中。
我们从骨关节炎倡议中选择了 300 名参与者（100 名用于开发队列；200 名用于验证队列），他们在基线和 24 个月时具有完整的临床、放射学和 MRI 数据。我们使用半自动程序来量化胫骨股骨和髌骨软骨损伤、BML 体积和全膝关节积液滑膜炎体积。候选综合评分是根据预设方法从基线到 24 个月的变化求和得出的。我们评估了候选综合评分的 1）区分有无膝关节骨关节炎进展的组的能力（17 种放射学和患者报告的定义）、2）对变化的敏感性（标准化反应均值）、以及 3）与膝关节骨关节炎进展的传统结果测量的相对表现。
在验证队列中测试的 13 个综合评分中有 3 个合格（按对变化的敏感性排序）：全膝关节累积软骨损伤、未加权总膝关节评分和 BML 加积液滑膜炎体积。与放射学进展相关的累积软骨损伤变化（Kellgren/Lawrence 分级：比值比 [OR] 1.84；关节间隙宽度进展：OR 2.11）。未加权总膝关节评分（OR 1.97）和 BML 加积液滑膜炎评分（OR 1.92）的变化与 Western Ontario 和 McMaster 大学骨关节炎指数膝关节疼痛进展相关。
出现了两个综合评分，反映了膝关节骨关节炎进展的不同领域。首先，累积损伤，通过全膝关节软骨损伤评分来衡量，反映了随时间积累的损伤。其次，动态疾病活动，通过 BML 加积液滑膜炎评分来衡量，与患者疾病状态和症状的变化有关。
