Liew Jean W, Petrow Eva, Tilley Sarah, LaValley Michael P, Roemer Frank W, Guermazi Ali, Lewis Cora E, Torner James, Nevitt Michael C, Lynch John A, Felson David
Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
Ann Rheum Dis. 2025 Jan;84(1):115-123. doi: 10.1136/ard-2024-226060. Epub 2025 Jan 2.
Preventing worsening osteoarthritis (OA) in persons with early OA is a major treatment goal. We evaluated if different early OA definitions yielded enough cases of worsening OA within 2-5 years to make trial testing treatments feasible.
We assessed different definitions of early OA using data from Multicenter Osteoarthritis (MOST) Study participants who were followed up longitudinally. We defined early OA as having at least minimal knee pain (WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain ≥3/20) with different levels of pre-radiographic OA. For MRI, we required knee pain and used MRI definitions with combinations of cartilage damage, osteophytes, bone marrow lesions and meniscus damage. The primary outcome, worsening OA at 2 or 5 years, combined structural (Kellgren and Lawrence grade ≥2 with joint space narrowing ≥1) and symptom (WOMAC pain ≥6 with increase ≥2 from baseline) outcomes. We also examined structural and symptom outcomes separately.
For worsening OA at 2 years, we included 750 participants (mean age 65 years, 60% female, 90% white, mean body mass index 29.2 kg/m). Fewer than 10% of early OA knees had the combined outcome at 2 or 5 years. At 2 years, for several early OA definitions, roughly 20% of knees had either structural or symptom worsening outcomes. Two-year trials of either, but not both, outcomes would need to recruit over 1200 patients.
Most knees with early OA are stable and do not progress. Some painful knees experience worse pain but not structural progression and vice versa. Trial testing treatments to prevent OA illness or disease will be challenging.
预防早期骨关节炎（OA）患者的病情恶化是一个主要治疗目标。我们评估了不同的早期OA定义在2至5年内是否能产生足够数量的病情恶化OA病例，以使试验性治疗测试可行。
我们使用多中心骨关节炎（MOST）研究参与者的纵向随访数据评估了早期OA的不同定义。我们将早期OA定义为至少有轻度膝关节疼痛（西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛评分≥3/20）且具有不同程度的放射学前期OA。对于磁共振成像（MRI），我们要求有膝关节疼痛，并使用了结合软骨损伤、骨赘、骨髓病变和半月板损伤的MRI定义。主要结局为2年或5年时OA病情恶化，综合了结构（Kellgren和Lawrence分级≥2且关节间隙狭窄≥1）和症状（WOMAC疼痛评分≥6且较基线增加≥2）结局。我们还分别检查了结构和症状结局。
对于2年时病情恶化的OA，我们纳入了750名参与者（平均年龄65岁，60%为女性，90%为白人，平均体重指数29.2kg/m²）。在2年或5年时，不到10%的早期OA膝关节出现综合结局。在2年时，对于几种早期OA定义，约20%的膝关节出现了结构或症状恶化结局。仅针对其中一种（而非两种）结局进行的两年试验将需要招募超过1200名患者。
大多数早期OA膝关节病情稳定且无进展。一些疼痛的膝关节疼痛加剧但无结构进展，反之亦然。试验性测试预防OA疾病的治疗方法将具有挑战性。
