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Radiographic abnormalities predict progression in osteoarthritis patients

NEW YORK (Reuters Health) – Radiographic abnormalities strongly predict the risk of progression in clinical osteoarthritis (OA) patients, according to a report in the January issue of The Journal of Rheumatology.

In a longitudinal study, Dr. Frederick Wolfe, of the National Data Bank for Rheumatic Diseases, Wichita, Kansas, and Dr. Nancy E. Lane of the University of California, San Francisco, examined the rate of progression of radiographic joint space narrowing (JSN) in 1507 patients with knee OA.

They evaluated extended weight-bearing anterior-posterior views of the knee and determined long-term outcomes of the disease. Baseline demographic and severity measurements were also collected. This included data on body mass index, pain, global severity, Health Assessment Questionnaire disability, and erythrocyte sedimentation rate. Kaplan-Meier analyses and Cox regression were used to obtain rates and predictors of progression, using a JSN score of 3 as "failure."

The investigators report that "among symptomatic patients with OA of the knee, 25% with JSN of 1 and 2 will progress to complete joint obliteration in 7.41 and 4.49 years, respectively; and 50% are estimated to reach that endpoint in 12.03 and 7.44 years."

Multivariate analysis showed that initial JSN, body mass index, duration of symptoms, and global severity predicted progression.

However, only JSN was a strong predictor of progression. While body mass index predicted JSN in patients with JSN=0 at onset, it was not a predictor in those with more severe disease.

Contralateral JSN only predicted progression in patients with initial homolateral JSN scores of 0, the team explains. "Assessment of homolateral osteophytes aided prediction in patients with initial JSN=0, but was of much less help when JSN had a higher severity score."

Overall, they conclude that "the risk of progression in clinical OA patients with radiographic abnormalities is substantial."

J Rheumatol 2002;29:139-146.

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