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      The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology

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          Definition and classification of early osteoarthritis of the knee.

          With the emerging interest in regenerative medicine and tissue engineering, new treatment modalities being developed for joint disorders including joint surface lesions and articular cartilage defects. The clinical outcome of these novel approaches appears rather unpredictable and is due to many reasons but definitely also linked to the patient profile. As a typical example, symptomatic articular cartilage lesions can be presented in an otherwise normal joint, or associated with several other joint tissue alterations including meniscal lesions and abnormalities of the underlying bone. The outcome of novel treatments may well be influenced by the status of the whole joint, and the potential to develop osteoarthritis. To better identify the patients at risk and responders to certain treatments, it is of use to define and most importantly classify patients with "early osteoarthritis". Here, classification criteria for this group of patients are presented, allowing a more defined and accurate inclusion in clinical trials in the future.
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            Early diagnosis to enable early treatment of pre-osteoarthritis

            Osteoarthritis is a prevalent and disabling disease affecting an increasingly large swathe of the world population. While clinical osteoarthritis is a late-stage condition for which disease-modifying opportunities are limited, osteoarthritis typically develops over decades, offering a long window of time to potentially alter its course. The etiology of osteoarthritis is multifactorial, showing strong associations with highly modifiable risk factors of mechanical overload, obesity and joint injury. As such, characterization of pre-osteoarthritic disease states will be critical to support a paradigm shift from palliation of late disease towards prevention, through early diagnosis and early treatment of joint injury and degeneration to reduce osteoarthritis risk. Joint trauma accelerates development of osteoarthritis from a known point in time. Human joint injury cohorts therefore provide a unique opportunity for evaluation of pre-osteoarthritic conditions and potential interventions from the earliest stages of degeneration. This review focuses on recent advances in imaging and biochemical biomarkers suitable for characterization of the pre-osteoarthritic joint as well as implications for development of effective early treatment strategies.
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              Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: data from the osteoarthritis initiative.

              It is widely believed that there are multiple sources of pain at a tissue level in osteoarthritis (OA). Magnetic Resonance Images (MRIs) provide a wealth of anatomic information and may allow identification of specific features associated with pain. We hypothesized that in knees with OA, bone marrow lesions (BMLs), synovitis, and effusion would be associated with weight-bearing and (less so with) non-weight-bearing pain independently. In a cross-sectional study of persons with symptomatic knee OA using univariate and multivariate logistic regressions with maximal BML, effusion, and synovitis defined by Boston Leeds Osteoarthritis Knee Score as predictors, and knee pain using weight-bearing and non-weight-bearing Western Ontario and McMaster University OA Index pain questions as the outcome, we tested the association between MRI findings and knee symptoms. 160 participants, mean age 61 (+/-9.9), mean body mass index (BMI) 30.3 (+/-4.7) and 50% female, stronger associations were seen with weight-bearing compared with non-weight-bearing knee pain with adjusted risk ratios (RRs) of weight-bearing knee pain, for increasing maximal BML scores of 1.0 (referent) (maximal BML=0), 1.2, 1.9, and 2.0 (P for trend=0.006). For effusion scores, adjusted RRs of knee pain were 1.0, 1.7, 2.0, and 2.6 (P for trend=0.0004); and for synovitis scores, adjusted ORs were 1.0, 1.4, 1.5, and 1.9 (P for trend=0.22). Cross-sectionally, maximal BML and effusion scores are independently associated with weight-bearing and less so with non-weight-bearing knee pain, supporting the idea that pain in OA is multifactorial. These MRI features should be considered as possible new treatment targets in knee OA.
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                Author and article information

                Journal
                Rheumatology International
                Rheumatol Int
                Springer Science and Business Media LLC
                0172-8172
                1437-160X
                August 2017
                April 27 2017
                August 2017
                : 37
                : 8
                : 1227-1236
                Article
                10.1007/s00296-017-3700-y
                28451793
                e6f4e371-679d-475e-a66c-f8583572af44
                © 2017

                http://www.springer.com/tdm

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