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Performance of distinct knee osteoarthritis classification criteria in the ELSA-Brasil musculoskeletal study

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Abstract

Objective

To compare the performance of different knee osteoarthritis (OA) classification criteria in a subsample of subjects of ELSA-Brasil Musculoskeletal cohort (ELSA-Brasil MSK) in comparison with the clinical-radiographic evaluation of an experienced rheumatologist.

Method

A cross-sectional study of the diagnostic accuracy of different knee OA classification criteria: radiographic OA, symptomatic OA, clinical and clinical-radiographic criteria of the American College of Rheumatology (ACR), and the definition proposed by the National Institute for Health and Care Excellence (NICE), UK. The study also evaluated some alternative definitions of OA including a combination of criteria. In total, 250 subjects participated. Only one knee per subject was included. When both or none of the knees were affected, one knee was randomly selected for analysis. OA prevalence, sensitivity, specificity, positive and negative predictive values, and accuracy were presented (CI 95%; α = 5%).

Results

The mean age was 56.1 years (SD = 8.7), 48.8% female, and 39.2% presented knee OA according to the rheumatologist. The sensitivity and the specificity of radiographic OA were 51% and 96.7%, respectively, while the NICE definition showed 57.0% and 76.3%, respectively. The other OA criteria showed good levels of specificity, but the levels of sensitivity were below 30%. Considering NICE and/or X-ray result in combination, the sensitivity increased (73.4%), while the specificity reduced slightly (73.0%) in relation to the original NICE definition.

Conclusions

Radiographic OA showed the best performance, followed by NICE definition, especially in combination with X-ray results.

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Acknowledgements

The authors would like to thank the management and staff of the radiology service Clínica Radiológica Javert Barros for their valuable assistance in this study, especially to Dr. Evandro Barros Naves.

Role of the funding source

The ELSA-Brasil was supported by Ministério da Saúde Brasil (BR), Secretaria de Ciência Tecnologia e Insumos Estratégicos (BR), Ministério da Ciência e Tecnologia (BR), Departamento de Ciência e Tecnologia (Decit –BR), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq-BR), and Financiadora de Estudos e Projetos (FINEP-BR). The ELSA-Brasil MSK baseline study was supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES-BR). SMB is a research fellow of CNPq and State of Minas Gerais Agency for Research and Technology (FAPEMIG). The contents of this manuscript are solely the responsibility of the authors. The investigators are solely responsible for the content of the manuscript and the decision to submit for publication. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. SMB has research fellowships from the Brazilian National Research Council (CNPq) and from the Research Foundation of Minas Gerais (FAPEMIG).

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Authors and Affiliations

  1. Faculty of Medicine, ELSA-Brasil Investigation Centre, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Rita de Cássia Corrêa Miguel, Luciana Andrade Machado, Luciana Costa-Silva, Rosa Weiss Telles & Sandhi Maria Barreto

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  1. Rita de Cássia Corrêa Miguel
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Contributions

SMB, RWT, LACM, and RCCM conceived and design the study. RCCM and LCS acquired the data. RCCM performed data analysis. RCCM, SMB, RWT, and LACM interpreted the data. RCCM wrote the first draft of the manuscript. All authors revised the manuscript for intellectual content and approved the final version for submission.

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Correspondence to Sandhi Maria Barreto.

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Miguel, R.d.C., Machado, L.A., Costa-Silva, L. et al. Performance of distinct knee osteoarthritis classification criteria in the ELSA-Brasil musculoskeletal study. Clin Rheumatol 38, 793–802 (2019). https://doi.org/10.1007/s10067-018-4347-0

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