Abstract
Background and purposes
Discordance between clinical and radiological profiles in knee osteoarthritis has been reported. We hypothesized that the discordance could be due to limited radiological variables studied. This study essentially analyzed many more radiological features than previous studies in order to seek an association between clinical and radiographic features.
Methods
One hundred and eighty patients with knee osteoarthritis were enrolled as per the American College of Rheumatology (ACR) guidelines. Visual analog scale (VAS) for knee pain and the knee-specific Western Ontario Mac University (WOMAC) index for pain, stiffness, and disability were recorded. Five additional radiological features apart from those in the Kellgren-Lawrence (KL) classification grading system were recorded by two authors who were blinded to the clinical diagnosis. The variables significantly associated were analyzed by linear regression model.
Results
Pain was significantly associated with increasing KL grades; physical function was nearly significant and stiffness was not. On analysis of individual radiological features, WOMAC pain was significant with subchondral sclerosis, joint space width, and tibiofemoral alignment although the correlation was week. VAS pain was significant with the latter two and with articular incongruity. Functional disability was associated with medial joint-space narrowing, tibiofemoral alignment, loose bodies, and juxta-articular osteopenia. However, in the linear regression model, pain and stiffness were significantly associated with articular incongruity and functional disability and total clinical scores with juxta-articular osteopenia.
Conclusion
When the radiological features were extended beyond those included in KL grades, pain, stiffness, and disability correlated well with radiography; articular incongruity with pain and stiffness; and juxta-articular osteopenia with physical disability and clinical severity.
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References
Cobb S, Merchant WR, Rubin T. The relation of symptoms to osteoarthritis. J Chronic Dis. 1957;5(2):197–204.
Hart DJ, Spector TD, Brown P, Wilson P, Doyle DV, Silman AJ. Clinical signs of early osteoarthritis: reproducibility and relation to x ray changes in 541 women in the general population. Ann Rheum Dis. 1991;50(7):467–70.
Felson DT. The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum. 1990;20(3):42–50.
Lanyon P, O’Reilly S, Jones A, Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis. 1998;57(10):595–601.
Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis. 1966;25(1):1–24.
Lethbridge-Cejku M, Scott WW, Reichle R, Ettinger WH, Zonderman A, Costa P, Plato CC, Tobin JD, Hochberg MC. Association of radiographic features of osteoarthritis of the knee with knee pain: data from the Baltimore longitudinal study of aging. Arthritis Care Res. 1995;8(3):182–8.
Davis MA, Ettinger WH, Neuhaus JM, Barclay JD, Segal MR. Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. J Rheumatol. 1992;19(12):1943–9.
McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Determinants of disability in osteoarthritis of the knee. Ann Rheum Dis. 1993;52(4):258–62.
Jordan JM, Luta G, Renner JB, Linder GF, Dragomir A, Hochberg MC, Fryer JG. Self-reported functional status in osteoarthritis of the knee in a rural southern community: the role of socio demographic factors, obesity, and knee pain. Arthritis Care Res. 1996;9(4):273–8.
Szebenyi B, Hollander AP, Dieppe P, Quilty B, Duddy J, Clarke S, Kirwan JR. Association between pain, function, and radiographic features in Osteoarthritis of the knee. Arthritis Rheum. 2006;54(1):230–5.
Brandt KD, Radin EL, Dieppe PA, van de Putte L. Yet more evidence that osteoarthritis is not a cartilage disease. Ann Rheum Dis. 2006;65(10):1261–4.
Jones G, Ding C, Scott F, Glisson M, Cicuttini F. Early radiographic osteoarthritis is associated with substantial changes in cartilage volume and tibial bone surface area in both males and females. Osteoarthr Cartil. 2004;12(2):169–74.
WOMAC Bellamy N. Osteoarthritis index A users guide. London: University of western Ontario; 1996.
Pua Y-H, Cowan SM, Wrigley TV, Bennell KL. Discriminant validity of the Western Ontario and McMaster Universities osteoarthritis index physical functioning subscale in community samples with hip osteoarthritis. Arch Phys Med Rehabil. 2009;90(10):1772–7.
Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M, Howell D, Kaplan D, Koopman W, Longley S, Mankin H, McShane DJ, Medsger T, Meenan R, Mikkelsen W, Moskowitz R, Murphy W, Rothschild B, Segal M, Sokoloff L, Wolfe F. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum. 1986;29(8):1039–49.
Duncan R, Peat G, Thomas E, Hay E, McCall I, Croft P. Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be? Ann Rheum Dis. 2007;66(1):86–91.
Kellgren JH, Lawrence JS. Atlas of standard radiographs of arthritis. II. IN: The epidemiology of chronic rheumatism. Philadelphia, PA: F.A. Davis; 1963.
Cimen OB, Incel NA, Yapici Y, Apaydin D, Erdogan C. Obesity related measurements and joint space width in patients with knee osteoarthritis. Ups J Med Sci. 2004;109(2):159–64.
Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil. 2007;15:A:A1–56.
Colebatch AN, Hart DJ, Zhai G, Williams FM, Spector TD, Arden NK. Effective measurement of knee alignment using AP knee radiographs. Knee. 2009;16(1):42–5.
Claessens AA, Schouten JSAG, Van-den-Ouweland FA, Valkenburg HA. Do clinical findings associate with radiographic osteoarthritis of the knee? Ann Rheum Dis. 1990;49(10):771–4.
Grotle M, Hagen KB, Natvig B, Dahl FA, Kvien TK. Obesity and osteoarthritis in knee, hip and/or hand: an epidemiological study in the general population with 10 years follow-up. BMC Musculoskeletal Disord. 2008;9:132.
Hannanl MT, Felson DT, Pincus T. Analysis of discordance between radiographic change and knee pain in osteoarthritis of the knee. J Rheumatol. 2000;27(6):1513–7.
Anderson-Mackenzie JM, Quasnichka HL, Starr RL, Lewis EJ, Billingham ME, Bailey AJ. Fundamental subchondral bone changes in spontaneous knee osteoarthritis. Int J Biochem Cell Biol. 2005;37(1):224–36.
Sowers MF, Hayes C, Jamadar D, Capul BA, Lachance L, Jannausch M, Welch G. Magnetic resonance-detected subchondral bone marrow and cartilage defect characteristics associated with pain and x-ray-defined knee osteoarthritis. Osteoarthr Cartil. 2003;11(6):387–93.
Chang CB, Han I, Kim SJ, Seong SC, Kim TK. Association between radiological findings and symptoms at the patellofemoral joint in advanced knee osteoarthritis. J Bone Jt Surg Br. 2007;89(10):1324–8.
Haugeberg G, Orstavik RE, Kvein TK. Effects of rheumatoid arthritis on bone. Curr Opin Rheumatol. 2003;15(4):469–75.
Colville-Nash PR, Scott DL. Angiogenesis and rheumatoid arthritis: pathogenic and therapeutic implications. Ann Rheum Dis. 1992;51(7):919–25.
Sengupta M, Zhang YQ, Niu JB, Guermazi A, Grigorian M, Gale D, Felson DT, Hunter DJ. High signal in knee osteophytes is not associated with knee pain. Osteoarthr Cartil. 2006;14(5):413–7.
Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P, Sack B, Torner J, Bradley L, Zhang Y. Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ. 2009;339:b2844.
Acknowledgments
The authors thank Dr. R.P Mishra, Ph.D., biostatistician, for assistance in statistical analysis.
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Sanghi, D., Avasthi, S., Mishra, A. et al. Is radiology a determinant of pain, stiffness, and functional disability in knee osteoarthritis? A cross-sectional study. J Orthop Sci 16, 719–725 (2011). https://doi.org/10.1007/s00776-011-0147-y
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DOI: https://doi.org/10.1007/s00776-011-0147-y