MRI-based grading may help determine which knees suitable for osteoarthritis treatment
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Using MRIs to grade articular pathologies can help identify knees suitable for osteoarthritis trials, as well as those without cartilage damage for which treatment is not indicated, according to data published in Arthritis Care & Research.
“To be eligible for inclusion into a [disease modifying OA drug] trial from a structural perspective, knees with Kellgren Lawrence grades (KLG) 2 and 3 are typically included,” Wolfgang Wirth, PhD, of the department of imaging and functional musculoskeletal research at the Institute of Anatomy & Cell Biology, at Paracelsus Medical University in Austria, and colleagues wrote. “These knees exhibit definite structural disease, are at risk for progression, but are not considered end-stage structural OA.
“The previous studies investigating the association between MRI-detected tissue pathologies and subsequent quantitatively measured cartilage loss focused on selected MRI features only or on knees (predominantly) without radiographic OA and no study previously evaluated whether MRI-based ordinal multi-tissue assessment could support a more targeted selection of participants based on projected accelerated subsequent cartilage loss for a DMOAD trial and which sensitivity to change could be achieved using such criteria,” they added.
To examine the predictive qualities of MRI-based articular pathologies regarding later medial femorotibial compartment quantitative cartilage thickness loss, Wirth and colleagues analyzed data collected as part of the Osteoarthritis Initiative. Patients included in the database were those aged 45 to 79 years with symptomatic OA, those who were at risk for symptomatic OA, and those who had no discernible risk factors for the disease. According to the researchers, experienced radiologists were responsible for conducting two MRI assessments at baseline and at 24 months in 599 participants.
The assessments and analysis included cartilage damage assessments in articular subregions via the MRI OsteoArthritis Knee Score (MOAKS) scoring system. In addition, bone marrow lesions, medial meniscus extrusion and meniscus morphology were assessed. The primary outcome measure was the average cartilage thickness in the medial femorotibial compartment. The researchers additionally calculated the difference in the value between the two visits. Knees were classified as medial compartment (MFTC) progressors or non-progressors based on MFTC change in cartilage thickness, with the smallest detectable change threshold being –111 m.
According to the researchers, MFTC MOAKS cartilage damage (OR = 2.77; 95% CI, 1.76, 4.36), MFTC bone marrow lesions (OR = 2.69; 95% CI, 1.89, 3.83), medial meniscus extrusion or damage (OR = 2.21; 95% CI, 1.37, 3.55), and MOAKS severity subscales for cartilage and meniscus damage were all associated with later progression. Additionally, the standardized response mean was greater in knees with these pathologies, vs. those without, and was associated with the severity of said pathologies.
“MRI-based semi-quantitative assessment in only a limited number of subregions constitutes a valuable tool for the specific selection of knees likely to exhibit subsequent structural progression over the course of a trial,” Wirth and colleagues wrote. “In addition, MRI-based scoring of joint damage also allows excluding knees, in which a treatment with DMOADs is not indicated (eg, knees without cartilage damage).”
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