Background Although studies have predominantly focused on whether disease progression predicts symptoms in knee osteoarthritis (OA), there is very little data examining whether the presence of knee symptoms may be an independent predictor of the structural progression of knee OA.
Objectives To complement and extend previous studies, we examined whether baseline and persistent knee symptoms predicted accelerated cartilage volume loss, incident and progressive radiographic OA (ROA) and total knee replacement (TKR).
Methods Participants from the Osteoarthritis Initiative were grouped according to the absence (Kellgren-Lawrence [KL] grade ≤1, n=2120) or presence (KL ≥2, n=2249) of baseline ROA. Clinical symptoms (pain, stiffness and function) were assessed at baseline using Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Cartilage volume in the medial and lateral compartments was assessed by magnetic resonance imaging (MRI) at baseline and 48 months. Associations with incident and progressive ROA were assessed at 48 months and TKR at 72 months.
Results Higher levels of baseline and persistent knee symptoms predicted greater annual percentage of cartilage loss in the medial (all p<0.05) and lateral (all p≤0.03) compartment in people both with and without ROA. Greater baseline and persistent knee symptoms were associated with incidence (OR range 1.02 to 1.29, all p≤0.005) and progression (OR range 1.01 to 1.22, all p≤0.01) of ROA, as well as TKR (OR range 1.03 to 1.35; all p<0.001).
Conclusions Greater baseline and persistent knee symptoms predicted accelerated cartilage loss, incident and progressive ROA and TKR. Although a major focus in OA research has been the link between structural disease and symptom progression, data from this study demonstrate that symptoms are important independent predictors of disease progression. This suggests that targeting symptoms may be important for preserving joint structure.
Disclosure of Interest J. Martel-Pelletier Shareholder of: ArthroLab Inc., A. Teichtahl: None declared, F. Cicuttini: None declared, Y. Wang: None declared, F. Abram Employee of: ArthroLab Inc., J.-P. Pelletier Shareholder of: ArthroLab Inc.