5 research outputs found
Can We Identify Patients with High Risk of Osteoarthritis Progression Who Will Respond to Treatment? A Focus on Biomarkers and Frailty
Can we identify patients with high risk of osteoarthritis progression who will respond to treatment? A focus on biomarkers ans frailty
Osteoarthritis (OA), a disease affecting different
patient phenotypes, appears as an optimal candidate for
personalized healthcare. The aim of the discussions of the
European Society for Clinical and Economic Aspects of
Osteoporosis and Osteoarthritis (ESCEO) working group
was to explore the value of markers of different sources in
defining different phenotypes of patients with OA. The
ESCEO organized a series of meetings to explore the
possibility of identifying patients who would most benefit
from treatment for OA, on the basis of recent data and
expert opinion. In the first meeting, patient phenotypes were
identified according to the number of affected joints,
biomechanical factors, and the presence of lesions in the
subchondral bone. In the second meeting, summarized in
the present article, the working group explored other
markers involved in OA. Profiles of patients may be defined according to their level of pain, functional limitation, and
presence of coexistent chronic conditions including frailty
status. A considerable amount of data suggests that magnetic
resonance imaging may also assist in delineating
different phenotypes of patients with OA. Among multiple
biochemical biomarkers identified, none is sufficiently
validated and recognized to identify patients who should be
treated. Considerable efforts are also being made to identify
genetic and epigenetic factors involved in OA, but results
are still limited. The many potential biomarkers that could
be used as potential stratifiers are promising, but more
research is needed to characterize and qualify the existing
biomarkers and to identify new candidates
Total joint replacement of hip or knee as an outcome measure for structure modifying trials in osteoarthritis
Objective: The Group for the Respect of Ethics and Excellence in Science (GREES) organized a working group to assess the value of time to joint surgery as a potential therapeutic failure outcome criterion for osteoarthritis (OA) of the hip or knee in the assessment of potential structure modifying agents. Methods: PubMed was searched for manuscripts from 1976 to 2004. Relevant studies were discussed at a 1-day meeting. Results: There are no accepted guidelines for 'time to' and 'indications for' joint replacement surgery. A limited number of trials have examined joint replacement surgery within the study population. Several parameters, particularly joint space narrowing (interbone distance), correlate with surgical intervention. However, at the level of the knee, none of the parameters have positive predictive value for joint replacement surgery better than 30%. In contrast, lack of significant joint space narrowing has a strong negative predictive value for joint replacement surgery (> 90%), that remains after controlling for OA pain severity. Conclusion: At this time, GREES cannot recommend time to joint surgery as a primary endpoint of failure for structure modifying trials of hip or knee OA-as the parameter has sensitivity but lacks specificity. In contrast, in existing trials, a lack of progression of joint space narrowing has predictive value of > 90% for not having surgery. GREES suggests utilizing joint space narrowing (e.g., > 0.3-0.7 mm) combined with a lack of clinically relevant improvement in symptoms (e.g., greater than or equal to 20-25%) for 'failure' of a secondary outcome in structure modifying trials of the hip and knee. (C) 2004 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved
OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group
Objective. To define pain and physical function cutpoints that would, coupled with structural severity, define a surrogate measure of "need for joint replacement surgery," for use as an outcome measure for potential structure-modifying interventions for osteoarthritis (OA). Methods. New scores were developed for pain and physical function in knee and hip OA. A cross-sectional international study in 1909 patients was conducted to define data-driven cutpoints corresponding to the orthopedic surgeons' indication for joint replacement. A post hoc analysis of 8 randomized clinical trials (1379 patients) evaluated the prevalence and validity of cutpoints, among patients with symptomatic hip/knee OA. Results. In the international cross-sectional study, there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement; indeed, it was not possible to determine cutpoints for pain and function defining this indication. The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression, high level of pain, and high degree of function impairment was low (2%-12%). The most discriminatory cutpoint to define an indication for joint replacement was found to be [pain (0-100) + physical function (0-100) > 80]. Conclusion. These results do not support a specific level of pain or function that defines an indication for joint replacement. However, a tentative cutpoint for pain and physical function levels is proposed for further evaluation. Potentially, this symptom level, coupled with radiographic progression, could be used to define "nonresponders" to disease-modifying drugs in OA clinical trials. (J Rheumatol 2011;38:1765-9; doi:10.3899/jrheum.110403