title: Structure modification in knee osteoarthritis: methodology and outcome parameters.
abstract: Managing osteoarthritis (OA) with structure-modifying agents (SMAs) is an important emerging topic receiving increased attention from both lay individuals and health care professionals as a promising alternative in the management of OA.
  
  
  OBJECTIVE
  To review the methodology and outcome parameters purported to be used in the assessment of the structure-modifying potential of various interventions.
  
  
  METHODS
  A Medline search was performed to select the relevant published articles. This review does not go into detail about various aspects of the design and conduct of structure-modifying studies; however, a vast number of relevant references are provided and may be accessed by interested readers.
  
  
  RESULTS
  Enhancing the feasibility of SMAs trials aimed at documenting efficacy can be accomplished by carefully selecting: (1) the outcome parameters, (2) the imaging methodology, and (3) the patient population. Most of the relevant issues that need to be considered by investigators before embarking on a study of this nature have been addressed in this article.
  
  
  CONCLUSIONS
  Most of the evidence to date focuses on the superiority of the radiographic-based techniques in measuring joint space narrowing among a homogeneous population of OA patients. More research is warranted before other techniques such as ultrasound, chondroscopy, and magnetic resonance imaging, can be proven to be reliable.
authors.affiliation: Nutramax Laboratories, Inc., Baltimore, Maryland, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Hammad
mesh_terms: D001182:Arthroscopy; D015415:Biomarkers / Q000032:analysis; D002358:Cartilage, Articular / Q000000981:diagnostic imaging; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000473:pathology; D008279:Magnetic Resonance Imaging; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000188:drug therapy*; D018579:Patient Selection; D012107:Research Design; D012196:Review Literature as Topic; D018401:Sample Size; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D015415:Biomarkers