title: A systematic review of the association between radiographic and clinical osteoarthritis of hip and knee.
abstract: OBJECTIVE
  There is ongoing debate on whether an association between radiographic and clinical osteoarthritis (OA) exists. We hypothesized that the inconsistency in the detection of an association might be caused by different definitions of OA, by different radiographic protocols, and by scoring methods for radiographic damage and symptoms. The goal of this study was to evaluate which methodological criteria are important to detect an association between radiographic and clinical OA of hip and knee.
  
  
  METHODS
  A literature search was performed with the keywords 'OA', 'hip', 'knee', 'radiographic', and 'clinical' and results were screened for relevant studies. Quality criteria for study characteristics and methodology were developed. Studies were classified according to these criteria and the presence of an association between radiographic and clinical OA was scored. The importance of methodological quality and patient characteristics on the presence of an association was evaluated.
  
  
  RESULTS
  The literature search resulted in 39 studies describing an association between radiographic and clinical OA. The frequency of an association between radiographic and clinical OA outcome measures diminished when less quality criteria were fulfilled. Specifically the criterion for standardized outcome measures appeared important in the detection of an association. The association was not influenced by patient characteristics. Only four studies were identified that fulfilled all quality criteria and in these studies an association was found for the knee joint and an inconsistent association was found for the hip joint.
  
  
  CONCLUSIONS
  Methodological quality criteria are of importance to reveal an association between radiographic and clinical OA.
authors.affiliation: Department of Rheumatology & Clinical Immunology, University Medical Center (UMC) Utrecht, The Netherlands. M.B.Kinds@umcutrecht.nl
authors.forename: M B
authors.initials: MB
authors.lastname: Kinds
authors.forename: P M J
authors.initials: PM
authors.lastname: Welsing
authors.forename: E P
authors.initials: EP
authors.lastname: Vignon
authors.forename: J W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: M A
authors.initials: MA
authors.lastname: Viergever
authors.forename: A C A
authors.initials: AC
authors.lastname: Marijnissen
authors.forename: F P J G
authors.initials: FP
authors.lastname: Lafeber
mesh_terms: D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011859:Radiography