What comes first? Multitissue involvement leading to radiographic osteoarthritis: magnetic resonance imaging-based trajectory analysis over four years in the osteoarthritis initiative.
OBJECTIVE
To assess whether the presence of structural osteoarthritis (OA) features over as many as 4 years prior to incident radiographic OA increases the risk of radiographic OA in a nested, case-control design.


METHODS
We studied 355 knees from the Osteoarthritis Initiative cohort that developed radiographic OA before the 48-month visit. They were matched one-to-one by sex, age, and contralateral knee radiographic status with a control knee. Magnetic resonance images (MRIs) were read for bone marrow lesions (BMLs), cartilage damage, meniscal damage (including tears and extrusion), Hoffa synovitis, and effusion synovitis. Conditional logistic regression was applied to assess the risk of radiographic OA with regard to the presence of BMLs (score ≥2), cartilage lesions (score ≥1.1), meniscal damage (any) and extrusion of ≥3 mm ± (score ≥2), and Hoffa and effusion synovitis (any). Time points were defined as incident radiographic OA visit (P0), 1 year prior to the detection of radiographic OA (P -1), 2 years prior to the detection of radiographic OA (P -2), etc.


RESULTS
The presence of Hoffa synovitis (hazard ratio [HR] 1.76 [95% confidence interval (95% CI) 1.18-2.64]), effusion synovitis (HR 1.81 [95% CI 1.18-2.78]), and medial meniscal damage (HR 1.83 [95% CI 1.17-2.89]) at P -2 predicted radiographic OA incidence. At P -1, all features but meniscal extrusion predicted radiographic OA, with highest odds for medial BMLs (HR 6.50 [95% CI 2.27-18.62]) and effusion synovitis (HR 2.50 [95% CI 1.76-3.54]). The findings at P -3 and P -4 did not reach statistical significance.


CONCLUSIONS
Our findings indicate that the presence of specific structural features of MRI-detected joint damage 2 years prior to incident radiographic OA increases the risk of incident radiographic OA. However, 1 year prior to radiographic OA, the presence of almost any abnormal morphologic feature increases the risk of radiographic OA in the subsequent year.
Boston University School of Medicine, Boston, Massachusetts, and University of Erlangen-Nuremberg, Erlangen, Germany.
Frank W
FW
Roemer
University of Arizona College of Medicine, Tucson, and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
C Kent
CK
Kwoh
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Michael J
MJ
Hannon
Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and University of Sydney, St. Leonards, New South Wales, Australia.
David J
DJ
Hunter
Paracelsus Medical University, Salzburg, Austria, and Chondrometrics GmbH, Ainring, Germany.
Felix
F
Eckstein
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Tomoko
T
Fujii
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Robert M
RM
Boudreau
Boston University School of Medicine, Boston, Massachusetts.
Ali
A
Guermazi
D000368:Aged; D001853:Bone Marrow / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D011859:Radiography; D013585:Synovitis / Q000473:pathology*; D000070600:Tibial Meniscus Injuries