title: Clinical significance of worsening versus stable preradiographic MRI lesions in a cohort study of persons at higher risk for knee osteoarthritis.
abstract: BACKGROUND
  Whether preradiographic lesions in knees at risk for osteoarthritis are incidental versus disease is unclear. We hypothesised, in persons without but at higher risk for knee osteoarthritis, that: 12-48 month MRI lesion status worsening is associated with 12-48 month incident radiographic osteoarthritis (objective component of clinical definition of knee osteoarthritis) and 48-84 month persistent symptoms.
  
  
  METHODS
  In 849 Osteoarthritis Initiative participants Kellgren/Lawrence (KL) 0 in both knees, we assessed cartilage damage, bone marrow lesions (BMLs), and menisci on 12 month (baseline) and 48 month MRIs. Multivariable logistic regression was used to evaluate associations between 12-48 month worsening versus stable status and outcome (12-48 month incident KL ≥1 and KL ≥2, and 48-84 month persistent symptoms defined as frequent symptoms or medication use most days of ≥1 month in past 12 month, at consecutive visits 48-84 months), adjusting for age, gender, body mass index (BMI), injury and surgery.
  
  
  RESULTS
  Mean age was 59.6 (8.8), BMI 26.7 (4.2) and 55.9% were women. 12-48 month status worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs was associated with 12-48 month incident radiographic outcomes, and worsening of cartilage damage and BMLs with 48-84 month persistent symptoms. There was a dose-response association for magnitude of worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs and radiographic outcomes, and cartilage damage and BMLs and persistent symptoms.
  
  
  CONCLUSIONS
  In persons at higher risk, worsening MRI lesion status was associated with concurrent incident radiographic osteoarthritis and subsequent persistent symptoms. These findings suggest that such lesions represent early osteoarthritis, and add support for a paradigm shift towards investigation of intervention effectiveness at this stage.
authors.affiliation: Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Leena
authors.initials: L
authors.lastname: Sharma
authors.affiliation: Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Nevitt
authors.affiliation: School of Medicine, University of Maryland, Baltimore, Maryland, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Hochberg
authors.affiliation: Department of Radiology, Boston University, Boston, Massachusetts, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Guermazi
authors.affiliation: Department of Radiology, Boston University, Boston, Massachusetts, USA University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Roemer
authors.affiliation: Department of Radiology, Boston University, Boston, Massachusetts, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Crema
authors.affiliation: Brown University, Pawtucket, Rhode Island, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Eaton
authors.affiliation: The Ohio State University, Columbus, Ohio, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
authors.affiliation: Division of Rheumatology, University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona, USA.
authors.forename: Kent
authors.initials: K
authors.lastname: Kwoh
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Cauley
authors.affiliation: Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Orit
authors.initials: O
authors.lastname: Almagor
authors.affiliation: Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Chmiel
mesh_terms: D001853:Bone Marrow / Q000000981:diagnostic imaging; D002357:Cartilage Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D002358:Cartilage, Articular / Q000000981:diagnostic imaging; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000000981:diagnostic imaging; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D000070600:Tibial Meniscus Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology
keywords: Epidemiology; Knee Osteoarthritis; Magnetic Resonance Imaging; Osteoarthritis