Severity of joint pain and Kellgren-Lawrence grade at baseline are better predictors of joint space narrowing than bone scintigraphy in obese women with knee osteoarthritis

Steven A. Mazzuca, Kenneth D. Brandt, Donald S. Schauwecker, Barry Katz, Joan M. Meyer, Kathleen A. Lane, John D. Bradley, Steven Hugenberg, Frederick Wolfe, Larry W. Moreland, Louis W. Heck, David E. Yocum, Thomas J. Schnitzer, Leena Sharma, Susan Manzi, Chester V. Oddis

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Abstract

Objective. To compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a baseline late-phase bone scan and assessments of the radiographic and symptomatic severity of knee Osteoarthritis (OA) at baseline as predictors of loss of articular cartilage thickness, as reflected in joint space narrowing (JSN) in the medial tibiofemoral compartment. Methods. Subjects (174 obese women, 45-64 yrs of age, with unilateral knee OA) were a subset of a larger cohort who participated in a placebo controlled trial of a disease modifying OA drug. Uptake of technetium medronate (99mTc-MDP) in anteroposterior (AP) and lateral views of a late-phase bone scan was measured at baseline in a region of interest drawn around the medial tibia, and was adjusted for (i.e., expressed as a ratio to) uptake in a reference segment of the tibial shaft, which served as an internal standard. Each subject underwent a fluoroscopically standardized radiographic examination of the knees (semiflexed AP view) and a pain assessment with the WOMAC OA Index at baseline, 16 months, and 30 months. Results. Controlling for baseline joint space width and treatment group, multiple linear regression models showed that the adjusted 99mTc-MDP uptake at baseline was a significant predictor of joint space narrowing (JSN) in the index knee at 16 months (b = 0.180, p = 0.015) and 30 months (b = 0.221, p = 0.049). In the contralateral knee, uptake was only a marginally significant predictor of JSN at 30 months (b = 0.246, p = 0.083). Uptake in the upper and middle tertiles of the distribution predicted subjects who would exhibit JSN ≥ 0.50 mm within 16 months with 65% sensitivity (PPV 23%) and 36% specificity (NPV 77%). In contrast, a prediction rule based solely on the presence of Kellgren-Lawrence grade 3 OA severity and greater than median WOMAC Pain score identified progressors with 65% sensitivity (PPV 48%) and 79% specificity (NPV 88%). Conclusion. Although the level of adjusted 99mTc-MDP uptake was significantly associated with JSN in knees with established radiographic OA, baseline bone scintigraphy is inferior to the radiographic severity of OA and knee pain (alone or in combination) as a predictor of loss of articular cartilage in subjects with knee OA.

Original languageEnglish
Pages (from-to)1540-1546
Number of pages7
JournalJournal of Rheumatology
Volume32
Issue number8
StatePublished - Aug 2005

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Knee Osteoarthritis
Arthralgia
Radionuclide Imaging
Joints
Technetium Tc 99m Medronate
Bone and Bones
Osteoarthritis
Knee
Articular Cartilage
Linear Models
Pain
Technetium
Pain Measurement
Tibia
Placebos
Sensitivity and Specificity
Pharmaceutical Preparations

Keywords

  • Bone scintigraphy
  • Knee
  • Osteoarthritis
  • Progression
  • Risk factors

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Severity of joint pain and Kellgren-Lawrence grade at baseline are better predictors of joint space narrowing than bone scintigraphy in obese women with knee osteoarthritis. / Mazzuca, Steven A.; Brandt, Kenneth D.; Schauwecker, Donald S.; Katz, Barry; Meyer, Joan M.; Lane, Kathleen A.; Bradley, John D.; Hugenberg, Steven; Wolfe, Frederick; Moreland, Larry W.; Heck, Louis W.; Yocum, David E.; Schnitzer, Thomas J.; Sharma, Leena; Manzi, Susan; Oddis, Chester V.

In: Journal of Rheumatology, Vol. 32, No. 8, 08.2005, p. 1540-1546.

Research output: Contribution to journalArticle

Mazzuca, SA, Brandt, KD, Schauwecker, DS, Katz, B, Meyer, JM, Lane, KA, Bradley, JD, Hugenberg, S, Wolfe, F, Moreland, LW, Heck, LW, Yocum, DE, Schnitzer, TJ, Sharma, L, Manzi, S & Oddis, CV 2005, 'Severity of joint pain and Kellgren-Lawrence grade at baseline are better predictors of joint space narrowing than bone scintigraphy in obese women with knee osteoarthritis', Journal of Rheumatology, vol. 32, no. 8, pp. 1540-1546.
Mazzuca, Steven A. ; Brandt, Kenneth D. ; Schauwecker, Donald S. ; Katz, Barry ; Meyer, Joan M. ; Lane, Kathleen A. ; Bradley, John D. ; Hugenberg, Steven ; Wolfe, Frederick ; Moreland, Larry W. ; Heck, Louis W. ; Yocum, David E. ; Schnitzer, Thomas J. ; Sharma, Leena ; Manzi, Susan ; Oddis, Chester V. / Severity of joint pain and Kellgren-Lawrence grade at baseline are better predictors of joint space narrowing than bone scintigraphy in obese women with knee osteoarthritis. In: Journal of Rheumatology. 2005 ; Vol. 32, No. 8. pp. 1540-1546.
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T1 - Severity of joint pain and Kellgren-Lawrence grade at baseline are better predictors of joint space narrowing than bone scintigraphy in obese women with knee osteoarthritis

AU - Mazzuca, Steven A.

AU - Brandt, Kenneth D.

AU - Schauwecker, Donald S.

AU - Katz, Barry

AU - Meyer, Joan M.

AU - Lane, Kathleen A.

AU - Bradley, John D.

AU - Hugenberg, Steven

AU - Wolfe, Frederick

AU - Moreland, Larry W.

AU - Heck, Louis W.

AU - Yocum, David E.

AU - Schnitzer, Thomas J.

AU - Sharma, Leena

AU - Manzi, Susan

AU - Oddis, Chester V.

PY - 2005/8

Y1 - 2005/8

N2 - Objective. To compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a baseline late-phase bone scan and assessments of the radiographic and symptomatic severity of knee Osteoarthritis (OA) at baseline as predictors of loss of articular cartilage thickness, as reflected in joint space narrowing (JSN) in the medial tibiofemoral compartment. Methods. Subjects (174 obese women, 45-64 yrs of age, with unilateral knee OA) were a subset of a larger cohort who participated in a placebo controlled trial of a disease modifying OA drug. Uptake of technetium medronate (99mTc-MDP) in anteroposterior (AP) and lateral views of a late-phase bone scan was measured at baseline in a region of interest drawn around the medial tibia, and was adjusted for (i.e., expressed as a ratio to) uptake in a reference segment of the tibial shaft, which served as an internal standard. Each subject underwent a fluoroscopically standardized radiographic examination of the knees (semiflexed AP view) and a pain assessment with the WOMAC OA Index at baseline, 16 months, and 30 months. Results. Controlling for baseline joint space width and treatment group, multiple linear regression models showed that the adjusted 99mTc-MDP uptake at baseline was a significant predictor of joint space narrowing (JSN) in the index knee at 16 months (b = 0.180, p = 0.015) and 30 months (b = 0.221, p = 0.049). In the contralateral knee, uptake was only a marginally significant predictor of JSN at 30 months (b = 0.246, p = 0.083). Uptake in the upper and middle tertiles of the distribution predicted subjects who would exhibit JSN ≥ 0.50 mm within 16 months with 65% sensitivity (PPV 23%) and 36% specificity (NPV 77%). In contrast, a prediction rule based solely on the presence of Kellgren-Lawrence grade 3 OA severity and greater than median WOMAC Pain score identified progressors with 65% sensitivity (PPV 48%) and 79% specificity (NPV 88%). Conclusion. Although the level of adjusted 99mTc-MDP uptake was significantly associated with JSN in knees with established radiographic OA, baseline bone scintigraphy is inferior to the radiographic severity of OA and knee pain (alone or in combination) as a predictor of loss of articular cartilage in subjects with knee OA.

AB - Objective. To compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a baseline late-phase bone scan and assessments of the radiographic and symptomatic severity of knee Osteoarthritis (OA) at baseline as predictors of loss of articular cartilage thickness, as reflected in joint space narrowing (JSN) in the medial tibiofemoral compartment. Methods. Subjects (174 obese women, 45-64 yrs of age, with unilateral knee OA) were a subset of a larger cohort who participated in a placebo controlled trial of a disease modifying OA drug. Uptake of technetium medronate (99mTc-MDP) in anteroposterior (AP) and lateral views of a late-phase bone scan was measured at baseline in a region of interest drawn around the medial tibia, and was adjusted for (i.e., expressed as a ratio to) uptake in a reference segment of the tibial shaft, which served as an internal standard. Each subject underwent a fluoroscopically standardized radiographic examination of the knees (semiflexed AP view) and a pain assessment with the WOMAC OA Index at baseline, 16 months, and 30 months. Results. Controlling for baseline joint space width and treatment group, multiple linear regression models showed that the adjusted 99mTc-MDP uptake at baseline was a significant predictor of joint space narrowing (JSN) in the index knee at 16 months (b = 0.180, p = 0.015) and 30 months (b = 0.221, p = 0.049). In the contralateral knee, uptake was only a marginally significant predictor of JSN at 30 months (b = 0.246, p = 0.083). Uptake in the upper and middle tertiles of the distribution predicted subjects who would exhibit JSN ≥ 0.50 mm within 16 months with 65% sensitivity (PPV 23%) and 36% specificity (NPV 77%). In contrast, a prediction rule based solely on the presence of Kellgren-Lawrence grade 3 OA severity and greater than median WOMAC Pain score identified progressors with 65% sensitivity (PPV 48%) and 79% specificity (NPV 88%). Conclusion. Although the level of adjusted 99mTc-MDP uptake was significantly associated with JSN in knees with established radiographic OA, baseline bone scintigraphy is inferior to the radiographic severity of OA and knee pain (alone or in combination) as a predictor of loss of articular cartilage in subjects with knee OA.

KW - Bone scintigraphy

KW - Knee

KW - Osteoarthritis

KW - Progression

KW - Risk factors

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