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. 2011;6(10):e25426.
doi: 10.1371/journal.pone.0025426. Epub 2011 Oct 21.

Association between several clinical and radiological determinants with long-term clinical progression and good prognosis of lower limb osteoarthritis

Erlangga Yusuf  1 , Jessica Bijsterbosch, P Eline Slagboom, Herman M Kroon, Frits R Rosendaal, Tom W J Huizinga, Margreet Kloppenburg
Affiliations

Association between several clinical and radiological determinants with long-term clinical progression and good prognosis of lower limb osteoarthritis

Erlangga Yusuf et al. PLoS One. 2011.

Abstract

Objective: To investigate the factors associated with clinical progression and good prognosis in patients with lower limb osteoarthritis (OA).

Methods: Cohort study of 145 patients with OA in either knee, hip or both. Progression was defined as 1) new joint prosthesis or 2) increase in WOMAC pain or function score during 6-years follow-up above pre-defined thresholds. Patients without progression with decrease in WOMAC pain or function score lower than pre-defined thresholds were categorized as good prognosis. Relative risks (RRs) for progression and good prognosis with 95% confidence interval (95% CI) were calculated by comparing the highest tertile or category to the lowest tertile, for baseline determinants (age, sex, BMI, WOMAC pain and function scores, pain on physical examination, total range of motion (tROM), osteophytes and joint space narrowing (JSN) scores), and for worsening in WOMAC pain and function score in 1-year. Adjustments were performed for age, sex, and BMI.

Results: Follow-up was completed by 117 patients (81%, median age 60 years, 84% female); 62 (53%) and 31 patients (26%) showed progression and good prognosis, respectively. These following determinants were associated with progression: pain on physical examination (RR 1.2 (1.0 to 1.5)); tROM (1.4 (1.1 to 1.6); worsening in WOMAC pain (1.9 (1.2 to 2.3)); worsening in WOMAC function (2.4 (1.7 to 2.6)); osteophytes 1.5 (1.0 to 1.8); and JSN scores (2.3 (1.5 to 2.7)). Worsening in WOMAC pain (0.1 (0.1 to 0.8)) and function score (0.1 (0.1 to 0.7)), were negatively associated with good prognosis.

Conclusion: Worsening of self-reported pain and function in one year, limited tROM and higher osteophytes and JSN scores were associated with clinical progression. Worsening in WOMAC pain and function score in 1- year were associated with lower risk to have good prognosis. These findings help to inform patients with regard to their OA prognosis.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: This study was financially supported by Pfizer (Groton, CT, United States of America) and TI-Pharma. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Cumulative probability plot of Western Ontario and McMaster Universities (WOMAC) scores change of patients without prosthesis during follow-up (n = 81) for WOMAC pain scores change (above) and WOMAC function scores change (below).
The horizontal line above is the line set at minimal perceptible clinical improvement (MPCI) score which is used as the cut-off to define progression and the horizontal line below is the line set to define good prognosis.
See this image and copyright information in PMC

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