Gossec, L. et al. OMERACT/OARSI initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. J. Rheumatol. 34, 1432-1435

Medicine Faculty, Paris 5 René Descartes University
The Journal of Rheumatology (Impact Factor: 3.19). 07/2007; 34(6):1432-5.
Source: PubMed


Time to theoretical indication of joint replacement surgery has been proposed as a primary outcome for potential structure-modifying interventions for osteoarthritis (OA). The objectives of this OMERACT/OARSI Working Group were to identify pain, physical function, and structure states that represent the progression from early to late disease for individuals with OA of the hip and knee, and to create a composite measure of these 3 domains to define states of OA severity and a surrogate measure of "need for joint replacement surgery."
For pain, focus groups and one-on-one interviews were used. For function, Rasch analysis was performed on existing indices the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS), each of which subsumes the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questions. For structure, a comparison of existing indices (Kellgren-Lawrence, OARSI stages, and joint space width) was performed for the hip and the knee.
For pain, key features of pain that are most distressing to people with OA from early to late disease were identified. For function, the reduction of the number of items based on the existing indices continues. For structure, the analysis is also ongoing.
Preliminary results were presented at OMERACT 8; the final objective will be to combine the 3 domains (pain, function, and structure) and to create a composite index that could define states of severity and "need for total joint replacement," which could be used to evaluate treatment response to disease-modifying drugs in OA clinical trials.

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    • "These disease-modifying drugs have to be evaluated using primary outcome measures that reflect structural modification , i.e., radiographs in osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing spondylitis, ultrasonography or magnetic resonance imaging. At the present time, in OA, structural variables, particularly minimal joint space width (JSW) on plain radiographs are considered as the most appropriate primary outcome measure [1] [2]. However, change in JSW, expressed in millimeters, is a continuous variable that does not provide information on the proportion of patients with favorable evolution, i.e., does not make it possible to classify patients as " progressors " or " non-progressors " . "
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