M. Nevitt

University of California, San Francisco, San Francisco, California, United States

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Publications (228)1073.98 Total impact

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    ABSTRACT: We investigated the association between objectively measured daily walking and knee structural change, defined either as radiographic worsening or as cartilage loss, in people at risk of or with knee osteoarthritis (OA). Participants from the Multicenter Osteoarthritis Study (MOST) with Kellgren-Lawrence grades 0-2 and daily walking (measured with the StepWatch) at the 60-month visit were included. Participants had fixed-flexion, weight-bearing radiographs and knee magnetic resonance images (MRI) at 60 and 84 months. Radiographic worsening was read in both knees using the Osteoarthritis Research Society International grading, and MRI were read for 1 knee using the Whole-Organ MRI Score semiquantitative scoring. OR and 95% CI were calculated comparing those in the middle tertile against the lowest and highest tertiles of daily walking using logistic regression models and generalized estimating equations. Data on walking with moderate to vigorous intensity (min with > 100 steps/min/day) were associated to structural change using multivariate and logistic regression models. The 1179 study participants (59% women) were 67.0 years old (± 7.6), with a mean (± SD) body mass index of 29.8 kg/m(2) (± 5.3) who walked 6981 (± 2630) steps/day. After adjusting for confounders, we found no significant associations between daily walking and radiographic worsening or cartilage loss. More time spent walking at a moderate to vigorous intensity was not associated with either radiographic worsening or cartilage loss. Results from the MOST study indicated no association between daily walking and structural changes over 2 years in the knees of people at risk of or with mild knee OA.
    The Journal of Rheumatology 06/2015; DOI:10.3899/jrheum.150071 · 3.17 Impact Factor
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    ABSTRACT: The purpose of this study was to assess the concurrent validity and sensitivity to change of three knee osteoarthritis (OA) grading scales. The Kellgren-Lawrence (KL) and the Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) grading scales are well-established. The third scale, the compartmental grading scale for OA (CG) is a novel scale which grades JSN, femoral osteophytes, tibial erosion and subluxation to create a total score. One sample of 72 posteroanterior fixed-flexion radiographs displaying mild to moderate knee OA was selected from the Multicenter Osteoarthritis Study to study validity. A second sample of 75 radiograph pairs, which showed an increase in OA severity over 30 months, was selected to study sensitivity to change. The three radiographic grading scales were applied to each radiograph in both samples. Spearman's rank correlation coefficients were used to correlate the radiographic grades and the change in grades over 30 months with a Whole-organ Magnetic Resonance Imaging Score (WORMS)-based composite score which included five articular features of knee OA. Correlations between the KL, OARSI JSN and CG grading scales and the MRI-based score were 0.836, 0.840 and 0.773 (p<0.0001) respectively while correlations between change in the radiographic grading scales and change in the MRI-based score were 0.501, 0.525 and 0.492 (p<0.0001). All three radiographic grading scales showed high validity and are suitable to assess knee OA severity. They showed moderate sensitivity to change; therefore caution should be taken when using ordinal radiographic grading scales to monitor knee OA over time. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 05/2015; DOI:10.1016/j.joca.2015.05.003 · 4.66 Impact Factor
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    ABSTRACT: To explore whether baseline to 12-month follow-up (M) change in femorotibial cartilage thickness (differs between subjects who received a KR between 24M and 60M from those without KR. In this prospective cohort study, 531 right knees from Osteoarthritis Initiative participants with definite radiographic KOA (KLG2-4) were studied. Segmentation was applied to coronal fast low angle shot (FLASH) magnetic resonance images (MRI), to quantitatively determine cartilage thickness in 16 femorotibial subregions. Unadjusted p-values (t-tests) and p-values adjusted for age, baseline BMI, KLG and sex (generalized estimating equation models) were used to evaluate differences in longitudinal one-year rates of cartilage thickness between KRs and non-KRs, with TKA status as fixed effect. Of the 531 participants (age 63±9y, BMI 30±4.8) 40 received a femorotibial KR within 4 years. At baseline, KRs had thinner medial and lateral femorotibial cartilage (-15%; p<0.001) than non-KRs. Longitudinal cartilage thickness change was significantly greater in KRs than in non-KRs in a) the total femorotibial joint (area under curve [AUC]=0.64), b) the lateral compartment (AUC=0.66), c) both tibiae (AUC≥0.61), and d) the first 9 (of 16) ordered values (OVs) of subregion change (AUC=0.64-0.69). Discrimination was stronger for KRs that occurred at 24/36M (n=18) than for those at 48M/60M (n=22). Knees with incident KR displayed smaller baseline cartilage thickness and greater lateral as well as location-independent (OV) femorotibial cartilage loss than non-KRs. Discrimination of cartilage loss was greater for KRs occurring within 2 years after the measurement than for those occurring later. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    05/2015; DOI:10.1002/acr.22608
  • Osteoarthritis and Cartilage 04/2015; 23:A53-A54. DOI:10.1016/j.joca.2015.02.113 · 4.66 Impact Factor
  • Osteoarthritis and Cartilage 04/2015; 23:A61-A62. DOI:10.1016/j.joca.2015.02.128 · 4.66 Impact Factor
  • Osteoarthritis and Cartilage 04/2015; 23:A344. DOI:10.1016/j.joca.2015.02.631 · 4.66 Impact Factor
  • Osteoarthritis and Cartilage 04/2015; 23:A181. DOI:10.1016/j.joca.2015.02.956 · 4.66 Impact Factor
  • Osteoarthritis and Cartilage 04/2015; 23:A211-A212. DOI:10.1016/j.joca.2015.02.410 · 4.66 Impact Factor
  • Osteoarthritis and Cartilage 04/2015; 23:A216-A217. DOI:10.1016/j.joca.2015.02.417 · 4.66 Impact Factor
  • Osteoarthritis and Cartilage 04/2015; 23:A213-A214. DOI:10.1016/j.joca.2015.02.414 · 4.66 Impact Factor
  • Osteoarthritis and Cartilage 04/2015; 23:A173. DOI:10.1016/j.joca.2015.02.942 · 4.66 Impact Factor
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    ABSTRACT: Background Debilitating pain associated with knee osteoarthritis (OA) often leads patients to seek and complete total knee arthroplasty (TKA). To date, few studies have evaluated the relation of functional impairment to the risk of TKA, despite the fact that OA is associated with functional impairment. Questions/purposes The purpose of our study was to (1) evaluate whether function as measured by WOMAC physical function subscale was associated with undergoing TKA; and (2) whether any such association varied by sex. Methods The National Institutes of Health-funded Multicenter Osteoarthritis Study (MOST) is an observational cohort study of persons aged 50 to 79 years with or at high risk of symptomatic knee OA who were recruited from the community. All eligible subjects with complete data were included in this analysis. Our study population sample consisted of 2946 patients with 5796 knees; 1776 (60%) of patients were women. We performed a repeated-measures analysis using baseline WOMAC physical function score to predict the risk of TKA from baseline to 30 months and WOMAC score at 30 months to predict risk of incident TKA from 30 months to 60 months. We used generalized estimating equations to account for the correlation between two knees within an individual and across the two periods. We calculated relative risk (RR) of TKA over 30 months by WOMAC function using a score of 0 to 5 as the referent in multiple binomial regressions with log link. Results Those with the greatest functional impairment (WOMAC scores 40-68; 62 TKAs in 462 knee periods) had 15.5 times (95% confidence interval [CI], 7.6-31.8; p Conclusions Baseline physical function appears to be an important element in patients considering TKA. Future studies should examine whether interventions to improve function can reduce the need for TKA. Level of Evidence Level III, observational cohort study.
    Clinical Orthopaedics and Related Research 03/2015; DOI:10.1007/s11999-015-4211-3 · 2.88 Impact Factor
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    ABSTRACT: To examine the relation of cartilage loss and bone marrow lesions (BMLs) in the medial and lateral patellofemoral joint (PFJ) to knee pain. We categorized the location of full-thickness cartilage loss and BMLs in the PFJ on knee MRIs from the Multicenter Osteoarthritis (MOST) and Framingham Osteoarthritis (FOA) Studies as no damage, isolated medial, isolated lateral, or both medial and lateral (mixed). We determined the relation of MRI lesions in each PFJ region to prevalent knee pain. Differences in knee pain severity were compared among categories of PFJ full-thickness cartilage loss and BMLs using quantile regression. In MOST (n=1137 knees), compared with knees without full-thickness cartilage loss, knees with isolated lateral or mixed PFJ full-thickness cartilage loss had 1.9 (1.3, 2.8) and 1.9 (1.2, 2.9) times the odds of knee pain, respectively, while isolated medial cartilage loss had no association with knee pain.. BMLs in both the medial and lateral PFJ had 1.5 (1.1, 2.0) times the odds of knee pain compared with knees without BMLs. Knee pain severity was lowest in knees with isolated medial PFJ cartilage loss or BMLs. In FOA (n=934 knees), neither isolated medial nor lateral cartilage loss was associated with knee pain, whereas isolated BMLs in either region were associated with pain. Results were not completely concordant but suggest that knee pain risk and severity is greatest with cartilage loss isolated to (MOST) or inclusive of (MOST and FOA) the lateral PFJ. While BMLs in either the medial or lateral PFJ are related to pain. Copyright © 2014. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 01/2015; 23(4). DOI:10.1016/j.joca.2014.12.023 · 4.66 Impact Factor
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    ABSTRACT: Vitamin K-dependent proteins, including the mineralization inhibitor matrix-gla protein (MGP), are found in joint tissues including cartilage and bone. Previous studies suggest low vitamin K status is associated with higher osteoarthritis (OA) prevalence and incidence. To clarify what joint tissues vitamin K is relevant to in OA, we investigated the cross-sectional and longitudinal association between vitamin K status and knee OA structural features measured using MRI. Plasma phylloquinone (PK, vitamin K1) and dephosphorylated-uncarboxylated MGP ((dp)ucMGP) were measured in 791 older community-dwelling adults who had bilateral knee MRIs (mean±SD age=74±3y; 67% female). The adjusted odds ratios (and 95% confidence intervals) [OR(95%CI)] for presence and progression of knee OA features according to vitamin K status were calculated using marginal models with generalized estimating equations, adjusted for age, sex, BMI, triglycerides and other pertinent confounders. Longitudinally, participants with very low plasma PK (<0.2nM) were more likely to have articular cartilage and meniscus damage progression after 3 years [OR(95%CIs): 1.7(1.0-3.0), 2.6(1.3-5.2) respectively] compared to sufficient PK (≥1.0nM). Higher plasma (dp)ucMGP (reflective of lower vitamin K status) was associated with higher odds of meniscus damage, osteophytes, bone marrow lesions, and subarticular cysts cross-sectionally [ORs(95%CIs) comparing highest to lowest quartile: 1.6(1.1-2.3); 1.7(1.1-2.5); 1.9(1.3-2.8); 1.5(1.0-2.1), respectively]. Community-dwelling men and women with very low plasma PK were more likely to have progression of articular cartilage and meniscus damage. Plasma (dp)ucMGP was associated with presence of knee OA features but not progression. Future studies are needed to clarify mechanisms underlying vitamin Ks role in OA. Copyright © 2014. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 12/2014; 23(3). DOI:10.1016/j.joca.2014.12.008 · 4.66 Impact Factor
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    ABSTRACT: Knee osteoarthritis causes functional limitation and disability in the elderly. Vitamin D has biological functions on multiple knee joint structures and can play important roles in the progression of knee osteoarthritis. The metabolism of vitamin D is regulated by parathyroid hormone (PTH). The objective was to investigate whether serum concentrations of 25-hydroxyvitamin D [25(OH)D] and PTH, individually and jointly, predict the progression of knee osteoarthritis. Serum 25(OH)D and PTH were measured at the 30- or 36-mo visit in 418 participants enrolled in the Osteoarthritis Initiative (OAI) who had ≥1 knee with both symptomatic and radiographic osteoarthritis. Progression of knee osteoarthritis was defined as any increase in the radiographic joint space narrowing (JSN) score between the 24- and 48-mo OAI visits. The mean concentrations of serum 25(OH)D and PTH were 26.2 μg/L and 54.5 pg/mL, respectively. Approximately 16% of the population had serum 25(OH)D < 15 μg/L. Between the baseline and follow-up visits, 14% progressed in JSN score. Participants with low vitamin D [25(OH)D < 15 μg/L] had >2-fold elevated risk of knee osteoarthritis progression compared with those with greater vitamin D concentrations (≥15 μg/L; OR: 2.3; 95% CI: 1.1, 4.5). High serum PTH (≥73 pg/mL) was not associated with a significant increase in JSN score. However, participants with both low vitamin D and high PTH had >3-fold increased risk of progression (OR: 3.2; 95%CI: 1.2, 8.4). Our results suggest that individuals deficient in vitamin D have an increased risk of knee osteoarthritis progression. © 2014 American Society for Nutrition.
    Journal of Nutrition 12/2014; 144(12):2002-8. DOI:10.3945/jn.114.193227 · 4.23 Impact Factor
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    ABSTRACT: Objective: To develop and validate a new and improved software method to rapidly determine femur-tibia angle (FTA). Methods: Three readers, two skilled and one unskilled, without any formal medical training, measured FTA in 142 subjects from the Osteoarthritis Initiative (OAI). The reader reliability was assessed using the intra-class correlation coefficient (ICC), root mean square standard deviation (RMSSD), and Blande-Altman plots, comparing the existing and new FTA methods. Gender-specific linear regression assessed the relationship of FTA with the hipe-knee-ankle angle (HKA). Results: The ICC (RMSSD) for intra- and inter-reader reproducibility of the existing FTA method was 0.96 (0.77 degrees) and 0.92 (1.38 degrees), respectively, and for the new technique was 0.98 (0.25 degrees) and 0.98 (0.37 degrees), with similar results for all three readers. Blande-Altman 95% limits of agreement were greater than +/- 2 degrees for the existing, and +/- 1 degrees for the new method. The r-value for the relation of FTA to HKAwas 0.68 and 0.72 for the existing and new methods, respectively. Varus (HKA <= -2 degrees)/neutral (-2 degrees < HKA < 2 degrees)/valgus (HKA >= -2 degrees) alignment based on predicted HKA agreed moderately with measured HKA (weighted kappa = 0.53), and had moderate sensitivity (73%) and specificity (84%) for varus malalignment. The new FTA was related to HKA using a linear equation with a slope of 0.98 and an offset of 4.0 degrees. Conclusions: Since it is largely automated and uses unambiguous anatomical landmarks, the new method is highly reproducible and can be made on a standard posteroanterior (PA) knee radiograph by a relatively unskilled reader.
    Osteoarthritis and Cartilage 10/2014; 22(10):1668-74. DOI:10.1016/j.joca.2014.06.011 · 4.66 Impact Factor
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    ABSTRACT: Objective: To compare cross-sectional and longitudinal side-differences in thigh muscle anatomical cross-sectional areas (ACSAs), muscle strength, and specific strength (strength/ACSA), between knees with early radiographic change vs knees without radiographic knee osteoarthritis (RKOA), in the same person. Design: 55 (of 4796) Osteoarthritis Initiative (OAI) participants fulfilled the inclusion criteria of early RKOA in one limb (definite tibiofemoral osteophytes; no radiographic joint space narrowing [JSN]) vs no RKOA (no osteophyte; no JSN) in the contralateral limb. ACSAs of the thigh muscles and quadriceps heads were determined using axial MRIs at 33%/30% femoral length (distal to proximal). Isometric extensor and flexor muscle strength were measured (Good Strength Chair). Baseline quadriceps ACSA and extensor (specific) strength represented the primary analytic focus, and 2-year changes of quadriceps ACSAs the secondary focus. Results: No statistically significant side-differences in quadriceps (or other thigh muscle) ACSAs, muscle strength, or specific strength were observed between early RKOA vs contralateral limbs without RKOA (P >= 0.44), neither in men nor in women. The 2-year reduction in quadriceps ACSA in limbs with early RKOA was -0.9 +/- 6% (mean +/- standard deviation) vs -0.5 +/- 6% in limbs without RKOA (statistical difference P = 0.85). Conclusion: Our results do not provide evidence that early unilateral radiographic changes, i.e., presence of osteophytes, are associated with cross-sectional or longitudinal differences in quadriceps muscle status compared with contralateral knees without RKOA. At the stage of early unilateral RKOA there thus appears to be no clinical need for countervailing a potential dys-balance in quadriceps ACSAs and strength between both knees.
    Osteoarthritis and Cartilage 10/2014; 22(10):1634-8. DOI:10.1016/j.joca.2014.06.002 · 4.66 Impact Factor
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    ABSTRACT: Objective Investigate the relationship between sedentary behavior and physical function in adults with knee osteoarthritis (OA), controlling for moderate-vigorous physical activity (MVPA) levels.Methods Sedentary behavior was objectively measured by accelerometer on 1,168 participants ages 49-83 years in the Osteoarthritis Initiative with radiographic knee OA at the 48-month clinic visit. Physical function was assessed using 20-meter walk and chair stand testing. Sedentary behavior was identified by accelerometer activity counts/minute <100. The cross-sectional association between sedentary quartiles and physical function was examined by multiple linear regression, adjusting for demographic factors (age, sex, race/ethnicity, education level), health factors (comorbidity, body mass index, knee pain, knee OA severity, presence of knee symptoms), and average daily MVPA minutes.ResultsAdults with knee OA spent two-thirds of their daily time in sedentary behavior. The average gait speed among the most sedentary quartile was 3.88 feet/second, which was significantly slower than the speed of the less sedentary groups (4.23, 4.33, and 4.33 feet/second, respectively). The average chair stand rate among the most sedentary group was significantly lower (25.9 stands/minute) than the rates of the less sedentary behavior groups (28.9, 29.1, and 31.1 stands/minute, respectively). These trends remained significant in multivariable analyses adjusted for demographic factors, health factors, and average daily MVPA minutes.Conclusion Being less sedentary was related to better physical function in adults with knee OA independent of MVPA time. These findings support guidelines to encourage adults with knee OA to decrease time spent in sedentary behavior in order to improve physical function.
    08/2014; 67(3). DOI:10.1002/acr.22432
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    ABSTRACT: Background. Knee osteoarthritis (OA) and frailty are two conditions that are associated with functional limitation and disability in elders, yet their relation to one another is not known. Methods. We included participants from two large, multicenter studies enriched with community dwelling older adults with knee OA (Multicenter Osteoarthritis Study and Osteoarthritis Initiative). Knee OA was defined radiographically (ROA) and symptomatically (SOA). Frailty was defined using the Study of Osteoporotic Fracture index as the presence of >= 2 of the following: (i) weight loss >5% between two consecutive visits; (ii) inability to arise from chair five times without support; (iii) poor energy. Cross-sectional and longitudinal associations of knee OA with prevalent and incident frailty, respectively, were examined using binomial regression with robust variance estimation, adjusting for potential confounders. Results. In the cross-sectional analyses, frailty was more prevalent among participants with ROA (4.39% vs 2.77%; PR 1.60 [1.07, 2.39]) and SOA (5.88% vs 2.79%; PR 1.92 [1. 35, 2.74]) compared with those without ROA or SOA, respectively. In the longitudinal analyses, risk of developing frailty was greater among those with ROA (4.73% vs 2.50%; RR 1.45 [0.91, 2.30]) and SOA (6.30% vs 2.83%; RR 1.66 [1.11, 2.48]) than those without ROA or SOA, respectively. Conclusions. Knee OA is associated with greater prevalence and risk of developing frailty. Understanding the mechanisms linking these two common conditions of older adults would aid in identifying novel targets for treatment or prevention of frailty.
    The Journals of Gerontology Series A Biological Sciences and Medical Sciences 07/2014; 70(3). DOI:10.1093/gerona/glu102 · 4.98 Impact Factor
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    ABSTRACT: Objective. To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage. Methods. The Multicenter Osteoarthritis Study is a US National Institutes of Health-funded cohort study of older adults with or at risk of knee osteoarthritis. Subjects identified painful areas around the knee on a knee pain map and the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain with stairs and walking on level ground. Cartilage damage and bone marrow lesions were assessed from knee magnetic resonance imaging. We determined the sensitivity, specificity, positive and negative predictive values for presence of anterior knee pain (AKP), pain with stairs, absence of pain while walking on level ground, and combinations of tests in discriminating knees with isolated PFJ structural damage from those with isolated tibiofemoral joint (TFJ) or no structural damage. Knees with mixed PFJ/TFJ damage were removed from our analyses because of the inability to determine which compartment was causing pain. Results. There were 407 knees that met our inclusion criteria. "Any" AKP had a sensitivity of 60% and specificity of 53%; and if AKP was the only area of pain, the sensitivity dropped to 27% but specificity rose to 81%. Absence of moderate pain with walking on level ground had the greatest sensitivity (93%) but poor specificity (13%). The combination of "isolated" AKP and moderate pain with stairs had poor sensitivity (9%) but the greatest specificity (97%) of strategies tested. Conclusion. Commonly used questions purported to identify knees with PFJ structural damage do not identify this condition with great accuracy.
    The Journal of Rheumatology 06/2014; 41(8). DOI:10.3899/jrheum.131555 · 3.17 Impact Factor

Publication Stats

8k Citations
1,073.98 Total Impact Points


  • 1993–2015
    • University of California, San Francisco
      • • Department of Epidemiology and Biostatistics
      • • Division of Prevention Science
      San Francisco, California, United States
  • 2009–2014
    • CSU Mentor
      Long Beach, California, United States
  • 1996–2012
    • University of San Francisco
      San Francisco, California, United States
  • 2008
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States
  • 2007
    • Wake Forest School of Medicine
      • Sticht Center on Aging
      Winston-Salem, NC, United States
  • 1996–2007
    • University of Pittsburgh
      • • Department of Medicine
      • • Department of Epidemiology
      • • Department of Orthopaedic Surgery
      Pittsburgh, Pennsylvania, United States
  • 2006
    • Stanford University
      Palo Alto, California, United States
  • 2000–2003
    • University of Tennessee
      • Department of Preventive Medicine
      Knoxville, TN, United States