Michael C Nevitt

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

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Publications (443)2931.25 Total impact

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    ABSTRACT: Background/Purpose: Widespread pain (WSP) is associated with morbidity, and poor mental and physical functioning, but its etiology is not well understood. It has been hypothesized that painful peripheral pathology may result in WSP. Previous cross-sectional studies have shown an association of knee pain and radiographic knee osteoarthritis (ROA) with WSP. However, the independent relations of knee OA and knee pain, to incident WSP is unknown. We examined the relation of ROA, symptomatic knee OA (SxOA) and consistent frequent knee pain (CFKP) to incident WSP in a large prospective cohort. Methods: We used data from the Multicenter Osteoarthritis (MOST) Study, a NIH-funded longitudinal prospective cohort of 3026 older adults with or at risk of knee OA. ROA was defined as having radiographic tibiofemoral OA (Kellgren & Lawrence grade ≥2) on the 60-month radiographs. The definition of CFKP was met if a participant reported knee pain on most days during the past month at the 60-month telephone interview and at the clinic visit that occurred on average one month later. SxOA was defined as having both ROA and CFKP at 60 months. We also considered knee replacement as equivalent to ROA and SxOA. WSP was defined as pain above and below the waist, on both sides of the body and axially, using a standard homunculus, excluding knee pain. Incident WSP was defined as presence of WSP at 84 months among those who were free of WSP at 60 months. We assessed the relation of baseline ROA, SxOA, and CFKP, respectively, to incident WSP using logistic regression, adjusting for baseline age, sex, BMI, comorbidities, physical activity, WOMAC pain intensity, study site, depressive symptoms, pain catastrophizing and fatigue. Results: At baseline, 1309 subjects were eligible for ROA analysis (age mean, SD; 67.3, 7.8; BMI 30.5, 6.0 kg/m2, 56% women), 1316 for SxOA analysis (age 67.3, 7.8; BMI 30.4, 5.9 kg/m2, 55% women) and 1383 for CFKP analysis (age 67.4, 7.8; BMI 30.5, 6.0 kg/m2, 55% women). Baseline presence of unilateral ROA was associated with a non-significant 30% lower risk of incident WSP compared with those without ROA (adjusted OR 0.70, 95% CI 0.46-1.07, p=0.10). Similar results were found for those with bilateral ROA. Similarly, neither baseline unilateral nor bilateral SxOA were associated with risk of incident WSP compared with those without SxOA. Baseline presence of unilateral CFKP was also not significantly associated with incident WSP, while bilateral CFKP approached significance (see table). Conclusion: Neither ROA, SxOA nor CFKP increased the risk of developing WSP. These results suggest that neither knee joint pathology nor joint pain are major factors in the onset of WSP. Further study is required to clarify what factors contribute to the onset of WSP.
    American College of Rheumatology, San Francisco, CA; 11/2015
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    ABSTRACT: Background/Purpose: Widespread pain (WSP) may be present in individuals for numerous reasons, and its presence may affect the degree to which people engage in activities. How the presence of WSP affects the risk of developing knee pain or knee osteoarthritis (OA) is unknown and could enhance the understanding of pain mechanisms in OA. For example, people with WSP may have a lower risk of developing knee OA due to less frequent loading of the knee or they may have an increased risk due to maladaptive movement patterns. The purpose of this study was to determine if WSP is associated with future consistent frequent knee pain (CFKP) or radiographic OA (ROA) two years later. Methods: Subjects from the Multicenter Osteoarthritis (MOST) study, a NIH-funded longitudinal prospective cohort of older adults with or at risk of knee OA were assessed at the 60-month (baseline) and 84-month (follow up) visits. WSP was defined at baseline as pain on both sides of the body, above and below the waist, and axial pain, using a standard homunculus, with the exception that the knees were not included in defining WSP. Incident CFKP was defined as reporting knee pain on most days during the past month at the 84-month telephone interview and again during the clinic visit that occurred on average one month later among participants who were free of CFKP at 60 months. Incident ROA was defined as presence of Kellgren & Lawrence grade 2 or knee replacement of either knee at follow-up among those who were free of ROA (and knee replacement) at baseline. We assessed the relation of WSP to risk of CFKP and ROA respectively, using multinomial regression adjusting for baseline age, sex, BMI, comorbidities, physical activity and clinic site; the model was also adjusted for depressive symptoms, pain catastrophizing, fatigue and ROA when CFKP was the outcome, and for WOMAC pain severity when ROA was the outcome. Results: There were 923 eligible subjects for analysis of incident CFKP (mean age (SD); 67.4 (7.5); BMI 30.0 (5.6) kg/m2, 56% women,19% WSP), and 675 for incident ROA (age 65.6 (7.4); BMI 28.9 (4.7) kg/m2 , 60% women, 30% WSP). Baseline presence of WSP was associated with a non-significant 59% increased risk of incident CFKP compared with those without WSP (adjusted OR 1.59, 95% CI 0.94-2.68, p=0.08). Baseline WSP was associated with a non-significant 14% lower risk of incident ROA,(adjusted OR 0.86, 95% CI 0.46-1.63, p=0.65). WSP was associated with a non-significant 65% increased risk of unilateral CFKP vs. no CFKP (adjusted OR 1.65, 95% CI 0.92-2.96, p=0.09) and with a non-significant 35% increased risk of bilateral CFKP vs. no CFKP (adjusted OR 1.35, 95% CI 0.49-3.73, p=0.56). For both incident unilateral and bilateral ROA vs. no ROA, WSP was not statistically significantly associated; unilateral ROA had 1% lower risk (adjusted OR 0.99, 95% CI 0.51-1.92, p=0.97), and bilateral ROA had 77% lower risk (adjusted OR 0.23, 95% CI 0.02-2.53, p=0.23). Conclusion: WSP was not significantly associated with either incident CFKP or ROA. Development of knee pain and ROA does not appear to be influenced by underlying WSP, suggesting that screening for or managing WSP will not have a meaningful influence on the development of knee pain or ROA.
    American College of Rheumatology, San Francisco, CA; 11/2015
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    ABSTRACT: Purpose: to determine if asymmetry between hips in pain or radiographic osteoarthritis (RHOA) is associated with worse pain and joint space narrowing (JSN) at baseline and longitudinally in knees contralateral to more affected hips. Methods: We studied 279 participants in the Osteoarthritis Initiative with baseline asymmetry between hips in pain and 483 with asymmetry in RHOA none of whom had a hip replacement for ≥4 years after baseline. RHOA assessed from pelvis radiographs was categorized as none, possible or definite and hip pain on most days of a month in the past year as present/absent. Knee pain (WOMAC scale) and JSN (fixed flexion radiographs) were categorized as none, mild and moderate-severe. We compared knees contralateral and ipsilateral to more affected hips on baseline knee pain and JSN using clustered multinomial regression and on change in knee pain and JSN over 4-5 years using generalized linear and logistic estimating equations. Results: Knees contralateral to painful hips had less baseline pain ("moderate-severe" vs. "none", relative risk ratio [RRR]: 0.39, 95% CI = 0.27-0.57), but greater baseline JSN ("moderate-severe" vs. "none", RRR: 1.62, 95% CI = 1.09-2.38) and greater worsening of pain during follow-up (p = 0.001). Knees contralateral to hips with worse RHOA had nonsignificant trends for greater baseline JSN (p = 0.10) and JSN progression (p = 0.17). Conclusion: These findings provide limited support for the hypothesis that early asymmetry in hip pain and RHOA is associated with worse pain and structural outcomes in knees contralateral to the more affected hip.
    Osteoarthritis and Cartilage 10/2015; DOI:10.1016/j.joca.2015.10.001 · 4.17 Impact Factor
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    ABSTRACT: Objective: To identify patterns of co-existing lesions on MRI in knees free of radiographic osteoarthritis and to examine their relation to incident disease. Methods: From a prospective cohort study, the Multicenter Osteoarthritis Study, one knee per subject without radiographic osteoarthritis in both tibiofemoral and patellofemoral joints at baseline was selected and followed up to 84-months. We used a novel approach, latent class analysis, to group the constellation of MRI lesions in each joint, i.e., cartilage damage, bone marrow lesion, meniscal tear, meniscal extrusion, synovitis, and effusion, to a manageable number of subgroups. The association of these subgroups with incident radiographic osteoarthritis in the same joint was assessed using logistic regression. Results: Among 885 eligible knees (mean age 60.5 years, 203 with incident disease in the tibiofemoral joint, 64 in the patellofemoral joint), four latent subgroups were identified in the tibiofemoral joint described briefly as: minimal lesions, mild lesions, moderate lesions (but limited meniscal lesions), and severe lesions. The odds ratios of incident disease in the tibiofemoral joint were 1.0, 5.6, 1.8, and 5.0, respectively. A similar set of four subgroups was identified in the patellofemoral joint, except that the fourth subgroup had limited meniscal lesions. The odds ratios of incident disease in the patellofemoral joint were 1.0, 3.8, 5.1, and 13.7, respectively. Conclusion: Different patterns of co-existing MRI lesions were identified that have different implications for risk of knee osteoarthritis. Meniscal damage seemed to play a different role in the development of incident disease in the tibiofemoral versus patellofemoral joints. This article is protected by copyright. All rights reserved.
    Arthritis and Rheumatology 09/2015; DOI:10.1002/art.39436
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    ABSTRACT: Objective: Pain is not always correlated with radiographic osteoarthritis (OA) severity possibly because people modify activities to manage symptoms. Measures of symptoms that consider pain in the context of activity level may therefore provide greater discrimination than pain alone. Our objective was to compare discrimination of a measure of pain alone with combined measures of pain relative to physical activity across radiographic OA levels. Methods: This is a cross-sectional study of the Osteoarthritis Initiative accelerometer substudy, including those with and without knee OA. Two composite pain and activity knee symptom (PAKS) scores were calculated as Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Pain Scale plus one divided by physical activity measures (step and activity counts). Symptom score discrimination across Kellgren and Lawrence (KL) grades were evaluated using histograms and quantile regression. Results: 1806 participants, mean age 65.1 (9.1) years, mean BMI 28.4 (4.8) kg/m(2) , and 55.6% female, were included. WOMAC, but not PAKS scores, exhibited a floor effect. Adjusted median WOMAC by KL grades 0 - 4 were 0, 0, 1, 1, and 3 respectively. Median PAKS1 and PAKS2 were 24.9, 26.0, 32.4, 46.1, 97.9, and 7.2, 7.2, 9.2, 12.9, 23.8, respectively. PAKS scores had more statistically significant comparisons between KL grades compared with WOMAC. Conclusions: Symptom assessments incorporating pain and physical activity did not exhibit a floor effect and were better able to discriminate radiographic severity than pain alone, particularly in milder disease. Pain in the context of physical activity level should be used to assess knee OA symptoms. This article is protected by copyright. All rights reserved.
    Arthritis and Rheumatology 09/2015; DOI:10.1002/art.39271
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    ABSTRACT: Background: pain may reduce stability and increase falls and subsequent fractures in older men. Objectives: to examine the association between joint pain and any pain with falls, hip and non-spine fractures in older community-dwelling men. Design: a cohort study. Setting and participants: analyses included 5,993 community-dwelling men aged ≥65 years from the MrOS cohort. Measurements: pain at hip, knee and elsewhere (any) was assessed by self-report. Men reported falls via questionnaires mailed 3× per year during the year following the baseline visit. Fractures were verified centrally. Mean follow-up time for fractures was 9.7 (SD 3.1) years. Logistic regression models estimated likelihood of falls and proportional hazards models estimated risk of fractures. Models were adjusted for age, BMI, race, smoking, alcohol use, medications use, co-morbidities and arthritis; fracture models additionally adjusted for bone mineral density. Results: one quarter (25%, n = 1,519) reported ≥1 fall; 710 reported ≥2 falls in the year after baseline. In multivariate models, baseline pain at hip, knee or any pain increased likelihood of ≥1 fall and ≥2 falls over the following year. For example, knee pain increased likelihood of ≥1 fall (odds ratio, OR 1.44; 95% confidence interval, CI 1.25-1.65) and ≥2 falls (OR 1.75; 95% CI 1.46-2.10). During follow-up, 936 (15.6%) men suffered a non-spine fracture (n = 217, 3.6% hip). In multivariate models, baseline pain was not associated with incident hip or non-spine fractures. Conclusions: any pain, knee pain and hip pain were each strong independent risk factors for falls in older men. Increased risk of falls did not translate into an increased risk of fractures.
    Age and Ageing 09/2015; DOI:10.1093/ageing/afv125 · 3.64 Impact Factor
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    ABSTRACT: Objective: To identify the independent relation of synovitis with incident radiographic knee osteoarthritis (OA) after adjusting for other structural factors known to cause synovitis. Design: We examined MRIs from knees that developed incident radiographic OA from the Multicenter Osteoarthritis Study (MOST) and compared these case knees with controls that did not develop OA. We examined baseline MRIs for knees developing OA at any time up to 84 months follow-up. We scored lesions in cartilage, meniscus, bone marrow and synovitis. Synovitis scores were summed (0-9) across 3 regions, suprapatellar, infrapatellar and intercondylar region, each of which was scored 0-3. After bivariate analyses examining each factor's association with incidence, we carried out multivariable regression analyses adjusting for age, sex, BMI, alignment and cartilage and meniscal damage. Results: We studied 239 case and 731 control knees. In bivariate analyses, cartilage lesions, meniscal damage, synovitis and bone marrow lesions were all risk factors for OA. After multivariable analyses, synovitis was associated with incident OA. A higher synovitis score increased the risk of incident OA (adjusted OR per unit increase 1.1; (95% CI 1.0, 1.2, p=.02), but increased risk was associated only with synovitis scores of >=3 (adjusted OR 1.6; 95% CI 1.2, 2.1, p = .003) CONCLUSIONS: Synovitis, especially when there is a substantial volume within the knee, is an independent cause of OA.
    Osteoarthritis and Cartilage 09/2015; DOI:10.1016/j.joca.2015.09.013 · 4.17 Impact Factor
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    ABSTRACT: To investigate the association of cartilage thickness change by MRI (over 24 months (M)) with knee osteoarthritis (OA) progression at 24-48M. This nested case-control study included 600 knees with baseline Kellgren Lawrence grade (KLG) 1-3 from 600 Osteoarthritis Initiative (OAI) participants. Case knees had both medial tibiofemoral radiographic joint space loss (≥0.7 mm) and a persistent increase in WOMAC pain (≥9 on a 0-100 scale) at 24-48M from baseline (n=194). Control knees (n=406) included 200 with neither radiographic nor pain progression, 103 with radiographic progression only and 103 with pain progression only. Medial and lateral femorotibial cartilages were segmented from sagittal 3Tesla baseline, 12M, and 24M MRIs. We used logistic regression to assess the association of change in cartilage thickness, with a focus on the central medial femorotibial (cMFTC) compartment, and OA progression. cMFTC thickness loss was statistically significantly associated with case status (odds ratio (OR) 1.9; 95% confidence interval [CI] 1.6, 2.3), p<0.0001), with both the central femur (OR=1.8; 95% CI 1.5, 2.2) and the central tibia (OR=1.6; 95%CI 1.3, 1.9) reaching p<0.05. Lateral femorotibial compartment cartilage thickness loss, in contrast, was not significantly associated with case status. Reduction in cMFTC cartilage thickness was associated strongly with radiographic progression (OR: 4.0; 95%CI: 2.9, 5.3; p<0.0001) and only weakly with pain progression (OR:1.3; 95% CI: 1.1, 1.6; p<0.01). Loss in medial femorotibial cartilage thickness over 24M is associated with the combination of radiographic and pain progression in the knee; this association was stronger for radiographic progression. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    Arthritis and Rheumatology 08/2015; DOI:10.1002/art.39324
  • Neil A Segal · Michael C Nevitt · John A Lynch · Jingbo Niu · James C Torner · Ali Guermazi ·
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    ABSTRACT: To determine the diagnostic performance of standing computerized tomography (SCT) of the knee for osteophytes and subchondral cysts compared with fixed-flexion radiography, using MRI as the reference standard. Twenty participants were recruited from the Multicenter Osteoarthritis Study. Participants' knees were imaged with SCT while standing in a knee-positioning frame, and with postero-anterior fixed-flexion radiography and 1T MRI. Medial and lateral marginal osteophytes and subchondral cysts were scored on bilateral radiographs and coronal SCT images using the OARSI grading system and on coronal MRI using Whole Organ MRI Scoring. Imaging modalities were read separately with images in random order. Sensitivity, specificity and accuracy for the detection of lesions were calculated and differences between modalities were tested using McNemar's test. Participants' mean age was 66.8 years, body mass index was 29.6 kg/m(2) and 50% were women. Of the 160 surfaces (medial and lateral femur and tibia for 40 knees), MRI revealed 84 osteophytes and 10 subchondral cysts. In comparison with osteophytes and subchondral cysts detected by MRI, SCT was significantly more sensitive (93 and 100%; p < 0.004) and accurate (95 and 99%; p < 0.001 for osteophytes) than plain radiographs (sensitivity 60 and 10% and accuracy 79 and 94%, respectively). For osteophytes, differences in sensitivity and accuracy were greatest at the medial femur (p = 0.002). In comparison with MRI, SCT imaging was more sensitive and accurate for detection of osteophytes and subchondral cysts than conventional fixed-flexion radiography. Additional study is warranted to assess diagnostic performance of SCT measures of joint space width, progression of OA features and the patellofemoral joint.
    The Physician and sportsmedicine 08/2015; 43(3):1-8. DOI:10.1080/00913847.2015.1074854 · 1.09 Impact Factor
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    ABSTRACT: Radiographic disease and knee pain are thought to decrease physical activity in people with knee osteoarthritis (OA), but this has not been formally studied. We examined change in objectively measured daily walking over two years and evaluated the association of certain risk factors with reduced walking among adults with or at risk of knee OA. Steps/day over 7 days were collected at baseline and two years later in subjects with or at risk of knee OA from the Multicenter Osteoarthritis Study using a StepWatch. We evaluated the presence of radiographic knee osteoarthritis (ROA), knee pain, worsening of ROA and pain over two years, obesity, depressive symptoms, living situation, catastophizing, fatigue, widespread pain and comorbidities with two-year change in daily walking using regression models adjusted for potential confounders. 1,318 met inclusion criteria (age 66.9 ± 7.7, 59% women, BMI 30.6 ± 5.9) and walked 126 ± 1700 steps/day fewer steps at 2 years (95% CI [-218, -35]). People with depressive symptoms at baseline walked 455 fewer steps/day [-872, -68], and there was a trend for people with ROA worsening to walk 183 fewer steps/day [-377.5, 11.7]. No other factors met statistical significance for change in daily walking. Adults with or at risk of knee OA experienced only minimal declines in daily walking over two years. Nonetheless, depressive symptoms and maybe worsening ROA are associated with a decline in steps/day in adults with or at risk of knee OA. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 08/2015; DOI:10.1016/j.joca.2015.08.004 · 4.17 Impact Factor
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    ABSTRACT: Two comorbidity indices were adapted for use in the FREEDOM trial and significantly correlated with the number of medications and impaired health status at baseline. The indices have applications for the analysis of clinical trial data and would allow for the appropriate adjustment of comorbidities when evaluating clinical trial outcomes. The purpose of this study is to adapt two published comorbidity indices for use with the FREEDOM clinical trial evaluating postmenopausal women with osteoporosis. FREEDOM enrolled women aged 60-90 years with a bone mineral density T-score <-2.5 at the lumbar spine or total hip and ≥-4.0 at both sites. Comorbidity indices were calculated using methods described by Sangha (Arthritis Rheum 49:156-163, 2003) and Wolfe (J Rheumatol 37:305-315, 2010) following modification. The adapted Sangha index included 12 conditions with a summary score of 0-12; the adapted Wolfe index included 7 conditions with a weighted summary score of 0-8. Higher scores indicated greater comorbidity. A panel of clinicians independently reviewed subjects' medical histories using a systematic process based on Medical Dictionary for Regulatory Activities (MedDRA) preferred terms to map specified comorbid conditions. Spearman correlations between the adapted indices and baseline subject characteristics expected to be associated with comorbidities were examined. Of the 7808 subjects in this study, 74 % had ≥1 comorbidities based on the adapted Sangha or Wolfe comorbidity indices. The mean (SD) adapted Sangha and Wolfe comorbidity indices were 1.4 (1.2) and 1.4 (1.3), respectively. Both indices correlated positively with age, body mass index, and the number of medications (r = 0.54 to 0.55) at baseline and inversely correlated with health-related quality of life (r = -0.22 to -0.30) (all P < 0.0001). Further, when either the adapted Sangha or Wolfe index was included as a covariate for assessing mortality over 36 months in the FREEDOM population, the hazard ratio of the comorbidity index indicated that the mortality risk increased by 27 or 28 %, respectively, for each unit increase in the adapted index (both P < 0.0001). Our work suggests these comorbidity indices may be adapted for use with clinical trial data, thereby allowing for the appropriate adjustment and reporting of covariates in the evaluation of clinical trial outcomes in an osteoporotic population.
    Osteoporosis International 07/2015; DOI:10.1007/s00198-015-3215-x · 4.17 Impact Factor
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    ABSTRACT: To provide a comprehensive simultaneous relation of various semiquantitative knee OA MRI features as well as the presence of baseline radiographic OA to quantitative longitudinal cartilage loss. We studied Multicenter OA Study (MOST) participants from a longitudinal observational study that included quantitative MRI measurement of cartilage thickness. These subjects also had Whole Organ MRI Score (WORMS) scoring of cartilage damage, bone marrow lesions (BMLs), meniscal pathology, and synovitis, as well as baseline radiographic evaluation for Kellgren and Lawrence (KL) grading. Knee compartments were classified as progressors when exceeding thresholds of measurement variability in normal knees. All potential risk factors of cartilage loss were dichotomized into "present" (score≥2 for cartilage, ≥1 for others) or "absent". Differences in baseline scores of ipsi-compartmental risk factors were compared between progressor and non-progressor knees by multivariable logistic regression, adjusting for age, sex, body mass index, alignment axis (degrees) and baseline KL grade. Odds ratios (OR) and 95% CIs were calculated for medial (MFTC) and lateral (LFTC) cartilage loss. Cartilage loss across both compartments was studied using Generalized Estimating Equations. 196 knees of 196 participants were included (age 59.8±6.3 years [mean±SD], BMI 29.5±4.6, 62% women). For combined analyses of MFTC and LFTC, baseline factors related to cartilage loss were radiographic OA (KL grade ≥2: aOR 4.8 [2.4-9.5], cartilage damage (aOR 2.3 [1.2-4.4]), meniscal damage (aOR 3.9 [2.1-7.4]) and extrusion (aOR 2.9 [1.6-5.3]), all in the ipsilateral compartment, but not BMLs or synovitis. Baseline radiographic OA and semiquantitatively assessed MRI-detected cartilage damage, meniscal damage and extrusion, but not BMLs or synovitis is related to quantitatively measured ipsicompartmental cartilage thinning over 30 months. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 07/2015; DOI:10.1016/j.joca.2015.06.017 · 4.17 Impact Factor
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    Osteoarthritis and Cartilage 06/2015; DOI:10.1016/j.joca.2015.05.024 · 4.17 Impact Factor
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    ABSTRACT: The ability to assess the efficacy and effectiveness of an intervention for the treatment of hip osteoarthritis (OA) requires strong clinical trial methodology. This consensus paper provides recommendations based on a narrative literature review and best judgment of the members of the committee for clinical trials of hip OA. We provide recommendations on clinical trial design, outcome measures, including structural (radiography), and patient and physician global assessments, performance based measures, molecular markers and experimental endpoints including MRI imaging. This information can be utilized by sponsors of trials for new therapeutic agents for hip OA. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
    Osteoarthritis and Cartilage 05/2015; 23(5):761-771. DOI:10.1016/j.joca.2015.03.006 · 4.17 Impact Factor
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    ABSTRACT: To determine whether knee cartilage composition differs between African-American and Caucasian-American women at risk for Osteoarthritis using in-vivo 3 Tesla MRI T2 relaxation time measurements. Right knee MRI studies of 200 subjects (100 African-American women, and 100 closely matched Caucasian-American women) were selected from the Osteoarthritis Initiative. Knee cartilage was segmented in the patellar (PAT), medial and lateral femoral (MF/LF), and medial and lateral tibial compartments (MT/LT)). Mean T2 relaxation time values per compartment and per whole joint cartilage were generated and analyzed spatially via laminar and grey-level co-occurrence matrix texture methods. Presence and severity of cartilage lesions per compartment were graded using a modified WORMS grading. Statistical analysis employed paired t- and McNemar testing. While African-American women and Caucasian-Americans had similar WORMS cartilage lesion scores (p=0.970), African-Americans showed significantly lower mean T2 values (∼1ms difference; ∼0.5SD) than Caucasian-Americans in the whole knee cartilage (p<0.001), and in the subcompartments (LF: p=0.001, MF: p<0.001, LT: p=0.019, MT: p=0.001) and particularly in the superficial cartilage layer (whole cartilage: p<0.001, LF: p<0.001, MF: p<0.001, LT: p=0.003, MT: p<0.001). T2 texture parameters were also significantly lower in the whole joint cartilage of African-Americans than in Caucasian-Americans (variance: p=0.001; contrast: p=0.018). In analyses limited to matched pairs with no cartilage lesions in a given compartment, T2 values remained significantly lower in African-Americans. Using T2 relaxation time as a biomarker for the cartilage collagen network, our findings suggest racial differences in the biochemical knee cartilage composition between African-American and Caucasian-American women. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 04/2015; 23(9). DOI:10.1016/j.joca.2015.04.023 · 4.17 Impact Factor
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    ABSTRACT: To determine what MRI-detectable osteoarthritis features that are not visualized on radiography demonstrate progression longitudinally in Kellgren and Lawrence (KL) grade 4knees. We studied subjects from the Multicenter Osteoarthritis Study who had KL grade 4 knees at baseline and had baseline and 30-month MRI. Cartilage damage, bone marrow lesions (BMLs), meniscal damage, synovitis (signal changes in Hoffa fat pad), and effusion (fluid equivalent signal in the joint cavity) were semiquantitatively scored using the WORMS system in 5 subregions of the medial and lateral tibiofemoral (TF) compartments. Analysis was performed for the compartment showing bone-on-bone appearance ("index") on radiograph and also for the other TF compartment of the same knee. Synovitis and effusion were assessed for the whole knee. Changes in scores at follow-up were noted for each feature. For cartilage and BML, within-grade changes were also recorded. 140 subjects (164 knees) were included (50% women, mean age 66.0±8.6 years, mean BMI 30.4±5.1 kg/m(2)). Longitudinally, 51 index compartments (34%) showed an increase in the sum of cartilage scores from all subregions. In the other compartment, 25% showed an increase in the sum score for cartilage damage. For BMLs in the index compartment, 50 knees (33%) showed an increase in maximum score and 32 (21%) showed a decrease. Meniscal status mostly remained stable. Effusion worsened in 36 knees (25%) and improved in 13 knees (9%). Synovitis worsened in 14 knees (10%) and improved in 6 knees (4%). In KL grade 4 knees, MRI-detected cartilage loss and fluctuation of BMLs, effusion, and synovitis occurred frequently over a 30-month period. Copyright © 2015. Published by Elsevier Ltd.
    Osteoarthritis and Cartilage 04/2015; 23(9). DOI:10.1016/j.joca.2015.04.018 · 4.17 Impact Factor

  • Osteoarthritis and Cartilage 04/2015; 23(Suppl 2):A276-A277. DOI:10.1016/j.joca.2015.02.505 · 4.17 Impact Factor

  • Osteoarthritis and Cartilage 04/2015; 23:A290-A291. DOI:10.1016/j.joca.2015.02.528 · 4.17 Impact Factor

  • OARSI 2015; 04/2015

  • Osteoarthritis and Cartilage 04/2015; 23:A68-A69. DOI:10.1016/j.joca.2015.02.140 · 4.17 Impact Factor

Publication Stats

38k Citations
2,931.25 Total Impact Points


  • 1984-2015
    • University of California, San Francisco
      • • Department of Epidemiology and Biostatistics
      • • Division of Hospital Medicine
      • • Division of Prevention Science
      • • Division of General Internal Medicine
      San Francisco, California, United States
  • 2014
    • University of San Francisco
      San Francisco, California, United States
  • 2011-2014
    • University of Oxford
      • Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS)
      Oxford, England, United Kingdom
  • 2013
    • The University of Tennessee Health Science Center
      • Division of Biostatistics and Epidemiology
      Memphis, Tennessee, United States
    • The University of Manchester
      Manchester, England, United Kingdom
  • 2008-2013
    • Boston University
      • Department of Radiology
      Boston, Massachusetts, United States
    • Women's College Hospital
      Toronto, Ontario, Canada
  • 2012
    • The Prevention Group
      Omaha, Nebraska, United States
    • Imperial College London
      Londinium, England, United Kingdom
  • 2010-2011
    • University of the Pacific (California - USA)
      Stockton, California, United States
    • University of California, Davis
      Davis, California, United States
  • 2009
    • University of Thessaly
      Iolcus, Thessaly, Greece
    • Wake Forest School of Medicine
      • Sticht Center on Aging
      Winston-Salem, NC, United States
  • 1993-2008
    • University of Pittsburgh
      • • Department of Epidemiology
      • • Department of Orthopaedic Surgery
      Pittsburgh, PA, United States
  • 2005
    • University of Queensland 
      • School of Human Movement Studies
      Brisbane, Queensland, Australia
    • VU University Amsterdam
      • IHS-Institute of Health Sciences
      Amsterdamo, North Holland, Netherlands
  • 2003
    • Peking Union Medical College Hospital
      • Department of Obstetrics and Gynecology
      Beijing, Beijing Shi, China
  • 2002
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States
  • 1999
    • University of California, Los Angeles
      • Department of Medicine
      Los Angeles, CA, United States
  • 1997
    • CSU Mentor
      Long Beach, California, United States
  • 1995-1996
    • University of Maryland, Baltimore
      • Department of Medicine
      Baltimore, Maryland, United States
  • 1994
    • Oregon Health and Science University
      • Division of General Internal Medicine
      Portland, OR, United States