David Felson

Boston Medical Center · Clinical Epidemiology

Objective To 1) develop and evaluate a machine learning model incorporating gait and physical activity to predict medial tibiofemoral cartilage worsening over two years in individuals without or with early knee osteoarthritis and 2) identify influential predictors in the model and quantify their effect on cartilage worsening. Design An ensemble ma...

Objective : To summarize proceedings of a workshop convened to discuss the current state of science in the disease of osteoarthritis (OA), identify the knowledge gaps, and examine the developmental and regulatory challenges in bringing these products to market. Design : Summary of the one-day workshop held virtually on June 22nd, 2021. Results :...

Objectives To assess the relation of obesity to opioid use in people with or at risk of knee osteoarthritis (OA), and the extent to which this association is mediated by number of painful joints or depressive symptoms. Methods We used data from the Multicenter Osteoarthritis Study, a longitudinal cohort of older adults with or at risk of knee OA....

OBJECTIVES To evaluate fat fraction of subchondral bone marrow oedema-like lesions (BMLs) and nearby marrow in knee osteoarthritis (OA) using Dixon MR imaging and to compare conventional volume measurements of BML change with an alternative technique using Dixon MRI and image registration. METHODS We analyzed 3T MR images from 17 symptomatic knee...

Objective: Knee replacement rates are increasing exponentially in the US and straining insurance budgets. We investigated how many knee replacements (KRs) would be prevented at different levels of pain improvement, a major target of osteoarthritis trials. Methods: We used data from the Osteoarthritis Initiative (OAI) to emulate a trial of knee p...

Background and aim Iron deficiency is associated with increased morbidity and mortality in older adults. However, data on its prevalence and incidence among older adults is limited. The aim of this study was to investigate the prevalence and incidence of iron deficiency in European community-dwelling older adults aged ≥ 70 years. Methods Secondary...

Objectives: There are no proven effective medical treatments to prevent calcium pyrophosphate crystal deposition (CPPD). Hypomagnesemia is a known CPPD risk factor. We carried out a real-world epidemiologic study on proton pump inhibitor (PPI) use, which can cause hypomagnesemia, and CPPD risk. Methods: We conducted a time-stratified, propensity...

Objective Eligibility for clinical trials in osteoarthritis (OA) is usually limited to Kellgren-Lawrence (KL) grades 2 and 3 knees. Our aim was to describe the prevalence and severity of cartilage damage in KL 2 and 3 knees by compartment and articular subregion. Design The Multicenter Osteoarthritis (MOST) study is a cohort study of individuals w...

Obesity increases the risk of knee osteoarthritis. Knee joint contact characteristics have been thought to provide insights into the pathogenesis of knee OA; however, the cartilage contact characteristics in individuals with obesity have not been fully described. We conducted cartilage‐to‐cartilage contact analyses through high‐precision fluoroscop...

p>OBJECTIVE: To examine whether knee subchondral cysts, measured on magnetic resonance imaging (MRI), are associated with incident knee osteoarthritis (OA) outcomes. METHODS: We used longitudinal data from the Multicenter Osteoarthritis Study, a community-based cohort of subjects with risk factors for knee OA. Participants without a history of kne...

Purpose To facilitate studies of knee osteoarthritis (OA) in large databases, case finding algorithms with high levels of diagnostic performance are needed. Methods From a UK general practitioner (GP) practice derived database, we selected adults ages 40–90 years meeting algorithms that included various combinations of codes for knee OA or knee pa...

Importance Many individuals who undergo total knee replacement (TKR) become long-term opioid users after TKR. Associations of physical therapy (PT) interventions before or after TKR with long-term use of opioids are not known. Objectives To evaluate associations of PT interventions before and after TKR with long-term opioid use after TKR. Design,...

Objective To determine reliability among four experienced and calibrated readers in cross-sectional and longitudinal semi-quantitative MRI assessments of knee osteoarthritis (OA) in the Multicenter Osteoarthritis (MOST) study. Design From all MOST participants with at least one knee with readable 60-month and 84-month paired knee MRIs (1.0 T extre...

Objective To compare bone marrow oedema-like lesion (BML) volume in subjects with symptomatic patellofemoral (PF) knee OA using four different MRI sequences and to determine reliability of BML volume assessment using these sequences and their correlation with pain. Methods Seventy-six males and females (mean age 55.8 years) with symptomatic patell...

Objective Our aim was to examine whether knee subchondral cysts, measured on magnetic resonance imaging (MRI), were associated with incident knee OA outcomes. Methods We used longitudinal data from the Multicentre Osteoarthritis Study (MOST), a community-based cohort of risk factors for knee OA. Participants without a history of knee surgery and/o...

Background: Data in the Offspring Framingham Osteoporosis Study (FOS) suggested that higher intake of dietary fiber was modestly protective against loss of bone mineral density at the femoral neck in men but not in women. Aim: To examine the relationship of fiber intake with risk of hip fractures in men. Methods: We included 367 men from the F...

Objective Hypomagnesemia increases the risk of chondrocalcinosis and calcium pyrophosphate disease. We examined whether the use of drugs that can cause hypomagnesemia, diuretics and proton pump inhibitors (PPIs), increases the risk of chondrocalcinosis. Methods Participants in the Multicenter Osteoarthritis (MOST) Study obtained weight-bearing kne...

Objective Develop a bone shape measure that reflects the extent of cartilage loss and bone flattening in knee osteoarthritis (OA) and test it against estimates of disease severity. Methods A fast region‐based convolutional neural network was trained to crop the knee joints in sagittal dual‐echo steady state MRI sequences obtained from the Osteoart...

Objective Develop a bone shape measure that reflects the extent of cartilage loss and bone flattening in knee osteoarthritis (OA) and test it against estimates of disease severity. Methods A fast region-based convolutional neural network was trained to crop the knee joints in sagittal dual-echo steady state MRI sequences obtained from the Osteoart...

Background Anti-nerve growth factor (NGF) has shown promise for osteoarthritis (OA) pain efficacy, but an unanticipated joint safety signal occurred in trials. To what extent this was related to OA natural history, or was a consequence of anti-NGF agents is unclear. Of the adverse joint safety events identified, osteonecrosis has specific diagnosti...

Objectives: To examine whether physical activity (PA) was associated with fatigue, and quantify the extent of potential mediation through depressive symptoms or physical function (PF) on the relationship between PA and fatigue in symptomatic knee osteoarthritis (KOA). Method: This longitudinal study used data from the Multicenter Osteoarthritis St...

Objective Inflammation worsens joint destruction in osteoarthritis (OA) and aggravates pain. Saturated and n-6 fatty acids (FAs) increase, whereas n-3 FAs reduce inflammation. We examined whether FA levels affected the development of OA. Design We studied participants from the Multicenter Osteoarthritis study (MOST) at risk of developing knee OA....

Objective To compare ground reaction force patterns (GRF) during walking among legs defined by presence or absence of knee pain and/or radiographic knee osteoarthritis (ROA). Method Principal component analysis extracted major modes of variation (PCs) in GRF data from the Multicenter Osteoarthritis Study during self-paced walking. Legs were catego...

Objective To examine the nature of differences in the relationship between frontal plane rearfoot kinematics and knee adduction moment (KAM) magnitudes. Design Cross-sectional study resulting from a combination of overground walking biomechanics data obtained from participants with medial tibiofemoral osteoarthritis at two separate sites. Statisti...

Background Varus thrust during walking, visualized as excessive frontal plane knee motion during weight acceptance, is a modifiable risk factor for progression of knee osteoarthritis. However, visual assessment does not capture thrust severity and quantification with optical motion capture is often not feasible. Inertial sensors may provide a conve...

Importance The benefits of vitamin D, omega-3 fatty acids, and exercise in disease prevention remain unclear. Objective To test whether vitamin D, omega-3s, and a strength-training exercise program, alone or in combination, improved 6 health outcomes among older adults. Design, Setting, and Participants Double-blind, placebo-controlled, 2 × 2 × 2...

Background Despite recent advances in the understanding of the genetic architecture of osteoarthritis (OA), only two genetic loci have been identified for OA of the hand, in part explained by the complexity of the different hand joints and heterogeneity of OA pathology. Methods We used data from the Rotterdam Study (RSI, RSII and RSIII) to create...

In Reply Dr Lei and colleagues correctly state that the positioning of the external pods of the biomechanical footwear in our trial¹ was individually adjusted. The treatment protocol for adjusting the pods was described in detail in Supplement 3 in the article. This is considerably more detail than most physical therapy or exercise intervention tri...

As the population ages, there is a growing burden due to musculoskeletal diseases, such as knee osteoarthritis, and subsequent functional decline. In the absence of a cure, there is a need to identify factors amenable to intervention to prevent or slow this process. The Multicenter Osteoarthritis (MOST) Study cohort was developed for this purpose....

The original version of this article, published on 13 February 2020, unfortunately contained a mistake.

Purpose: To identify baseline characteristics of adults with chronic low back pain (cLBP) that predict response (i.e., a clinically important improvement) and/or modify treatment effect across three nonpharmacologic interventions. Design: Secondary analysis of a randomized controlled trial. Setting: Academic safety net hospital and seven feder...

Objectives Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA. Methods In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) wer...

Importance Individually calibrated biomechanical footwear therapy may improve pain and physical function in people with symptomatic knee osteoarthritis, but the benefits of this therapy are unclear. Objective To assess the effect of a biomechanical footwear therapy vs control footwear over 24 weeks of follow-up. Design, Setting, and Participants...

Response to: 'Is non-industrial society undergoing an energy balance transition predisposed to accumulate abdominal adipose tissue and susceptible to knee osteoarthritis?' by Yu et al

Objective To identify plasma markers associated with an increased risk of radiographic knee osteoarthritis (OA) progression using a metabolomics approach. Methods Study participants were from the Multicenter Osteoarthritis Study (MOST) and were categorized into two groups based on the presence of baseline radiographic OA. Subjects in group 1 had u...

Objective Trials testing promising interventions in knee osteoarthritis (OA) often fail to show pain reductions. This may be due to change in activity whereby a person’s pain decreases, leading them to increase their activity levels, in turn increasing pain back to baseline levels. Using data from a trial of a beneficial treatment for knee pain, we...

BACKGROUND The role of intra-articular mineralization in osteoarthritis (OA) is unclear. Its understanding may potentially advance our knowledge of knee OA pathogenesis. We describe and assess the reliability of a novel computed tomography (CT) scoring system, the Boston University Calcium Knee Score (BUCKS) for evaluating intra-articular mineraliz...

Objectives It remains difficult to characterize the source of pain in knee joints either using radiographs or magnetic resonance imaging (MRI). We sought to determine if advanced machine learning methods such as deep neural networks could distinguish knees with pain from those without it and identify the structural features that are associated with...

Aim: The aim of the study was to identify sociodemographic, disease-related, physical and mental health-related determinants of fatigue at 2-year follow-up in individuals with symptomatic knee osteoarthritis (OA). Methods: A longitudinal analysis of participants with symptomatic knee OA from the Multicenter Osteoarthritis Study (MOST) was conducted...

Objective: Bone marrow lesions (BMLs) on MRI are typically subchondral in location, however, a proportion occur at knee ligament attachments and also include a cyst-like component. Our aim was to determine whether the volume of BML subtypes and synovial tissue volume (STV) was associated with symptoms in symptomatic knee OA. Method: Images were...

Objective We examined the association between sleep and odds of developing knee pain, and whether this relationship varied by status of widespread pain (WSP). Methods At the 60-month visit of the Multicenter Osteoarthritis Study, sleep quality and restless sleep were each assessed by using a single item from two validated questionnaires; each slee...

Objective: To determine the correlation between knee synovitis assessed on contrast-enhanced (CE) and non-contrast enhanced (NCE) magnetic resonance imaging (MRI) with histology in patients with knee osteoarthritis. Methods: A comprehensive literature search was performed, and related articles published through July 2018 were extracted. Spearman...

Introduction: We have a limited understanding of how antagonist muscle coactivation relates to measurement of strength in both individuals with and without knee osteoarthritis (KOA). Objective: We sought to determine if hamstring coactivation during a maximal quadriceps activation task attenuates net quadriceps strength. Design: Cross-sectiona...

Objectives: We investigated if serum total testosterone (T)-level is associated with knee pain and function in men and women with severe knee osteoarthritis (OA). Methods: We enrolled 272 adults ≥60 years (70.4±4.4 years, 53% women) who underwent unilateral total knee replacement (TKR) due to severe knee OA. Serum T-levels and WOMAC pain and fun...

Non-industrial societies with low energy balance levels are expected to be less vulnerable than industrial societies to diseases associated with obesity including knee osteoarthritis. However, as non-industrial societies undergo rapid lifestyle changes that promote positive energy balance, individuals whose metabolisms are adapted to energetic scar...

Objective: Studies suggest that parenteral MTX may be more efficacious than the oral form at equivalent doses for the treatment of rheumatoid arthritis. We carried out a meta-analysis to compare the efficacy of oral versus parenteral MTX in RA. Methods: PubMed, Web of Science and Embase were systematically searched from inception to June 8th 201...

Purpose: Our aim was to introduce a simplified MRI instrument, Rapid OsteoArthritis MRI Eligibility Score (ROAMES), for defining structural eligibility of patients for inclusion in disease-modifying osteoarthritis drug trials using a tri-compartmental anatomic approach that enables stratification of knees into different structural phenotypes and i...

Objective: Massive weight loss leads to marked knee pain reduction in persons with knee pain, but the reason for the reduction in pain is unknown. To quantify the contribution of MRI changes in pain sensitive structures, bone marrow lesions (BML), synovitis, and in pain sensitization, or depressive symptoms to knee pain improvement after substanti...

Objective To determine whether the Boston Overcoming Osteoarthritis through Strength Training Telephone‐Linked Communication (BOOST‐TLC) program, a novel telephone‐based motivational strength training exercise adherence counseling intervention, improved adherence to a strength training exercise program over 2‐years. Methods Two‐year, single‐blind...

The prevalence of obesity has grown rapidly over the past several decades and has been accompanied by an increase in the prevalence of chronic pain and prescription opioid use. Obesity, through its association with pain, may represent an important contributor to the opioid epidemic. This cross-sectional study investigated the relationship between o...

Objective To determine if clinical correlates of knee osteoarthritis(OA) affect likelihood of outcome to intra-articular steroid injections(IASI) in symptomatic knee OA. Methods Men and women aged≥40 years with painful knee OA who participated in an open label trial of IASI completed questionnaires and clinical examination. OMERACT-OARSI criteria...