OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group

To define pain and physical function cutpoints that would, coupled with structural severity, define a surrogate measure of "need for joint replacement surgery," for use as an outcome measure for potential structure-modifying interventions for osteoarthritis (OA). New scores were developed...

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Bibliographic Details
Published in:	Journal of rheumatology Vol. 38; no. 8; pp. 1765 - 1769
Main Authors:	GOSSEC, Laure, PATERNOTTE, Simon, HOCHBERG, Marc C, JORDAN, Joanne M, KATZ, Jeffrey N, KLOPPENBURG, Margreet, LANZAROTTI, Arturo, LIM, Keith, STEFAN LOHMANDER, L, MAHOMED, Nizar N, MAILLEFERT, Jean Francis, MANNO, Rebecca L, BINGHAM, Clifton O, MARCH, Lyn M, MAZZUCA, Steven A, PAVELKA, Karel, PUNZI, Leonardo, ROOS, Ewa M, ROVATI, Lucio C, SHI, Helen, SINGH, Jasvinder A, SUAREZ-ALMAZOR, Maria E, TAJANA-MESSI, Eleonora, CLEGG, Daniel O, DOUGADOS, Maxime, COSTE, Philippe, CONAGHAN, Philip G, DAVIS, Aileen M, GIACOVELLI, Giampaolo, GUNTHER, Klaus-Peter, HAWKER, Gillian
Format:	Journal Article Conference Proceeding
Language:	English
Published:	Toronto, ON Journal of Rheumatology Publishing 01-08-2011 Journal of Rheumatology Publishing Company Limited
Subjects:	Arthroplasty, Replacement, Hip Arthroplasty, Replacement, Knee Biological and medical sciences Clinical Medicine Cognitive science Cross-Sectional Studies Disease Progression Diseases of the osteoarticular system FUNCTION Humans International Cooperation Klinisk medicin Medical and Health Sciences Medical sciences Medicin och hälsovetenskap Miscellaneous. Osteoarticular involvement in other diseases Neuroscience Orthopedic surgery OSTEOARTHRITIS Osteoarthritis, Hip - physiopathology Osteoarthritis, Hip - surgery Osteoarthritis, Knee - physiopathology Osteoarthritis, Knee - surgery Outcome Assessment (Health Care) - methods PAIN Pain Measurement - methods Randomized Controlled Trials as Topic Reumatologi och inflammation Rheumatology and Autoimmunity SEVERITY Severity of Illness Index STRUCTURE OUTCOME MEASURE Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surveys and Questionnaires Treatment Outcome Knee Knee osteoarthritis Prognosis Indication Prosthesis Diseases of the osteoarticular system Rheumatology FUNCTION Hip Interest Pain Arthropathy STRUCTURE OUTCOME MEASURE Hip osteoarthritis Degenerative disease Osteoarthritis SEVERITY RADIOGRAPHIC FEATURES PAIN GLUCOSAMINE SULFATE DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL ASSOCIATION 3-YEAR 2-YEAR PHYSICAL-FUNCTION PROGRESSION
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Summary:	To define pain and physical function cutpoints that would, coupled with structural severity, define a surrogate measure of "need for joint replacement surgery," for use as an outcome measure for potential structure-modifying interventions for osteoarthritis (OA). New scores were developed for pain and physical function in knee and hip OA. A cross-sectional international study in 1909 patients was conducted to define data-driven cutpoints corresponding to the orthopedic surgeons' indication for joint replacement. A post hoc analysis of 8 randomized clinical trials (1379 patients) evaluated the prevalence and validity of cutpoints, among patients with symptomatic hip/knee OA. In the international cross-sectional study, there was substantial overlap in symptom levels between patients with and patients without indication for joint replacement; indeed, it was not possible to determine cutpoints for pain and function defining this indication. The post hoc analysis of trial data showed that the prevalence of cases that combined radiological progression, high level of pain, and high degree of function impairment was low (2%-12%). The most discriminatory cutpoint to define an indication for joint replacement was found to be [pain (0-100) + physical function (0-100) > 80]. These results do not support a specific level of pain or function that defines an indication for joint replacement. However, a tentative cutpoint for pain and physical function levels is proposed for further evaluation. Potentially, this symptom level, coupled with radiographic progression, could be used to define "nonresponders" to disease-modifying drugs in OA clinical trials.
Bibliography:	ObjectType-Article-2 content type line 25 ObjectType-Conference-1 SourceType-Conference Papers & Proceedings-1 PMCID: PMC3260473 L. Gossec, MD, PhD; S. Paternotte, MSc; M. Dougados, MD, Paris Descartes University, Medicine Faculty; APHP, Rheumatology B Department, Cochin Hospital; C.O. Bingham, MD, Associate Professor of Medicine, Divisions of Rheumatology and Allergy and Clinical Immunology, Johns Hopkins University; D.O. Clegg, MD, Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, University of Utah School of Medicine; P. Coste, MD, Medical Director, Expansciences Laboratories; P.G. Conaghan, MBBS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Section of Musculoskeletal Disease, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit; A.M. Davis, PhD, Senior Scientist and Professor, Division of Health Care and Outcomes Research and Arthritis and Community Research and Evaluation Unit, Toronto Western Research Institute, Departments of Rehabilitation Science and Health Policy, Management and Evaluation, University of Toronto; G. Giacovelli, PhD, Director of Biostatistics, Department of Biostatistics, Rottapharm-Madaus; K-P. Gunther, MD, Professor and Chair, Department of Orthopaedic Surgery, University of Dresden; G. Hawker, MD, MSc, Division of Rheumatology, Department of Medicine, Women’s College Hospital; Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto; M.C. Hochberg, MD, MPH, Professor of Medicine, Division of Rheumatology and Clinical Immunology, Department of Medicine and Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine; J.M. Jordan, MD, MPH, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Thurston Arthritis Research Center, University of North Carolina School of Medicine; J.N. Katz, MD, MS, Professor of Surgery and Orthopedic Medicine, Department of Orthopedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; and Department of Epidemiology, Harvard School of Public Health; M. Kloppenburg, MD, PhD, Department of Rheumatology, Department of Clinical Epidemiology, Leiden University Medical Center; A. Lanzarotti, MSc, Statistician, R&D Department, IBSA Institut Biochimique SA; K. Lim, MBBS, MD, FRACP, FRCP, Director of Rheumatology, Department of Rheumatology, St. Vincent’s Hospital and Western Hospital; L.S. Lohmander, Department of Orthopaedics, Clinical Sciences Lund, Lund University; N.N. Mahomed, MD, ScD, Smith and Nephew Chair in Orthopaedic Surgery, Associate Professor, Department of Surgery, Director, Division of Orthopaedic Surgery, University of Toronto, Toronto Western Hospital; J.F. Maillefert, MD, PhD, Associate Professor of Rheumatology, Department of Rheumatology, Dijon University Hospital; University of Burgundy; INSERM U887; R.L. Manno, MD, Senior Rheumatology Fellow, Division of Rheumatology, Johns Hopkins University; L.M. March, MD, PhD, Professor of Medicine and Public Health, Institute of Bone and Joint Research, University of Sydney, Royal North Shore Hospital; S.A. Mazzuca, PhD, Senior Scientist, Indiana University School of Medicine; K. Pavelka, Institute of Rheumatology, Charles University; L. Punzi, MD, PhD, Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova; E.M. Roos, PT, PhD, Professor of Musculoskeletal Function and Physical Therapy, Institute of Sports and Clinical Biomechanics, University of Southern Denmark; L.C. Rovati, MD, Chief Scientific Officer, Professor of Clinical Pharmacology, Department of Clinical Pharmacology, Rottapharm; H. Shi, MS, Hines VA Cooperative Studies Program Coordinating Center; J.A. Singh, MD, MPH, Associate Professor of Medicine, Birmingham VA Medical Center and University of Alabama; M.E. Suarez-Almazor, MD, PhD, Professor of Medicine, Section of Rheumatology, University of Texas, M.D. Anderson Cancer Center; E. Tajana-Messi, MSc, PhD, Clinical Research Senior Manager, R&D Department, IBSA Institut Biochimique SA.
ISSN:	0315-162X 1499-2752 0315-162X
DOI:	10.3899/jrheum.110403