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

Gossec, Laure; Paternotte, Simon; Bingham, Clifton O., III; Clegg, Daniel O.; Coste, Philippe; Conaghan, Philip G.; Davis, Aileen M.; Giacovelli, Giampaolo; Gunther, Klaus-Peter and Hawker, Gillian, et al. (2011) In Journal of Rheumatology 38(8). p.1765-1769
Abstract
Objective. 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). Methods. 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. Results. In the international cross-sectional... (More)
Objective. 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). Methods. 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. Results. 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]. Conclusion. 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. (J Rheumatol 2011;38:1765-9; doi:10.3899/jrheum.110403) (Less)
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@article{86ddd6eb-a70b-452c-9682-016345e8cb67,
  abstract     = {Objective. 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). Methods. 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. Results. 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]. Conclusion. 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. (J Rheumatol 2011;38:1765-9; doi:10.3899/jrheum.110403)},
  author       = {Gossec, Laure and Paternotte, Simon and Bingham, Clifton O., III and Clegg, Daniel O. and Coste, Philippe and Conaghan, Philip G. and Davis, Aileen M. and Giacovelli, Giampaolo and Gunther, Klaus-Peter and Hawker, Gillian and Hochberg, Marc C. and Jordan, Joanne M. and Katz, Jeffrey N. and Kloppenburg, Margreet and Lanzarotti, Arturo and Lim, Keith and Lohmander, Stefan and Mahomed, Nizar N. and Maillefert, Jean Francis and Manno, Rebecca L. and March, Lyn M. and Mazzuca, Steven A. and Pavelka, Karel and Punzi, Leonardo and Roos, Ewa M. and Rovati, Lucio C. and Shi, Helen and Singh, Jasvinder A. and Suarez-Almazor, Maria E. and Tajana-Messi, Eleonora and Dougados, Maxime},
  issn         = {0315-162X},
  keyword      = {OSTEOARTHRITIS,SEVERITY,PAIN,FUNCTION,STRUCTURE OUTCOME MEASURE},
  language     = {eng},
  number       = {8},
  pages        = {1765--1769},
  publisher    = {J Rheumatol Publ Co},
  series       = {Journal of Rheumatology},
  title        = {OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group},
  url          = {http://dx.doi.org/10.3899/jrheum.110403},
  volume       = {38},
  year         = {2011},
}