TY - JOUR T1 - OARSI/OMERACT Initiative to Define States of Severity and Indication for Joint Replacement in Hip and Knee Osteoarthritis. An OMERACT 10 Special Interest Group JF - The Journal of Rheumatology JO - J Rheumatol SP - 1765 LP - 1769 DO - 10.3899/jrheum.110403 VL - 38 IS - 8 AU - LAURE GOSSEC AU - SIMON PATERNOTTE AU - CLIFTON O. BINGHAM III AU - DANIEL O. CLEGG AU - PHILIPPE COSTE AU - PHILIP G. CONAGHAN AU - AILEEN M. DAVIS AU - GIAMPAOLO GIACOVELLI AU - KLAUS-PETER GUNTHER AU - GILLIAN HAWKER AU - MARC C. HOCHBERG AU - JOANNE M. JORDAN AU - JEFFREY N. KATZ AU - MARGREET KLOPPENBURG AU - ARTURO LANZAROTTI AU - KEITH LIM AU - L. STEFAN LOHMANDER AU - NIZAR N. MAHOMED AU - JEAN FRANCIS MAILLEFERT AU - REBECCA L. MANNO AU - LYN M. MARCH AU - STEVEN A. MAZZUCA AU - KAREL PAVELKA AU - LEONARDO PUNZI AU - EWA M. ROOS AU - LUCIO C. ROVATI AU - HELEN SHI AU - JASVINDER A. SINGH AU - MARIA E. SUAREZ-ALMAZOR AU - ELEONORA TAJANA-MESSI AU - MAXIME DOUGADOS Y1 - 2011/08/01 UR - http://www.jrheum.org/content/38/8/1765.abstract N2 - 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. ER -