RT Journal Article
SR Electronic
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
FD The Journal of Rheumatology
SP 1765
OP 1769
DO 10.3899/jrheum.110403
VO 38
IS 8
A1 LAURE GOSSEC
A1 SIMON PATERNOTTE
A1 CLIFTON O. BINGHAM III
A1 DANIEL O. CLEGG
A1 PHILIPPE COSTE
A1 PHILIP G. CONAGHAN
A1 AILEEN M. DAVIS
A1 GIAMPAOLO GIACOVELLI
A1 KLAUS-PETER GUNTHER
A1 GILLIAN HAWKER
A1 MARC C. HOCHBERG
A1 JOANNE M. JORDAN
A1 JEFFREY N. KATZ
A1 MARGREET KLOPPENBURG
A1 ARTURO LANZAROTTI
A1 KEITH LIM
A1 L. STEFAN LOHMANDER
A1 NIZAR N. MAHOMED
A1 JEAN FRANCIS MAILLEFERT
A1 REBECCA L. MANNO
A1 LYN M. MARCH
A1 STEVEN A. MAZZUCA
A1 KAREL PAVELKA
A1 LEONARDO PUNZI
A1 EWA M. ROOS
A1 LUCIO C. ROVATI
A1 HELEN SHI
A1 JASVINDER A. SINGH
A1 MARIA E. SUAREZ-ALMAZOR
A1 ELEONORA TAJANA-MESSI
A1 MAXIME DOUGADOS
YR 2011
UL http://www.jrheum.org/content/38/8/1765.abstract
AB 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.