Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Prediction of Total Knee Replacement in a Two-Year Multi-Centre Clinical Trial in Knee Osteoarthritis: Results from a 46 Year Observation.

Raynauld3,  Jean-Pierre, Martel-Pelletier1,  Johanne, Dorais5,  Marc, Abram4,  François, Haraoui2,  Boulos, Choquette2,  Denis, Pelletier6,  Jean-Pierre

CR-CHUM, Notre-Dame Hospital, Montreal, QC, Canada
Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, QC, Canada
Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital
Research and Development, ArthroVision Inc., Montreal
StatSciences Inc., Notre-Dame de l'Ile-Perrot
University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, QC, Canada

Background:

The aim of this study was to predict, using data from quantitative magnetic resonance imaging (qMRI), the incidence of total knee replacement (TKR) during the long-term follow-up of knee OA patients who formerly received treatment with licofelone or naproxen.

Methods:

Knee OA patients participating in a previous 2-year randomized, double-blind controlled trial evaluating the impact of licofelone (200 mg BID) vs. naproxen (500 mg BID) who had serial MRI acquisitions of the symptomatic knee[1] were recently contacted to evaluate retrospectively the incidence of TKR of the study knee. A sub-group of patients (n=123) who had taken all the study medication and had all the MRI evaluations (according-to-protocol [ATP]) were selected for this post-hoc retrospective analysis. The TKR incidence was assessed blindly to the treatment allocation with a standardized phone interview.

Results:

The patients' mean age was 63.5 years, 63.5% were female and the average body mass index (BMI) was 31.9 kg/m2. A total of 18 TKRs (14.6%) were performed upon this sub-population in the time frame of 4–6 years after completion of the original study. Interestingly, there were significantly more TKRs performed within the naproxen group than the licofelone group (61% vs. 39%, Fischer's exact test p=0.23). Further, we investigated the predictors of long-term TKRs by comparing, within the ATP cohort, the patients who had TKR to those who did not, using data at baseline or the change at 2 years. Data revealed that baseline values of bone marrow lesions (BMLs) of the medial tibial plateau (p=0.0001; Fisher's exact test), medial joint space width (X-ray) (p=0.0008), presence of severe medial meniscal tear (p=0.004), medial meniscal extrusion (p=0.01), and C reactive protein (CRP) level (p=0.05) were strong predictors of TKR. Changes at 2 years also yielded strong predictors including change in the cartilage volume of the medial compartment (p=0.005) and of the global joint (p=0.03), as well as change in WOMAC pain (p=0.009) and function (p=0.02) scores. Logistic regressions that included age, sex, and BMI in the model, yielded that baseline severe medial tear (p=0.006) and the presence of a medial BML (p=0.002) were the strongest independent predictors of long-term TKR.

Conclusion:

These data demonstrate that, in a knee OA clinical trial, it is possible to predict a "hard" outcome such as TKR using clinical and qMRIdata. The results are highly encouraging and support the use of qMRI as a surrogate for joint tissue damage upon which a DMOAD may act.

Reference:

[1]Raynauld, JP, et al. Ann Rheum Dis 2009;68:938-47.

To cite this abstract, please use the following information:
Raynauld, Jean-Pierre, Martel-Pelletier, Johanne, Dorais, Marc, Abram, François, Haraoui, Boulos, Choquette, Denis, et al; Prediction of Total Knee Replacement in a Two-Year Multi-Centre Clinical Trial in Knee Osteoarthritis: Results from a 46 Year Observation. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :196
DOI: 10.1002/art.27965

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