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Review
. 2023 Sep;31(9):1234-1241.
doi: 10.1016/j.joca.2023.04.015. Epub 2023 May 22.

A scoping review of how early-stage knee osteoarthritis has been defined

Jean W Liew  1 , Lauren K King  2 , Armaghan Mahmoudian  3 , Qiuke Wang  4 , Hayden F Atkinson  5 , David B Flynn  1 , C Thomas Appleton  6 , Martin Englund  7 , Ida K Haugen  8 , L Stefan Lohmander  9 , Jos Runhaar  4 , Tuhina Neogi  1 , Gillian Hawker  10 ; OARSI Early Osteoarthritis Classification Criteria Task Force
Affiliations
Review

A scoping review of how early-stage knee osteoarthritis has been defined

Jean W Liew et al. Osteoarthritis Cartilage. 2023 Sep.

Abstract

Background: Early-stage knee osteoarthritis (KOA) classification criteria will enable consistent identification and trial recruitment of individuals with knee osteoarthritis (OA) at an earlier stage of the disease when interventions may be more effective. Toward this goal, we identified how early-stage KOA has been defined in the literature.

Methods: We performed a scoping literature review in PubMed, EMBASE, Cochrane, and Web of Science, including human studies where early-stage KOA was included as a study population or outcome. Extracted data included demographics, symptoms/history, examination, laboratory, imaging, performance-based measures, gross inspection/histopathologic domains, and the components of composite early-stage KOA definitions.

Results: Of 6142 articles identified, 211 were included in data synthesis. An early-stage KOA definition was used for study inclusion in 194 studies, to define study outcomes in 11 studies, and in the context of new criteria development or validation in six studies. The element most often used to define early-stage KOA was Kellgren-Lawrence (KL) grade (151 studies, 72%), followed by symptoms (118 studies, 56%), and demographic characteristics (73 studies, 35%); 14 studies (6%) used previously developed early-stage KOA composite criteria. Among studies defining early-stage KOA radiographically, 52 studies defined early-stage KOA by KL grade alone; of these 52, 44 (85%) studies included individuals with KL grade 2 or higher in their definitions.

Conclusion: Early-stage KOA is variably defined in the published literature. Most studies included KL grades of 2 or higher within their definitions, which reflects established or later-stage OA. These findings underscore the need to develop and validate classification criteria for early-stage KOA.

Keywords: Classification criteria; Early-stage osteoarthritis; Knee osteoarthritis; Osteoarthritis; Scoping review; Symptomatic knee osteoarthritis.

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Conflict of interest statement

Declaration of Competing Interest JWL reports a Pfizer research grant completed in 2021, unrelated to this work; CTA reports grant funding from the Canadian Institutes of Health Research, Arthritis Society of Canada, and grant funding and consulting/honoraria from Abbvie, Fresenius Kabi, Novartis, and Pfizer; IKH reports a research grant from Pfizer/Lilly and consulting fees from Abbvie, Novartis, and GSK, all outside of the submitted work; and SL reports consulting/honoraria from Arthro Therapeutics AB, Sweden, and participation on a DSMB board for AstraZeneca. All other authors report no competing interests.

Figures

Figure 1
Figure 1
PRISMA flow diagram of study inclusion for the scoping review. *Exclusion reasons: Wrong study design, 52; Wrong patient population, 38; Duplicate, 26; Early OA did not refer to being early in the course of OA, 25; Clinical trial without abstract/manuscript, 23; No clear indication of Early-stage KOA population, 9; No full text available, 4 **Exclusion reasons: Duplicate, 9; No clear indication of early-stage KOA population, 2
Figure 2
Figure 2
Domains included in study definitions of early-stage KOA for n=211 synthesized studies
Figure 3
Figure 3
Most common elements, within domains, included in study definitions of early-stage KOA for n=211 synthesized studies Elements represented if used in ≥5 studies. The presence of an element was a potential inclusion criterion for early-stage KOA within a study. Composite OA criteria included the 1986 ACR OA classification criteria, the early OA classification criteria developed by Luyten, et al. (2012 and 2018), and the inclusion criteria for the Cohort Hip and Cohort Knee (CHECK).
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