THU0459 PREDICTORS ASSOCIATED WITH RAPID PROGRESSION OF KNEE OSTEOARTHRITIS
Authors: Elena Taskina, Ludmila Alekseeva, Natalia Kashevarova, Sergey Anikin, Evgenia Sharapova, Ekaterina Strebkova, Lena Zonova, Tatiana Raskina, Elvira Otteva, Irina Vinogradova, Aleksandr Lila
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Objectives:</h3> To identify knee OA rapid progression factors in a multicenter prospective study <h3>Methods:</h3> 185 female patients from 5 RF constituent territories aged 40-75 with confirmed Kellgren-Lawrence score grade I-III knee OA were included into prospective study after signing the informed consent form. Mean age was 59,2±7,4 years (42-75), mean BMI–27,7±4,4 kg/m<sup>2</sup>, mean disease duration–12±8,1 years. Individual patient's medical record included relevant anthropometric data, records from case history and clinical examination, VAS articular pain assessment, WOMAC scores, comorbidities. Instrumental diagnostic methods included plain radiography of knee joints, DEXA of the lumbar spine and femoral neck, MRI examination of knee joints. Stage II knee OA was established in 135 (73%) out of 185 patients, stage III – in 50 (27%). <h3>Results:</h3> Knee OA progression (form radiographic stage II to stage III) within 1 year follow up was documented in 15 patients (Group 2 – with progressed OA), while 170 patients did not show any progression (Group 1 - no progression). Both groups were comparable in terms of age, age at RA onset, and duration of the disease. Although patients who progressed had higher body weight (97,1±14,0 vs 74,2±10,8 kg, р&lt;0,0001) and BMI (31,9±5,8 vs 27,3±4,1 kg/m<sup>2</sup>, р&lt;0,0001). Patients from Group II had more intense knee pain during walking (VAS - 65,8±11,8 vs 47,5±18,7 mm (р&lt;0,0003), and higher WOMAC: pain- 330,5±66,0 vs 237,8±85,4 mm, р&lt;0,0001; function - 1044±190,4 vs 859,8±243,8 mm, р&lt;0,007. Patients from Group II showed higher rates of varus knee alignment (66,7% vs 35,3%, RR=1,89, 95% CI 1,25-2,85, р=0,02) and Н.valgus (86,7% vs 61,8%, RR=1,4, 95% CI 1,11-1,77, р=0,04), as well as higher rates of arterial hypertension (93,3% vs 71,8%, respectively, RR=1,3, 95% CI 1,1-1,53, р=0,05) and type 2 diabetes mellitus (DM) (33,3% vs 12,9%, RR=2,57, 95% CI 1,14-5,82, р=0,04). MRI showed higher percentage of medial and lateral tibia cartilage defects in Group 2 patients (57,2% vs 18,6%, respectively; RR=3,06, 95% CI 1,74-5,38, р&lt;0,003; 57,2% vs 14%, RR=4,08, 95% CI 2,23-7,46 р&lt;0,0006); bone marrow edema (BME) in medial (71,4% vs 12,2%, RR=5,83, 95% CI 3,38-10,1, р&lt;0,000004) and lateral tibial compartments (21,4% vs 4,1%, RR=5,25, 95% CI 1,47-18,7, р=0,03); subchondral cysts, occupying more than 25% of the area in medial and lateral tibial compartments (respectively, 28,6% vs 7,4%, RR=3,84, 95% CI 1,4-10,5, р&lt;0,03; and 35,7% vs 8,8%, RR=4,06, 95% CI 1,7-9,7, р=0,01). Synovitis (MRI findings) was documented in 100% patients from Group 2 and in 58,4% patients without OA progression (RR=1,71, 95% CI 1,5-2,0, р=0,002). A multivariate (discriminant) analysis showed that the most important risk factors for knee OA progression were: higher body weight, high WOMAC pain score, presence of type 2 DM, BME in medial tibial compartment, and cartilage damage in medial tibial compartment (MRI findings). A model capable of predicting rapid progression of knee OA in an individual patient with high accuracy (area under the ROC-curve 0,925 (95% CI 0,828–1,022)) has been developed based on identified RF and their coefficients. <h3>Conclusion:</h3> In a prospective multicenter study, using comprehensive instrumental examination the following key predictors of rapid knee OA progression were identified: excessive body weight, high WOMAC pain score, presence of type 2 DM, BME in medial tibial compartment, and cartilage damage in medial tibial compartment (MRI findings). <h3>Disclosure of Interests:</h3> Elena Taskina Speakers bureau: Bayer, Sandoz, Boeringer-ingelheim, Ludmila Alekseeva Speakers bureau: Bayer, Boeringer-ingelheim, Gedeon-Richter, Servier, Natalia Kashevarova: None declared, Sergey Anikin: None declared, Evgenia Sharapova: None declared, Ekaterina Strebkova: None declared, Lena Zonova Speakers bureau: Sandoz, Pfizer, Abbvie, Novartis, Bayer, Tatiana Raskina: None declared, Elvira Otteva Speakers bureau: Pfizer, Abbvie, Novartis, Irina Vinogradova Speakers bureau: Pfizer, MSD, Aleksandr Lila Speakers bureau: Sandoz, Pfizer, Abbvie, Novartis, Bayer