FRI0386 EARLY OSTEOARTHRITIS: IS ASYMPTOMATIC CLINICAL COURSE REAL?
Authors: N. Martusevich, S. Duben, A. Aleshkevich, A. Dmitrieva, T. Bondar, K. Gudkevich
Journal: Annals of the Rheumatic Diseases (2020)

Background: Osteoarthritis (OA) is the leading cause of disability among all RMDs. Early diagnosis of OA is complicated. So, there is an absence of clear markers of the diagnosis of OA, and this issue is now being discussed. Objectives: The aim of this study is to examine relatively healthy individuals without symptoms in order to evaluate MR-markers of early OA of the knee. Methods: We included 29 relatively healthy individuals. 55,17% (n=16) were women. Median age was 35 (32-41) years. They didn’t have any complaints, according to the preliminary criteria of early OA, symptoms of OA (1), didn’t have any significant concomitant diseases and elevated ESR, CRP. The exclusion criteria were previous trauma, orthopedic surgery, X-Ray signs of OA. MRI was performed on 1,5 Tl Siemens Magnetom Essenza. WORMS-scale was used to evaluate the knee joint structures. Results: In all examined joints we observed small changes characteristic of symptomatic OA (osteophytes, cartilage damage etc.). In 4 knees we found undamaged cartilage (0 points). In 5 knees we observed cartilage damage &gt;=4 points with marrow abnormality. In the Table 1 we present the frequency of any abnomaly (&gt;=1 points) in each parameter present in examined joints. The most commonly asymptomatic changes were observed in the patellofemoral joint. Small osteophytes were the most common changes. Table 1. Number of examined knee joints with different anomalies according to WORMS (&gt;=1 point). Parameter MFTJ (percent, total) LFTJ, (percent, total) PFJ (percent, total) S-region, (percent, total) Total, (percent, total) Cartilage 19,44% (n=7) 19,44% (n=7) 75,00% (n=27) - 83,33% (n=30) Marrow abnormality 0,00% 2,78% (n=1) 0,00% 13,89% (n=5) 16,67%(n=6) Bone cysts 0,00% 0,00% 0,00% 0,00% 0,00% Bone attrition 66,67% (n=24) 0,00% - - 66,67% (n=24) Osteophytes 88,89% (n=32) 86,11% (n=31) 97,22% (n=35) - 100,00% (n=36) Menisci 0,00% 2,78% (n=1) - - 2,78% (n=1) Ligaments - - - - 0,00% Synovitis - - - - 33,33% (n=12) Total – – – – 100,00% (n=36) Besides, we calculated mean points in each parameter in the scale and compared it with the maximum score in this parameter (in percent). Table 2 shows the results. The most severe change was bone attrition. Table 2. Mean points of different WORMS parameters in examined knee joints. Parameter MFTJ (percent, total) LFTJ, (percent, total) PFJ (percent, total) S-region, (percent, total) Total, (percent, total) Cartilage 1,30% 1,02% 7,64% - 2,91% Marrow abnormality 0,00% 0,37% 0,00% 4,63% 0,31% Bone cysts 0,00% 0,00% 0,00% 0,00% 0,00% Bone attrition 15,37% 0,00% 0,00% - 1,75% Osteophytes 6,59% 5,48% 8,33% - 6,69% Menisci 0,00% 0,93% - - 0,46% Ligaments - - - - 0,00% Synovitis - - - - 12,04% Total - - - - 3,61% We didn’t observe asymptomatic lesions in the medial meniscus, marrow abnormality in MFTJ and LFTJ, subchondral cysts in any location, ligament lesions. Despite minimal osteophytes almost in all individuals, they didn’t have any clinical features of knee OA. Conclusion: MRI of the knee joints in the cohort of young relatively healthy individuals without clinical features of OA revealed irreversible structural changes characteristic of symptomatic OA. There is no association between symptoms and structural damage. Based on these, we can make an assumption about asymptomatic stage of OA. In order to distinguish between definitions of early asymptomatic OA as a disease onset and asymptomatic structural changes as reflection of metabolic disorders it is necessary to follow up and to perform an in-depth examination of these individuals. References: [1]Migliore, A., Scirè, C.A., Carmona, L. et al. The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology. Rheumatol Int 37, 1227–1236 (2017). Disclosure of Interests: Natalia Martusevich Shareholder of: k, Svetlana Duben: None declared, Alexander Aleshkevich: None declared, Alena Dmitrieva: None declared, Tatsiana Bondar: None declared, Katsiarina Gudkevich: None declared