OARSI/OMERACT initiative to define states of severity and indication for joint replacement in hip and knee osteoarthritis. An OMERACT 10 Special Interest Group

Laure Gossec, Simon Paternotte, Clifton O Bingham, Daniel O Clegg, Philippe Coste, Philip G Conaghan, Aileen M Davis, Giampaolo Giacovelli, Klaus-Peter Gunther, Gillian Hawker, Marc C Hochberg, Joanne M Jordan, Jeffrey N Katz, Margreet Kloppenburg, Arturo Lanzarotti, Keith Lim, L Stefan Lohmander, Nizar N Mahomed, Jean Francis Maillefert, Rebecca L Manno, Lyn M March, Steven A Mazzuca, Karel Pavelka, Leonardo Punzi, Ewa M Roos, Lucio C Rovati, Helen Shi, Jasvinder A Singh, Maria E Suarez-Almazor, Eleonora Tajana-Messi, Maxime Dougados
Journal of Rheumatology 2011, 38 (8): 1765-9

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.

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