Clinical assessment of osteoarthritis of the knee

Article Abstract:

Osteoarthritis (OA) is a chronic arthritis, and involvement of the knee can cause serious pain and disability. However, methods used to diagnose OA vary, with no clear agreement on the best guidelines. Usually, patients are evaluated by X-ray, and the results are considered along with assessments of the patient's condition. However, the reproducibility of such clinical assessment is unknown. Thus, it is unclear whether one observer would report the same findings on re-examination of a single patient (within-observer variability), or whether several observers would agree as to their assessment of knee disease and function (between-observer variability). The within- and between-observer variations associated with 10 common physical signs of knee OA were evaluated by studying eight patients (six female) and five observers. The physical signs evaluated were bony swelling, tibiofemoral crepitus (clicking or crackling sound elicited by moving the calf bone relative to the thigh bone), nonbony swelling, medial (inner knee surface) tenderness, forward or sideways instability, patellofemoral (kneecap-thigh bone movement) crepitus, lateral (outside knee surface) tenderness, and patellofemoral tenderness. Within-observer agreement was best for detection of bony swelling, with a score of 0.74 out of 1.0, and worst for detection of patellofemoral tenderness (0.41 score), and within-observer agreement for bony swelling was consistent among the five observers. Between-observer agreement was less than within-observer agreement for all variables. Between-observer agreement was best for tibiofemoral crepitus and worst for front-back instability. Variability up to 20 degrees in measurement of knee joint flexibility was observed. The results indicate that studies of knee OA should make use of the most repeatable of physical signs for correct diagnosis, and the variability should be considered when determining the number of subjects to be studied. It is likely that training of examiners would decrease variability in medical evaluation of the knee joint. (Consumer Summary produced by Reliance Medical Information, Inc.)

Joints, Joints (Anatomy), Medical examination

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Osteoarthritis: definitions and criteria

Article Abstract:

Osteoarthritis (OA) is a joint disease characterized by bone overgrowth, accompanied by cartilage damage. X-ray features include joint space narrowing, changes in the bone below the joint, and osteophytosis, the formation of bony outgrowths. The disease is subclassified into primary forms of unknown cause and secondary forms, resulting from previous injury or disease. OA is also grouped according to the site of the affected joint. The American Rheumatism Association (ARA) recently defined osteoarthritis as a mixed group of conditions resulting in symptoms associated with abnormalities in cartilage, underlying bone, and joint margin. In a study to determine criteria for reporting OA of the knee, 85 historical, clinical, and biochemical features were evaluated in 264 patients with knee pain. One hundred thirty cases were diagnosed as primary osteoarthritis, and the remaining 107 cases were attributed to various conditions. The features that showed the greatest sensitivity and specificity for detecting osteoarthritis included age (over 50 years), crepitus (noise associated with bones rubbing together), bony enlargement, morning stiffness of less than 30 minutes, and X-ray evidence. However, the study had several shortcomings and the criteria were largely subjective. In addition, cartilage damage, a well known feature of OA, was excluded from the criteria. Thus, the ARA recommends that these criteria be used for reporting or describing OA of the knee, but not for diagnostic purposes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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Definitions of osteoarthritis in the knee and hand

Article Abstract:

Researchers still lack a standard definition for osteoarthritis of the knee and hand. Measurement scales of joint changes have been in use for decades, but further refinement is still needed. Problems remain in linking X-ray measurements with symptoms and function and in the ability to predict disease progress and determine the need for surgical intervention. The best definitions combine X-ray measurements with evaluations of pain and stiffness. New imaging methods, such as ultrasound, scintigraphy, and magnetic resonance imaging may be improvements over X rays.

Diseases, Knee, Hand

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