Multicenter Osteoarthritis Study (MOST) Second Renewal

 描述(申请人提供)：膝骨性关节炎(OA)是一种常见的慢性痛性疾病，是老年人行动不便的最常见原因。MOST研究一直是关于这种疾病的病程和影响其病程的因素的新知识的主要来源。自2003年开始这项研究以来，人们越来越认识到，当人们出现膝骨性关节炎的慢性症状时，他们通常在MRI上有疾病的晚期结构发现。半月板撕裂、排列失调和软骨丢失等发现会进一步导致结构恶化，几乎可以肯定地限制了预防机会。我们认为，如果从那些还没有出现严重的持续性膝关节疼痛或疾病的晚期结构性发现的人开始预防，预防的机会可能会更大。膝关节骨性关节炎的功能影响发生在经历了多个肌肉骨骼合并症的老年人中，预防膝关节骨性关节炎致残需要更广泛的视角，而不是只关注一个膝盖。例如，那些单膝疼痛的人在其他下肢肌肉骨骼区域疼痛的风险很高，即使更换了膝盖，他们最终也可能需要治疗由于第一个关节受到影响而出现的其他关节的疼痛。此外，除了功能丧失之外，患有骨性关节炎的人在参与外部环境时还会经历弯曲、跌倒和限制。我们建议，有机会开发尚未探索的治疗和疾病预防战略，通过使用新技术，并将重点放在比以前的研究更轻微或更早的疾病阶段，我们可以发现这样的机会。我们建议招募一个新的轻度疾病队列，并继续研究现有的大多数队列，以确定疾病的新风险因素，并研究疾病的后果。我们的目标是找到在早期阶段预防疾病的新战略，并在疾病发生后限制其影响。

 DESCRIPTION (provided by applicant): Knee osteoarthritis (OA) is a common chronic painful disorder that is the most frequent cause of mobility disability in older people. The MOST study has been a major source of new knowledge about the course of this disease and factors that affect its course. Since the study began in 2003, it is increasingly recognized that by the time people develop chronic symptoms of knee OA, they usually have advanced structural findings of disease on MRI. Findings such as meniscal tears, malalignment and cartilage loss drive further structural deterioration and almost certainly limit prevention opportunities. We believe that prevention opportunities are likely to be greater if started in those who do not yet have severe continuous knee pain or advanced structural findings of disease. The functional impacts of knee OA occur in older people who experience multiple musculoskeletal comorbidities, and preventing disablement from OA requires a broader perspective than a focus on a single knee. For example, those with pain in one knee are at high risk of pain in other lower extremity musculoskeletal regions and, even if the knee is replaced, they may ultimately need treatment for pain in other joints developing as a consequence of the first joint affected. Also, in additionto functional loss, persons with OA experience buckling, falls and constraints in their involvement with the outside environment. We suggest there are opportunities to develop treatments and disease prevention strategies that have been unexplored and that by using new technologies and focusing on persons at a milder or earlier disease stage than previous studies, we can identify such opportunities. We propose to recruit a new mild disease cohort and continue to study the existing MOST cohort to identify new risk factors for disease and to study consequences of disease. Our goal is to find new strategies to prevent disease at an early stage and to limit the impact of disease once it has occurred.