Multicenter Osteoarthritis Study (MOST) Second Renewal: Iowa Clinical Center

 描述（由申请人提供）：膝关节骨关节炎（OA）是一种常见的慢性疼痛性疾病，是老年人活动障碍的最常见原因。MOST研究是关于这种疾病的过程和影响其过程的因素的新知识的主要来源。自2003年研究开始以来，人们越来越认识到，当人们出现膝关节OA的慢性症状时，他们通常在MRI上有疾病的高级结构发现。诸如椎间盘撕裂、对线不良和软骨损失等发现会导致进一步的结构恶化，几乎肯定会限制预防机会。我们认为，如果从那些尚未出现严重持续性膝关节疼痛或疾病的晚期结构性发现的人开始，预防机会可能会更大。膝关节OA的功能影响发生在患有多种肌肉骨骼合并症的老年人中，预防OA致残需要更广泛的视角，而不仅仅是关注单个膝关节。例如，单膝关节疼痛的患者在其他下肢肌肉骨骼区域疼痛的风险很高，即使膝关节被替换，他们最终可能需要治疗由于第一个关节受影响而导致的其他关节疼痛。此外，除了功能丧失外，OA患者在参与外部环境时还会出现屈曲、福尔斯和限制。我们认为，有机会开发尚未探索的治疗和疾病预防策略，通过使用新技术并关注比以前研究更轻或更早疾病阶段的人，我们可以确定这样的机会。我们建议招募一个新的轻度疾病队列，并继续研究现有的MOST队列，以确定新的疾病风险因素并研究疾病的后果。我们的目标是找到新的战略，在早期阶段预防疾病，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.