Risk factors for anterior knee pain and the relation to future patellofemoral osteoarthritis

项目摘要/摘要 在美国，骨关节炎(OA)每年的成本超过810亿美元，这一负担类似于癌症。办公自动化 最常见的影响是膝关节，并与死亡率增加有关。目前还没有有效的 预防或治疗这种严重疾病的疗法。膝关节股骨(PF)骨关节炎，指的是在PF关节内的骨关节炎。 膝骨性关节炎的一种独特的亚型，发病率很高，39%的膝关节疼痛患者都有此病。 膝前痛(AKP)是终生最常见的慢性疼痛之一。AKP是 坚持不懈，影响一个人的机能和生活质量。AKP和PFOA可以代表PF的连续体 疾病。然而，缺乏AKP与入射全氟辛酸的关系的纵向数据。通过识别风险因素 对于AKP，我们不仅可以减轻这种常见疾病的负担，而且可能改变自然历史 膝盖疼痛和骨性关节炎。目前的建议旨在了解AKP的风险因素以及AKP与 事件全氟辛酸和功能限制。了解AKP的危险因素可以提高临床医生的能力 以解决这些症状并减缓其进展。我们将利用来自NIH资助的多中心的数据 骨关节炎(MOST)研究回答了我们提出的研究问题。在最近的社会变革管理计划的更新中，一个 招募了未建立骨性关节炎的队列。这为我们研究AKP和全氟辛酸提供了一个巨大的机会 发展，这是确定康复战略目标的第一个关键步骤。最大的是唯一的大的 世界上拥有关于膝关节疼痛位置、功能限制、潜力的必要纵向数据的队列 可能影响PF关节负荷的可修改的危险因素，以及评估了OA特征的PF关节成像， 通过利用这一丰富的资源使我们的建议变得可行。我们的具体目标如下：目标1：确定 可修改的危险因素(例如，下肢力量、步态力学、PF对齐、身体 质量指数)与两年内流行和偶发的碱性磷酸酶有关；目标2：确定碱性磷酸酶的关系 超过2年的事件全氟辛酸和功能限制。拟议的研究具有非常重要的意义，因为它将 确定AKP发生的可改变的风险因素及其下游影响(例如，全氟辛酸、胫股骨性关节炎、 TKR)。它的创新之处在于，不是采取典型的疾病发生后管理方法，而是 目前的提议将使我们能够制定战略，在我们有最大潜力的时候进行干预 对改变PF疾病的自然病史的影响，并随后将OA的负担降至最低。

PROJECT SUMMARY/ABSTRACT Osteoarthritis (OA) costs more than $81 billion per year in the United States, a burden similar to cancer. OA most commonly affects the knee joint and is associated with increased mortality. There are currently no effective therapies to prevent or treat this serious disease. Patellofemoral (PF) OA, which refers to OA in the PF joint, is a distinct subgroup of knee OA with substantial morbidity and is present in 39% of individuals with knee pain. Anterior knee pain (AKP) is one of the most common chronic pain conditions across the lifespan. AKP is persistent and affects a person’s function and quality of life. AKP and PFOA may represent a continuum of PF disease. However, longitudinal data is lacking on the relation of AKP to incident PFOA. By identifying risk factors for AKP, we could not only reduce the burden of this common condition, but potentially alter the natural history of knee pain and OA. The current proposal aims to understand risk factors for AKP and the relation of AKP to incident PFOA and functional limitations. Understanding risk factors for AKP in can improve clinicians’ abilities to address these symptoms and slow their progression. We will leverage data from the NIH-funded Multicenter Osteoarthritis (MOST) study to answer our proposed research questions. In the recent renewal of MOST, a cohort without established OA was recruited. This offers us a tremendous opportunity to study AKP and PFOA development, which is the first key step in identifying targets for rehabilitation strategies. MOST is the only large cohort in the world that has the necessary longitudinal data on knee pain location, functional limitations, potential modifiable risk factors that may influence PF joint loading, and PF joint imaging with OA features assessed, making our proposal feasible by leveraging this rich resource. Our specific aims are as follows: Aim 1: Determine the extent to which modifiable risk factors (e.g., lower extremity strength, gait mechanics, PF alignment, body mass index) are associated with prevalent and incident AKP over 2 years; Aim 2: Determine the relation of AKP to incident PFOA and functional limitations over 2 years. The proposed research is highly significant in that it will identify modifiable risk factors for AKP development and its downstream effects (e.g., PFOA, tibiofemoral OA, TKR). It is innovative in that, instead of taking the typical approach of managing disease after it occurs, the current proposal will allow us to develop strategies to intervene when we have the potential for the greatest impact on changing the natural history of PF disease, and subsequently minimizing the burden of OA.