Healthy knee aging vs. osteoarthritis in three large diverse cohorts: What is the clinical relevance of structural changes seen on radiographs?

膝骨性关节炎(KOA)是一种发病率很高的重大公共卫生问题，与 发病率和过早死亡率增加。它被确定为最大的未得到满足的医疗需求 肌肉骨骼状况。它通常被描述为一种缓慢进展的疾病，尽管有些人 有快速的结构进展。目前还没有可用的治疗方法来预防这种疾病或阻止其 进展，部分原因是在确定结构进展风险最高的膝盖方面存在挑战。这个 评估膝关节骨性关节炎发展后结构进展的标准是关节间隙宽度(JSW)的损失， 然而，关于正常年龄相关变化与疾病相关变化的信息有限。 JSW，性别和种族的潜在差异，或疼痛和功能的后果。两者之间的区别 进行性膝骨性关节炎的正常年龄相关性器官功能下降和JSW丢失特征尚不清楚， 代表着一个重要的知识鸿沟。 目前的建议是评估JSW变化在疼痛方面的临床相关性的关键的第一步 以及风险因素的评估。它使用来自三个最大和最大的 膝关节骨性关节炎的不同纵向观察研究：约翰斯顿县骨关节炎项目(JoCoOA)，a 基于人群的队列研究；多中心骨关节炎研究(MOST)和骨关节炎倡议 (OAI)，两组患有或有患症状性膝骨性关节炎风险的个人。在多次访问期间，这些 由大约10,500名参与者组成的三个队列收集了关于人口统计、风险 因素、患者报告的结果和相同的负重固定屈膝X线片对OA的评分 严肃性。 具体目标是1。)描述无病膝关节健康老化的自然病史； 根据膝关节结构、疼痛和功能的纵向变化确定膝关节亚组 从健康的膝关节老化到快速的骨性关节炎进展；评价健脾冲剂的临床意义 基于疼痛增加和功能限制的并发风险的个体膝关节的变化，以及 未来的膝关节置换手术。这些目标将分别针对男性和女性，并针对 白人和非裔美国人。

Knee osteoarthritis (KOA) is a major public health problem that has high prevalence and is associated with increased morbidity and premature mortality. It has been identified as the biggest unmet medical need among musculoskeletal conditions. It is typically described as a slowly progressive disease, though some individuals have rapid structural progression. There are currently no treatments available to prevent the disease or halt its progression, due in part to challenges in identifying knees at highest risk for structural progression. The standard for assessing structural progression following development of KOA is loss of joint space width (JSW), however there is limited information regarding normal age-related changes vs. disease-related changes in JSW, potential differences by sex and race, or consequences for pain and function. The distinction between normal age-related decline in organ function and JSW loss characteristic of progressive KOA is not known and represents an important knowledge gap. The current proposal is a critical first step in evaluating the clinical relevance of change in JSW in terms of pain and function, as well as evaluation of risk factors. It uses pooled data from three of the largest and most diverse longitudinal observational studies of KOA: the Johnston County Osteoarthritis Project (JoCoOA), a population-based cohort; and the Multicenter Osteoarthritis Study (MOST) and the Osteoarthritis Initiative (OAI), two cohorts of individuals with or at risk of developing symptomatic KOA. Over multiple visits, these three cohorts, together comprising ~10,500 participants, collected comparable data on demographics, risk factors, patient-reported outcomes, and identical weightbearing fixed flexion knee radiographs scored for OA severity. The specific aims are to 1.) Describe the natural history of healthy knee aging in disease-free knees; 2.) Identify subgroups of knees based on longitudinal changes in knee structure, pain and function across the spectrum from healthy knee aging to rapid OA progression; and 3.) Evaluate the clinical relevance of JSW changes for an individual knee based on concurrent risk of increased pain and functional limitations, and for future knee replacement. These aims will be addressed separately for men and women, and separately for whites and African Americans.