Association between biochemical cartilage markers and clinical symptoms in patients with hip osteoarthritis: cohort study with 2-year follow-up.

OBJECTIVES: To assess associations between uCTX-II or uCIIM and severity of hip pain in patients with mild-moderate hip osteoarthritis (OA) over a 2-year period, and establish whether the level of these biomarkers at baseline could estimate a specific trajectory of hip pain. DESIGN: A cohort study with a 2-year follow-up and 6-monthly measurements of urinary biomarkers (uCTX-II and uCIIM) and symptom severity. Patients were recruited from general practices. The primary outcome was hip pain, measured with the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) subscale and the Visual Analog Scale (VAS). Associations between hip pain and biomarkers were assessed using linear mixed-model analysis for repeated measurements. Five previously identified pain trajectories were used as outcome to investigate whether the level of biomarkers at baseline could estimate membership in one of the trajectories using multinomial regression analysis. RESULTS: LoguCTX-II and loguCIIM were not associated with WOMAC pain or VAS pain during the 2-year follow-up. Patients in the highly progressive pain trajectory and the moderate pain trajectory were more likely to have a higher loguCTX-II at baseline (OR 6.7; 95% CI 1.6-28.2 and OR 4.8; 95% CI 1.0-22.8, respectively) than patients in the mild pain trajectory. CONCLUSION: This study shows that in patients with mild-moderate hip OA the urinary biochemical markers uCTX-II and uCIIM are not cross-sectionally associated with hip pain during the 2-year follow-up. Because the uCTX-II level estimated a progressive or moderate hip pain trajectory, this correlation needs to be confirmed in additional patients with hip OA.

A statistical model of shape and density of the proximal femur in relation to radiological and clinical OA of the hip.

OBJECTIVE: Common radiological measures of osteoarthritis (OA) relate poorly to symptoms as experienced by patients. We created a statistical model of shape and density to see if Dual Energy X-ray (DXA) images of the hip contain symptom-related information that is not captured by common radiological measures. METHODS: DXA images of the hip were made in a prospective study of patients that met the American College of Rheumatology (ACR) criteria for hip OA. From the DXA scans, we constructed a statistical model of the appearance (shape combined with density) of the proximal femur of left and right side. The model yields a number of independent descriptors of the appearance (modes) which we related to various measures of radiological and clinical OA. These outcome measures were defined using Joint Space Width (JSW), Kellgren and Lawrence (K-L) scores, Visual Analogue Scale (VAS) and Western Ontario MacMaster Universities (WOMAC) pain scores and a self-reported global assessment score. RESULTS: Various modes showed significant relations with measures of OA. Interestingly, the modes that related well with radiological OA did not relate to clinical OA and vice-versa. Moreover, the modes were predictors of status and progression of clinical OA, independent from JSW and K-L. CONCLUSION: Statistical modeling of the appearance captures the patterns of variation in projected femoral morphology as visible on DXA images. We showed that these descriptors of subtle aspects of shape and density of the hip contain information about clinical status which common radiological measures do not. The presented results warrant further careful study of the method as a monitoring tool in clinical trials.

Effect of glucosamine sulphate on joint space narrowing, pain and function in patients with hip osteoarthritis; subgroup analyses of a randomized controlled trial.

OBJECTIVE: Recently we reported that glucosamine sulphate (GS) did not have an effect on the symptoms and progression of primary care patients with hip osteoarthritis (OA). The aim of this present study was to investigate whether there are subgroups of patients with hip OA for whom GS might be an effective therapy. METHOD: We randomized 222 patients with hip OA that met one of the American College of Rheumatology criteria to either 1500 mg of oral GS or placebo once daily for 2 years. Subgroup analyses were predefined for radiographic severity (Kellgren & Lawrence (KL)=1 vs >or=2) and for type of OA (localised vs generalised). Additional exploratory subgroup analyses focused on groups based on pain level, pain medication use, baseline joint space width (JSW), and concomitant knee OA at baseline. Primary outcome measures were Western Ontario MacMaster Universities (WOMAC) pain and function scores over 24 months, and joint space narrowing (JSN) after 24 months. RESULTS: In the predefined subgroups based on radiographic severity and type of OA, the outcomes WOMAC pain, function and JSN were similar for the GS and placebo group. CONCLUSION: GS was not significantly better than placebo in reducing symptoms and progression of hip OA in subgroups of patients.