Accelerated Knee OA: Lowering the Risk in Patients

Osteoarthritis (OA) is traditionally thought of as a slowly progressive disorder, but 3% to 4% of individuals at risk for OA develop it in less than 4 years and some in less than 12 months.¹ Individuals who are older, overweight, and/or have a new knee injury are more likely to develop this accelerated form of knee OA.^1,2

Adults with accelerated knee OA are twice as likely to report higher levels of knee pain than those who experience a more gradual onset of OA.³ Furthermore, individuals with accelerated knee OA are more likely to report knee pain and/or exhibit functional impairments before they have radiographic evidence of knee OA.³ Early detection of knee pain and functional impairments may help us identify individuals who will develop accelerated knee OA. However, we currently lack validated screening tools to recognize the individuals at risk for accelerated knee OA and there are no treatments to slow the rate of progression.

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The current conceptual model for accelerated knee OA³ may offer insights into strategies that may be implemented to reduce the risk of accelerated knee OA. This model proposes that being older or overweight leads to subtle changes within joint tissues, which radiographs fail to detect. These subtle changes in tissues may lead to knee pain. The presence of knee pain may predispose someone to a new knee injury,⁴ which may be a catalyst for accelerated knee osteoarthritis.^1,2,5 Based on this model, it may be critical to recognize an individual without knee OA who reports knee pain because pain may be a sign of subtle structural changes and a risk factor for a new knee injury. Regularly assessing patient-reported outcomes of knee pain, knee disability, or global impact of arthritis along with a 20-meter walk test and chair-stand test could be easily deployed evaluations that may differentiate a person who is at risk for accelerated knee OA.³ Clinicians should be proactive with a patient who reports worsening knee pain, disability, or exhibits decreased physical function.

When an older or overweight individual reports knee pain despite the lack of radiographic knee OA it may be beneficial to implement knee OA treatment guidelines. Treatment guidelines for knee OA often advocate for managing knee symptoms with a pharmacological intervention and exercise.⁶ An exercise program could be tailored to reduce knee pain, encourage weight loss/management, and reduce the risk of knee injury or falls. A more proactive approach to the management of knee pain among older or overweight adults may be the key to preventing a new injury or accelerated knee OA.

It is critical for clinicians to recognize that some adults develop accelerated knee OA, which is a painful and disabling disorder. It may be important to educate older or overweight individuals about their risk for accelerated knee osteoarthritis and to encourage them to report any new knee symptoms or injuries. More research is needed to understand accelerated knee OA, if we can predict who will develop accelerated knee OA, and whether it can be prevented or delayed. In the meantime, a clinician’s best option is to recognize an adult at risk for accelerated knee OA and to be more proactive when managing their joint symptoms because this may be a strategy to delay or prevent an accelerated onset of OA.

Research reported in this publication was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number R01AR065977. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

References

1. Driban JB, Eaton CB, Lo GH, Ward RJ, Lu B, McAlindon TE. Association of knee injuries with accelerated knee osteoarthritis progression: data from the Osteoarthritis Initiative. Arthritis Care Res. 2014;66(11):1673-1679.
2. Driban JB, Eaton CB, Lo GH, et al. Overweight older adults, particularly after an injury, are at high risk for accelerated knee osteoarthritis: data from the Osteoarthritis Initiative. Clin Rheumatol. 2016;35(4):1071-1076.
3. Driban JB, Price LL, Eaton CB, et al. Individuals with incident accelerated knee osteoarthritis have greater pain than those with common knee osteoarthritis progression: data from the Osteoarthritis Initiative. Clin Rheumatol. 2015.
4. Driban JB, Lo GH, Eaton CB, Price LL, Lu B, McAlindon TE. Knee Pain and a Prior Injury Are Associated with Increased Risk of a New Knee Injury: Data from the Osteoarthritis Initiative. J Rheumatol. 2015;42(8):1463-1469.
5. Driban JB, Ward RJ, Eaton CB, et al. Meniscal extrusion or subchondral damage characterize incident accelerated osteoarthritis: Data from the Osteoarthritis Initiative. Clin Anat. 2015;28(6):792-799.
6. Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: The chronic osteoarthritis management initiative of the U.S. bone and joint initiative. Semin Arthritis Rheum. 2014;43(6):701-712.