my aching knees detection and prevention · my aching knees detection and prevention . thomas m....
TRANSCRIPT
My Aching Knees
Detection and Prevention
Thomas M. Link M.D., Ph.D.Professor of Radiology
Department of Radiology and Biomedical Imaging, University of California San Francisco
2
Osteoarthritis (OA) is the most frequent joint disease
In the U.S. about 27 million suffer from symptomatic
osteoarthritis1
Affects nearly 50% of patients 75 years and older2
• results in long-term disability • enormous economical health
care cost burden3
Osteoarthritis
1 Lawrence et al. Arthritis and rheumatism 20082 Litwic et al. Br Med Bull. 20133 Kotlarz et al. Arthritis and rheumatism 2009; Illustration from www.healthcare.utah.edu
Disability
National Center for Health Statistics, United States, 2009
75-85 years 65-74 years 55-64 years
Lung
Dia
bete
s
Hea
rt
Bon
es/jo
ints
Life Expectancy
Women Men
Diagnosis with Radiographs
Diagnosis with MRI
Prevention
Risk score
Diagnosis with Radiographs
Diagnosis with MRI
Prevention
Risk score
7
Definition of Osteoarthritis degenerative joint disease
is based on clinical symptoms and on Radiographs/X-rays
knee
8
Knee - normal
9
Knee – mild osteoarthritis
10
Knee – mild osteoarthritis
11
Knee – moderate osteoarthritis
12
Knee – moderate osteoarthritis
13
Knee – severe osteoarthritis
14
Knee – severe osteoarthritis
Diagnosis with Radiographs
Diagnosis with MRI
Prevention
Risk score
16
MRI / Magnetic Resonance Imaging
17
MRI / Magnetic Resonance Imaging
18
MRI / Magnetic Resonance Imaging
cartilage – bone - meniscus
19
MRI / Magnetic Resonance Imaging
cartilage – bone - meniscus
Meniscal tear
20
MRI / Magnetic Resonance Imaging
cartilage – bone - meniscus
Meniscal tear
21
MRI / Magnetic Resonance Imaging
cartilage – bone - meniscus
22
MRI / Magnetic Resonance Imaging
cartilage – bone - meniscus
Collagen Chondrocytes
Cartilage loss
Irreversible
Does not grow back
Leads to osteoarthritis
Evolution of cartilage in OA
23Illustrations from Matzat et al. Quant Imaging Med Surg. 2013
Healthy Cartilage
Proteoglycans
Cartilage loss
24
MRI / Magnetic Resonance Imaging
Osteoarthritis – 29 year old man
25
MRI / Magnetic Resonance Imaging
Osteoarthritis – ACL degeneration45 yo woman
Diagnosis with Radiographs
Diagnosis with MRI
Prevention
Risk score
27
From the Press
Medical News Today 5/2017
28
Obesity: modifiable risk factor for OA
Weight loss slows OA1
Improvement of clinical symptoms2
Is a higher degree of weight loss associated with improved cartilage
health?
Obesity and Osteoarthritis (OA)
1 Serebrakian et al. JMRI 2014 2 Edwards et al. Arthritis 2012Illustration from www.clinicaladvisor.com
Early molecular changesCompositional T2 imaging
Molecular T2 Relaxation Time Mapping
29
• collagen content • free water
0 70T2 [ms]
Baseline 4 years 8 years
Assessment of molecular cartilage compositionbefore cartilage lesions occur:
Courtesy Zarnowski
30
MRI T2 measurements to detect molecular changes before cartilage damage
Obesity and Osteoarthritis (OA)
Do different degrees of weight loss have a different impact on cartilage health?
1 Joseph et al. Arthritis Research & Therapy 2011
Magnetic resonance imaging (MRI)
31
Baseline 48-month follow-up
1 Joseph et al. Arthritis Research & Therapy 2011
• Molecular cartilage imaging: T2 relaxation time
Patient selection
32
506 patients from the OAIage 62.4±9.3y, 60.6% females
BMI 30.2±3.5 – obese or overweight subjects
patients not loosing weight
253 subjects>10% weight loss
76 subjects
5-10% weight loss 177 subjects
1 Holdsworth et al. Int J Obes Relat Metab Disord. 2004
Results
Magnetic resonance imaging (MRI)
34
Baseline 48-month follow-up
1 Joseph et al. Arthritis Research & Therapy 20112 Yu et al. Osteoarthritis Cartilage 2015
35
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Stable weight 5-10% weight loss >10% weight loss5-10%weight loss
>10%weight loss
Cha
nge
ofT2
mea
sure
men
ts(m
s) o
ver4
y
Obese patients withoutweight loss
Cartilage
36
Baseline
0 70T2 [ms]
4 year follow-up
Cartilage molecular T2 maps of medial tibiaO
bese
with
>1
0% w
eigh
t los
sO
bese
with
out
wei
ght l
oss
37
Progression of defects Baseline 4 year follow-up
Obe
se w
ith
>10%
wei
ght l
oss
Obe
se w
ithou
t w
eigh
t los
s
38
5-10%weight loss
>10%weight loss
Cha
nge
ofkn
eepa
inov
er4y
Obese withoutweight loss
Pain
Obese and overweight patients with risk factors or mild to moderate radiographic evidence for OA:
• protective aspect of weight loss on cartilage
• patients with >10% weight loss benefit significantly more than patients with little or no weight loss
• potentially weight loss can prevent end stage OA
39
Conclusion
40
Forbes 10-2017
2017 Mayo Foundation for Medical Education and Research
41
Physical Activity and Osteoarthritis WGN-TVChicago
News 11/2009
RSNA Press conference
11/2011
Background
Loading = essential for normal cartilage development If excessive, may lead to degeneration over
time
Association of exercise with OA development is unclear Detrimental, beneficial, no effect on articular
cartilage
1Jones G, et al. 2Vanwanseele B, et al. 3Spector TD, et al. 4Cheng Y, et al. 5Rogers LQ, et al. 6Roos EM, et al. 7Chakravarty EF, et al. (See Reference Page)
Objective
To evaluate the effects of exerciseon knee cartilage
in middle-aged, asymptomatic subjects with and without OA risk factors
PHYSICAL ACTIVITY SCALE FOR THE ELDERLY
3 domains of physical activity over last 7 days Leisure, household, and occupational activities
Leisure ActivitiesSitting, walking, light, moderate, strenuous sport/recreation,
muscle strength training
Sedentary Moderate Exercisers StrenuousExercisers
EXERCISE LEVEL CLASSIFICATION
Color Map
Sedentary Light-moderate StrenuousExerciser Exerciser
Results
Strenuous exercisers = ↑ T2
Associated with more degenerated cartilage
Subjects with knee OA risk factors:
Mild - moderate exercisers = ↓ T2 values
Indicative of healthier cartilage
CONCLUSIONS
In line with American Heart Association Recommendations for Physical Activity in Adults150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise (or a combination of moderate and vigorous activity). Thirty minutes a day, five times a week is an easy goal to rememberAvoid too much high impact activity !
Recommendations
Diagnosis with Radiographs
Diagnosis with MRI
Prevention
Risk score
Outcome: at any subsequent timepoint (1 year – 8 years) N (%) of 641
KL >= 3 34 (5.31%)WOMAC >=5 at any two subsequent timepoints 53 (8.27%)
Total Knee Replacement 8 (1.25%)ANY OUTCOME 80 (12.48)
J Magnetic Resonance Imaging, 2017, in press
8 year Outcome Variables
Radiographic or clinical osteoarthritis
or total joint replacement
Risk score model
J Magnetic Resonance Imaging, 2017, in press
Risk Score
29.4%
Medial Femur T2 [ms]42.3
Medial Femur T2 [ms]30.8
Medial Femur T2 [ms]37.6
Effects of varying T2 values
0 ms
70 ms
Low risk: 34.1% Med Risk: 57.5% High Risk: 75.1%
Acknowledgments
Acknowledgments
National Institutes of Health U01 AR059507P50 AR060752 R01 AR46905 R01 AG017762, PAR-04-023, NIHNIH BAA-NHLBI-AR-10-06 OAI N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262
GSKUCSF REAC Program
Thank you!