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Osteoarthritis Cartilage. 2017 Dec;25(12):1926-1941. doi: 10.1016/j.joca.2017.08.009. Epub 2017 Aug 25.

Knee osteoarthritis phenotypes and their relevance for outcomes: a systematic review.

Author information

1
Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia. Electronic address: leticia.alle@sydney.edu.au.
2
Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia. Electronic address: luciano.melo@sydney.edu.au.
3
School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Electronic address: tie.yamato@sydney.edu.au.
4
Faculty of Medicine and Health Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia. Electronic address: kathryn.mills@mq.edu.au.
5
Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia. Electronic address: varshini.ravi@sydney.edu.au.
6
Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia. Electronic address: david.hunter@sydney.edu.au.

Abstract

OBJECTIVE:

To systematically review the literature for studies investigating knee osteoarthritis (OA) phenotypes to examine what OA characteristics are relevant for phenotyping.

METHODS:

A comprehensive search was performed in Medline, EMBASE, Web of Sciences, CINAHL, and Scopus databases from inception to September 2016. Inclusion was limited to observational studies of individuals with symptomatic knee OA that identified phenotypes based on any OA characteristics and assessed their association with clinically important outcomes. A descriptive synthesis of the data was performed.

RESULTS:

Of the 2777 citations retrieved, 34 studies were included. Clinical phenotypes were investigated most frequently, followed by laboratory, imaging and aetiologic phenotypes. Eight studies defined subgroups based on outcome trajectories (pain, function and radiographic progression trajectories). Most studies used a single patient or disease characteristic to identify patients subgroups while five included characteristics from multiple domains. We found evidence from multiple studies suggesting that pain sensitization, psychological distress, radiographic severity, body mass index (BMI), muscle strength, inflammation and comorbidities are associated with clinically distinct phenotypes. Gender, obesity and other metabolic abnormalities, the pattern of cartilage damage, and inflammation may be implicated in delineating distinct structural phenotypes. Only a few studies investigated the external validity of the phenotypes or their prospective validity using longitudinal outcomes.

CONCLUSIONS:

There is marked heterogeneity in the data selected by the studies investigating knee OA phenotypes. We identified the phenotypic characteristics that can be considered for a comprehensive phenotype classification in future studies. A framework for the investigation of phenotypes could be useful for future studies.

PROTOCOL REGISTRATION:

PROSPERO CRD42016036220.

KEYWORDS:

Heterogeneity; Knee; Osteoarthritis; Phenotype; Systematic review

PMID:
28847624
DOI:
10.1016/j.joca.2017.08.009
[Indexed for MEDLINE]
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