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J Rheumatol. 2019 Feb;46(2):198-203. doi: 10.3899/jrheum.170875. Epub 2018 Oct 1.

Quadriceps Weakness and Risk of Knee Cartilage Loss Seen on Magnetic Resonance Imaging in a Population-based Cohort with Knee Pain.

Author information

1
From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA. carson.c.chin@gmail.com.
2
C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada. carson.c.chin@gmail.com.
3
From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.
4
C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada.

Abstract

OBJECTIVE:

To determine whether baseline quadriceps weakness predicts cartilage loss assessed on magnetic resonance imaging (MRI).

METHODS:

Subjects aged 40-79 with knee pain (n = 163) were recruited from a random population sample and examined for quadriceps weakness with manual isometric strength testing, using a 3-point scoring system (0 = poor resistance, 1 = moderate resistance, 2 = full resistance), which was dichotomized as normal (grade 2) versus weak (grade 0/1). MRI of the more symptomatic knee was obtained at baseline and at mean of 3.3 years. Cartilage was graded 0-4 on MRI. Exponential regression analysis was used to evaluate whether quadriceps weakness was associated with whole knee cartilage loss, and in secondary analyses with compartment-specific cartilage loss, adjusted for age, sex, body mass index, Western Ontario and McMaster Universities Osteoarthritis Arthritis Index pain score, and baseline MRI cartilage score.

RESULTS:

Of 163 subjects, 54% were female, with a mean age of 57.7 years. Quadriceps weakness was seen in 11.9% of the subjects. Weakness was a predictor of whole knee cartilage loss (HR 3.48, 95% CI 1.30-9.35). Quadriceps weakness was associated with cartilage loss in the medial tibiofemoral (TF) compartment (HR 4.60, 95% CI 1.25-17.02), while no significant association was found with lateral TF (HR 1.53, 95% CI 0.24-9.78) or patellofemoral compartment (HR 2.76, 95% CI 0.46-16.44).

CONCLUSION:

In this symptomatic, population-based cohort, quadriceps weakness predicted whole knee and medial TF cartilage loss after 3 years. To our knowledge, this is the first study to show that a simple clinical examination of quadriceps strength can predict the risk of knee cartilage loss.

KEYWORDS:

CARTILAGE; COHORT; MAGNETIC RESONANCE IMAGING; OSTEOARTHRITIS; QUADRICEPS MUSCLE WEAKNESS

PMID:
30275263
DOI:
10.3899/jrheum.170875

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