Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature

A. Dell'Isola, R. Allan, S.L. Smith, Martijn Steultjens, S.S.P. Marreiros

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Abstract

Background
Knee Osteoarthritis (KOA) is a heterogeneous pathology characterized by a complex and multifactorial nature. It has been hypothesised that these differences are due to the existence of underlying phenotypes representing different mechanisms of the disease.

Methods
The aim of this study is to identify the current evidence for the existence of groups of variables which point towards the existence of distinct clinical phenotypes in the KOA population. A systematic literature search in PubMed was conducted. Only original articles were selected if they aimed to identify phenotypes of patients aged 18 years or older with KOA. The methodological quality of the studies was independently assessed by two reviewers and qualitative synthesis of the evidence was performed. Strong evidence for existence of specific phenotypes was considered present if the phenotype was supported by at least two high-quality studies.

Results
A total of 24 studies were included. Through qualitative synthesis of evidence, six main sets of variables proposing the existence of six phenotypes were identified: 1) chronic pain in which central mechanisms (e.g. central sensitisation) are prominent; 2) inflammatory (high levels of inflammatory biomarkers); 3) metabolic syndrome (high prevalence of obesity, diabetes and other metabolic disturbances); 4) Bone and cartilage metabolism (alteration in local tissue metabolism); 5) mechanical overload characterised primarily by varus malalignment and medial compartment disease; and 6) minimal joint disease characterised as minor clinical symptoms with slow progression over time.

Conclusions
This study identified six distinct groups of variables which should be explored in attempts to better define clinical phenotypes in the KOA population.
Original languageEnglish
Article number425
JournalBMC Musculoskeletal Disorders
Volume17
DOIs
Publication statusPublished - 12 Oct 2016

Fingerprint

Knee Osteoarthritis
Phenotype
Central Nervous System Sensitization
Joint Diseases
PubMed
Chronic Pain
Osteoarthritis
Population
Cartilage
Obesity
Biomarkers
Pathology
Bone and Bones

Keywords

  • knee
  • osteoarthritis
  • phenotype
  • sub-group
  • clinical

Cite this

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title = "Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature",
abstract = "BackgroundKnee Osteoarthritis (KOA) is a heterogeneous pathology characterized by a complex and multifactorial nature. It has been hypothesised that these differences are due to the existence of underlying phenotypes representing different mechanisms of the disease.MethodsThe aim of this study is to identify the current evidence for the existence of groups of variables which point towards the existence of distinct clinical phenotypes in the KOA population. A systematic literature search in PubMed was conducted. Only original articles were selected if they aimed to identify phenotypes of patients aged 18 years or older with KOA. The methodological quality of the studies was independently assessed by two reviewers and qualitative synthesis of the evidence was performed. Strong evidence for existence of specific phenotypes was considered present if the phenotype was supported by at least two high-quality studies.ResultsA total of 24 studies were included. Through qualitative synthesis of evidence, six main sets of variables proposing the existence of six phenotypes were identified: 1) chronic pain in which central mechanisms (e.g. central sensitisation) are prominent; 2) inflammatory (high levels of inflammatory biomarkers); 3) metabolic syndrome (high prevalence of obesity, diabetes and other metabolic disturbances); 4) Bone and cartilage metabolism (alteration in local tissue metabolism); 5) mechanical overload characterised primarily by varus malalignment and medial compartment disease; and 6) minimal joint disease characterised as minor clinical symptoms with slow progression over time.ConclusionsThis study identified six distinct groups of variables which should be explored in attempts to better define clinical phenotypes in the KOA population.",
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author = "A. Dell'Isola and R. Allan and S.L. Smith and Martijn Steultjens and S.S.P. Marreiros",
note = "Acceptance from webpage OA article Applied Gold exception as published immediate OA in OA journal. ET 19/12/19 Funding note The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7-PEOPLE-2013-ITN) under grant agreement n° 607510.",
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Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. / Dell'Isola, A.; Allan, R.; Smith, S.L.; Steultjens, Martijn; Marreiros, S.S.P.

In: BMC Musculoskeletal Disorders, Vol. 17, 425, 12.10.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature

AU - Dell'Isola, A.

AU - Allan, R.

AU - Smith, S.L.

AU - Steultjens, Martijn

AU - Marreiros, S.S.P.

N1 - Acceptance from webpage OA article Applied Gold exception as published immediate OA in OA journal. ET 19/12/19 Funding note The research leading to these results has received funding from the European Union’s Seventh Framework Programme (FP7-PEOPLE-2013-ITN) under grant agreement n° 607510.

PY - 2016/10/12

Y1 - 2016/10/12

N2 - BackgroundKnee Osteoarthritis (KOA) is a heterogeneous pathology characterized by a complex and multifactorial nature. It has been hypothesised that these differences are due to the existence of underlying phenotypes representing different mechanisms of the disease.MethodsThe aim of this study is to identify the current evidence for the existence of groups of variables which point towards the existence of distinct clinical phenotypes in the KOA population. A systematic literature search in PubMed was conducted. Only original articles were selected if they aimed to identify phenotypes of patients aged 18 years or older with KOA. The methodological quality of the studies was independently assessed by two reviewers and qualitative synthesis of the evidence was performed. Strong evidence for existence of specific phenotypes was considered present if the phenotype was supported by at least two high-quality studies.ResultsA total of 24 studies were included. Through qualitative synthesis of evidence, six main sets of variables proposing the existence of six phenotypes were identified: 1) chronic pain in which central mechanisms (e.g. central sensitisation) are prominent; 2) inflammatory (high levels of inflammatory biomarkers); 3) metabolic syndrome (high prevalence of obesity, diabetes and other metabolic disturbances); 4) Bone and cartilage metabolism (alteration in local tissue metabolism); 5) mechanical overload characterised primarily by varus malalignment and medial compartment disease; and 6) minimal joint disease characterised as minor clinical symptoms with slow progression over time.ConclusionsThis study identified six distinct groups of variables which should be explored in attempts to better define clinical phenotypes in the KOA population.

AB - BackgroundKnee Osteoarthritis (KOA) is a heterogeneous pathology characterized by a complex and multifactorial nature. It has been hypothesised that these differences are due to the existence of underlying phenotypes representing different mechanisms of the disease.MethodsThe aim of this study is to identify the current evidence for the existence of groups of variables which point towards the existence of distinct clinical phenotypes in the KOA population. A systematic literature search in PubMed was conducted. Only original articles were selected if they aimed to identify phenotypes of patients aged 18 years or older with KOA. The methodological quality of the studies was independently assessed by two reviewers and qualitative synthesis of the evidence was performed. Strong evidence for existence of specific phenotypes was considered present if the phenotype was supported by at least two high-quality studies.ResultsA total of 24 studies were included. Through qualitative synthesis of evidence, six main sets of variables proposing the existence of six phenotypes were identified: 1) chronic pain in which central mechanisms (e.g. central sensitisation) are prominent; 2) inflammatory (high levels of inflammatory biomarkers); 3) metabolic syndrome (high prevalence of obesity, diabetes and other metabolic disturbances); 4) Bone and cartilage metabolism (alteration in local tissue metabolism); 5) mechanical overload characterised primarily by varus malalignment and medial compartment disease; and 6) minimal joint disease characterised as minor clinical symptoms with slow progression over time.ConclusionsThis study identified six distinct groups of variables which should be explored in attempts to better define clinical phenotypes in the KOA population.

KW - knee

KW - osteoarthritis

KW - phenotype

KW - sub-group

KW - clinical

U2 - 10.1186/s12891-016-1286-2

DO - 10.1186/s12891-016-1286-2

M3 - Article

VL - 17

JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

SN - 1471-2474

M1 - 425

ER -