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New APPROACH article investigates the clinical characteristics of OA patients with an increased likelihood for progression of joint damage and pain

News 2021

By using a unique multi-step participant selection procedure as well as complex machine learning models, the APPROACH researchers were able to assess the likelihood of joint damage and pain progression. The combination of characteristics among the participants in the APPROACH cohort study presents potentially the best patient selection for evaluation of treatments which stop, slow down or reduce progression of joint damage and decrease pain in osteoarthritis patients. 

Title

Baseline clinical characteristics of predicted structural and pain progressors in the IMI-APPROACH knee OA cohort

Authors

Eefje Martine van Helvoort, Christoph Ladel, Simon Mastbergen, Margreet Kloppenburg, Francisco J Blanco, Ida K Haugen, Francis Berenbaum, Jaume Bacardit, Pawel Widera, Paco M J Welsing and Floris Lafeber.

Available here.

Background

One of the major challenges in knee osteoarthritis (OA) clinical trials is the selection of patients. To demonstrate successful reduction or halting of disease progression, patients are needed in whom the disease would have progressed without intervention.

The IMI-APPROACH cohort study used a unique, multistep selection procedure to include people with an increased change for progression of joint damage or pain. As a first step, complex machine learning models were used to assign an S progression score and a P progression score to each patient. The S progression score reflects the likelihood of showing progression of joint damage, the P progression score reflects the likelihood of showing pain progression. The S and P progression scores were combined into one general ranking score which orders patients by the likelihood of showing progression (either for joint damage and/or pain) during the study period.

Objectives

This study provides the clinical characteristics of the IMI-APPROACH patients in relation to their S progression score, P progression score, and ranking score.

Methods

Firstly, correlations between multiple clinical characteristics and the S progression score, P progression, or ranking score were determined. Secondly, for all scores (S progression score, P progressions score, and general ranking score) separately, patients were divided in three equal groups: low score, intermediate score, and high score. Then differences in clinical characteristics between patients with a high score and patients with a low score were evaluated.

Results

The S progression score is strongly correlated to minimum joint space width (minJSW; a higher minJSW means less joint damage). The P progression score is strongly correlated to the KOOS pain score. The general ranking score is correlated to both, minJSW and KOOS pain.

Patients with a high S progression score had higher minJSW compared to patients with a low S progression score, indeed providing an opportunity to observe progression of joint damage. Patients with a high P progression score had more pain compared to patients with a low P progression score, not providing an opportunity to observe pain progression but with the possibility to show pain reduction when treated (which was not the case in this study). Patients with a high general ranking score have higher minJSW and more pain.

Conclusion

The unique, multi-step selection procedure of the IMI-APPROACH cohort study led to the inclusion of patients with a high minJSW (e.g. little joint damage) and severe pain. This combination of characteristics provides potentially the best patient selection for evaluation of treatments that stop/slow-down/reduce progression of joint damage and decrease pain.

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