Structure modification in knee osteoarthritis: methodology and outcome parameters

Managing osteoarthritis (OA) with structure-modifying agents (SMAs) is an i mportant emerging topic receiving increased attention. from both lay indivi duals and health care professionals as a promising alternative in the manag ement of OA. Objective: To review the methodology and outcome parameters purported to be used in the assessment of the structure-modifying potential of various int erventions. Design: A Medline search was performed to select the relevant published art icles. This review does not go into detail about various aspects of the des ign and conduct of structure-modifying studies; however, a vast number of r elevant references are provided and may be accessed by interested readers. Results: Enhancing the feasibility of SMAs. trials aimed at documenting eff icacy can be accomplished by carefully selecting: (1) the. outcome paramete rs, (2) the imaging methodology, and (3) the patient population. Most of th e relevant issues that need to be considered by investigators before embark ing on a study of this nature have been addressed in this article. Conclusion: Most of the evidence to date focuses on the superiority of the radiographic-based techniques in measuring joint space narrowing among a ho mogeneous population of CA patients. More research is warranted before othe r techniques such as ultrasound, chondroscopy, and magnetic resonance imagi ng, can be proven to be reliable. (C) 2001 OsteoArthritis Research Society International.