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

Dell�Isola, A.; Smith, S. L.; Allan, R.; Steultjens, M.; Marreiros, S. S. P.

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.

Citation

Dell’Isola, A., Smith, S. L., Allan, R., Steultjens, M., & Marreiros, S. S. P. (2016). Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskeletal Disorders, 17(1), Article 425. https://doi.org/10.1186/s12891-016-1286-2

• Journal Article Type: Article
• Acceptance Date: Oct 7, 2016
• Online Publication Date: Oct 12, 2016
• Publication Date: 2016-12
• Deposit Date: Jun 5, 2020
• Publicly Available Date: Jun 8, 2020
• Journal: BMC Musculoskeletal Disorders
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 1
• Article Number: 425
• DOI: https://doi.org/10.1186/s12891-016-1286-2
• Public URL: https://nottingham-repository.worktribe.com/output/4584599
• Publisher URL: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-016-1286-2