C. Kent Kwoh

Interests

Research

Dr. Kwoh’s major research interests include outcome assessment and the examination of risk factors for the development and progression of a spectrum of arthritis and musculoskeletal diseases. His more recent work includes the examination of risk factor assessment and outcomes related to knee and hip osteoarthritis; the identification of biomarkers, most notably MRI imaging biomarkers, for the development and/or progression of knee osteoarthritis; the examination of racial/ethnic disparities in the utilization of joint replacement and other treatment options for osteoarthritis; and the evaluation of predictive factors for outcomes following total joint replacement. His major research contributions include the earlier detection of OA onset and/or progression through the use of MRI imaging biomarkers; the characterization of knee pain location and patterns; and the identification of imaging biomarkers of knee pain. He has been the member of committees for the development of guidelines for the management of hand, hip and knee osteoarthritis for the American College of Rheumatology, Osteoarthritis Research Society International and the American Academy of Orthopaedic Surgeons. He has had continuous funding from the National Institutes of Health (NIH) since 1989. He is author or co-author of more than 200 peer-reviewed journal articles and book chapters. 

Courses

Scholarly Contributions

Chapters

• Kwoh, C. K., Vina, E. R., Vina, E. R., & Kwoh, C. K. (2016). Osteoarthritis. In Hazzard's Geriatric Medicine and Gerontology. McGraw Hill.
• Kwoh, C. K. (2015). Osteoarthritis. In Andreoli and Carpenter’s Cecil Essentials of Medicine(pp 805-08). Philadelphia, PA: Saunders Elsevier.

Journals/Publications

• Amesbury, R., Ragati-Haghi, H., Mathiessen, A., Laffaye, T., Stein, R. I., Collins, J. E., Kent Kwoh, C., & Duryea, J. (2024). Gender differences in patterns of cartilage loss: Data from the Osteoarthritis Initiative. Osteoarthritis and cartilage.
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  Understanding gender-specific differences in patterns of cartilage loss can improve our knowledge of the pathogenesis of knee osteoarthritis (KOA) development and progression and may inform clinical trials of treatments for KOA. The goal of our observational study was to examine gender differences in patterns of cartilage loss in the central weight-bearing regions of the femur.
• Jordan, D., Elfar, J., Kwoh, C. K., & Li, Z. M. (2024). Estimation of radiographic joint space of the trapeziometacarpal joint with computed tomographic validation. Journal of medical imaging (Bellingham, Wash.), 11(2), 024001.
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  Joint space width (JSW) is a common metric used to evaluate joint structure on plain radiographs. For the hand, quantitative techniques are available for evaluation of the JSW of finger joints; however, such techniques have been difficult to establish for the trapeziometacarpal (TMC) joint. This study aimed to develop a validated method for measuring the radiographic joint space of the healthy TMC joint.
• Wilson, D. L., Zhou, L., Sudano, D. G., Ashbeck, E. L., Kwoh, C. K., Krebs, L., Sheer, A., Smith, J., Tudeen, M., Lo-Ciganic, W. H., Wilson, D. L., Zhou, L., Sudano, D. G., Ashbeck, E. L., Kwoh, C. K., Krebs, L., Sheer, A., Smith, J., Tudeen, M., & Lo-Ciganic, W. H. (2024). Risk of Coccidioidomycosis Infection Among Individuals Using Biologic Response Modifiers, Corticosteroids, and Oral Small Molecules. ACR open rheumatology, 6(5), 287-293.
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  The study objective was to examine associations between the use of biologic response modifiers (BRMs), corticosteroids, and oral small molecules (OSMs) and subsequent coccidioidomycosis infection risk among US Medicare beneficiaries with rheumatic or autoimmune diseases.
• Eckstein, F., Guermazi, A., Hunter, D. J., Kwoh, C. K., Maschek, S., Nevitt, M. C., Roemer, F. W., Wirth, W., & Wisser, A. (2023).

  Selection of Knees With Subsequent Cartilage Thickness Loss Based on Magnetic Resonance Imaging Semiquantitative Grading: Data From the Osteoarthritis Initiative Foundation for the National Institutes of Health Biomarker Cohort

  . Arthritis Care & Research, 75(8), 1773-1782. doi:10.1002/acr.25078
• Gilles, G., Vohra, A., Robles, D., Taljanovic, M. S., Ashbeck, E. L., Caruso, C., Duryea, J., Bedrick, E. J., Guermazi, A., & Kwoh, C. K. (2023).

  Reliability and Validity of Single Axial Slice vs. Multiple Slice Quantitative Measurement of the Volume of Effusion-Synovitis on 3T Knee MRI in Knees with Osteoarthritis

  . Journal of Clinical Medicine, 12(7), 2691. doi:10.3390/jcm12072691
• Gilles, G., Vohra, A., Robles, D., Taljanovic, M. S., Ashbeck, E. L., Caruso, C., Duryea, J., Bedrick, E. J., Guermazi, A., & Kwoh, C. K. (2023). Reliability and Validity of Single Axial Slice vs. Multiple Slice Quantitative Measurement of the Volume of Effusion-Synovitis on 3T Knee MRI in Knees with Osteoarthritis. Journal of clinical medicine, 12(7).
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  Effusion-synovitis (ES) is recognized as a component of osteoarthritis, creating a need for rapid methods to assess ES on MRI. We describe the development and reliability of an efficient single-slice semi-automated quantitative approach to measure ES. We used two samples from the Osteoarthritis Initiative (OAI): 50 randomly selected OAI participants with radiographic osteoarthritis (i.e., Kellgren-Lawrence (KL) grade 2 or 3) and a subset from the Foundation for the National Institutes of Health Osteoarthritis Biomarker study. An experienced musculoskeletal radiologist trained four non-expert readers to use custom semi-automated software to measure ES on a single axial slice and then read scans blinded to prior assessments. The estimated intraclass correlation coefficient (ICC) for intra-reader reliability of the single-slice ES method in the KL 2-3 sample was 0.96 (95% CI: 0.93, 0.97), and for inter-reader reliability, the ICC was 0.90 (95% CI: 0.87, 0.95). The intra-reader mean absolute difference (MAD) was 35 mm (95% CI: 28, 44), and the inter-reader MAD was 61 mm (95% CI: 48, 76). Our single-slice quantitative knee ES measurement offers a reliable, valid, and efficient surrogate for multi-slice quantitative and semi-quantitative assessment.
• Hannon, C. P., Goodman, S. M., Austin, M. S., Yates, A., Guyatt, G., Aggarwal, V. K., Baker, J. F., Bass, P., Bekele, D. I., Dass, D., Ghomrawi, H. M., Jevsevar, D. S., Kwoh, C. K., Lajam, C. M., Meng, C. F., Moreland, L. W., Suleiman, L. I., Wolfstadt, J., Bartosiak, K., , Bedard, N. A., et al. (2023). 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. Arthritis & rheumatology (Hoboken, N.J.), 75(11), 1877-1888.
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  To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA).
• Hannon, C. P., Goodman, S. M., Austin, M. S., Yates, A., Guyatt, G., Aggarwal, V. K., Baker, J. F., Bass, P., Bekele, D. I., Dass, D., Ghomrawi, H. M., Jevsevar, D. S., Kwoh, C. K., Lajam, C. M., Meng, C. F., Moreland, L. W., Suleiman, L. I., Wolfstadt, J., Bartosiak, K., , Bedard, N. A., et al. (2023). 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective. The Journal of arthroplasty, 38(11), 2193-2201.
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  To develop evidence-based consensus recommendations for the optimal timing of hip and knee arthroplasty to improve patient-important outcomes including, but not limited to, pain, function, infection, hospitalization, and death at 1 year for patients with symptomatic and radiographic moderate-to-severe osteoarthritis or advanced symptomatic osteonecrosis with secondary arthritis of the hip or knee who have previously attempted nonoperative therapy, and for whom nonoperative therapy was ineffective, and who have chosen to undergo elective hip or knee arthroplasty (collectively referred to as TJA).
• Hannon, C. P., Goodman, S. M., Austin, M. S., Yates, A., Guyatt, G., Aggarwal, V. K., Baker, J. F., Bass, P., Bekele, D. I., Dass, D., Ghomrawi, H. M., Jevsevar, D. S., Kwoh, C. K., Lajam, C. M., Meng, C. F., Moreland, L. W., Suleiman, L. I., Wolfstadt, J., Bartosiak, K., , Bedard, N. A., et al. (2023). Erratum to "2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective" [The Journal of Arthroplasty 38 (2023) 2193-2201]. The Journal of arthroplasty.
• Harris, R. J., Parimi, N., Cawthon, P. M., Strotmeyer, E. S., Boudreau, R. M., Brach, J. S., Kwoh, C. K., & Cauley, J. A. (2023). Response letter to "sarcopenia, osteoporosis and fractures: what we see". Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 34(2), 427.
• Kwoh, C. K., Sun, X., Guermazic, A., Bedricka, E., Roemerb, F., Lui, S., & Li, Z. (2023). Comparison of evaluation metrics of deep learning for imbalanced imaging data in osteoarthritis studies. Osteoarthritis and Cartilage, 31(9), 1242-1248. doi:10.1016/j.joca.2023.05.006
• Lo, G. H., Richard, M. J., McAlindon, T. E., Kriska, A. M., Price, L. L., Rockette-Wagner, B., Eaton, C. B., Hochberg, M. C., Kwoh, C. K., Nevitt, M. C., & Driban, J. B. (2023). Strength Training Is Associated With Less Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis & rheumatology (Hoboken, N.J.).
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  We aimed to evaluate the relationship of a history of strength training with symptomatic and structural outcomes of knee osteoarthritis (OA).
• Vina, E. R., Patel, P., Grest, C. V., Kwoh, C. K., Jakiela, J. T., Bye, T., & White, D. K. (2023). Does Physical Activity Confound Race Differences in Osteoarthritis-Related Functional Limitation?. Arthritis care & research.
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  This study sought to determine the extent to which physical activity confounds the relation between race and the incidence of osteoarthritis (OA)-related functional limitation.
• Armstrong, D. G., Zhou, W., Tan, T., Marrero, D. G., Lane, A. I., Kwoh, C. K., Knapp, S. M., & Calhoun, E. A. (2022). Rates of Diabetes-Related Major Amputations Among Racial and Ethnic Minority Adults Following Medicaid Expansion Under the Patient Protection and Affordable Care Act.. JAMA network open, 5(3), e223991. doi:10.1001/jamanetworkopen.2022.3991
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  It is not known whether implementation of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the outcomes among racial and ethnic minority adults at risk of diabetes-related major amputations..To explore the association of early Medicaid expansion with outcomes of diabetic foot ulcerations (DFUs)..This cohort study included hospitalizations for DFUs among African American, Asian and Pacific Islander, American Indian or Alaska Native, and Hispanic adults as well as adults with another minority racial or ethnic identification aged 20 to 64 years. Data were collected from the State Inpatient Databases for 19 states and the District of Columbia for 2013 to the third quarter of 2015. The analysis was performed on December 4, 2019, and updated on November 9, 2021..States were categorized into early-adopter states (expansion by January 2014) and nonadopter states..Poisson regression was performed to examine the associations of state type, time, and their combined association with the proportional changes of major amputation rate per year per 100 000 population..Among the 115 071 hospitalizations among racial and ethnic minority adults with DFUs (64% of sample aged 50 to 64 years; 35%, female; 61%, African American; 25%, Hispanic; 14%, other racial and ethnic minority group), there were 36 829 hospitalizations (32%) for Medicaid beneficiaries and 10 500 hospitalizations (9%) for uninsured patients. Hospitalizations increased 3% (95% CI, 1% to 5%) in early-adopter states and increased 8% (95% CI, 6% to 10%) in nonadopter states after expansion, a significant difference (P for interaction 
• Bangerter, N., Bizien, M. D., Cain, D. W., Carlson, K., Clegg, D. O., Finco, M., Hanrahan, C., Hose, K., Jackson, C. G., Kwoh, C. K., Lee, S. J., Leiner, M., Reda, D. J., Robin, L., Sawitzke, A. D., Sindowski, T., Spencer, R. G., & Taylor, M. D. (2022).

  Effect of Pulsed Low-Intensity Ultrasonography on Symptom Relief and Tibiofemoral Articular Cartilage Thickness Among Veterans Affairs Enrollees With Knee Osteoarthritis: A Randomized Clinical Trial

  . JAMA Network Open, 5(3), e220632. doi:10.1001/jamanetworkopen.2022.0632
• Bowes, M. A., Collins, J. E., Dam, E. B., Deveza, L. A., Eckstein, F., Guermazi, A., Hoffmann, S., Hunter, D. J., Katz, J. N., Kraus, V. B., Kwoh, C. K., Losina, E., Lynch, J. A., Nevitt, M. C., & Roemer, F. W. (2022).

  Multivariable Modeling of Biomarker Data From the Phase I Foundation for the National Institutes of Health Osteoarthritis Biomarkers Consortium

  . Arthritis Care & Research, 74(7), 1142-1153. doi:10.1002/acr.24557
• Burant, C. J., Graham, G. C., Deimling, G., Kresevic, D., Kahana, E., Wykle, M., Kwoh, C. K., & Ibrahim, S. A. (2022). The Effects of Osteoarthritis on Depressive Symptomatology Among Older U.S. Military Veterans. International journal of aging & human development, 914150221084952.
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  Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies.A causal model was developed and tested using structural equation modeling that examined depression scores of 503 older (age 50-85), male Veterans with moderate to severe symptomatic OA of the knee\hip.The results of the structural equation modeling produced a final model of depressive symptomatology that fit the data well (Chi square = 12.23, DF = 11, p = .346; TLI = .99; CFI = 1.00; RMSEA = .02).The findings indicate the central role that OA severity (pain, stiffness, and functional difficulties) plays in the mental health of older Veterans in terms of the level of reported depressive symptoms.
• Cochran, G., Cochran, G., Donohue, J. M., Donohue, J. M., Gellad, W. F., Gellad, W. F., Gordon, A. J., Gordon, A. J., Guo, J., Guo, J., Kuza, C. C., Kuza, C. C., Kwoh, C. K., Kwoh, C. K., Lo‐Ciganic, W., Lo‐Ciganic, W., Malone, D. C., Malone, D. C., Weiss, J. C., , Weiss, J. C., et al. (2022).

  Changes in predicted opioid overdose risk over time in a state Medicaid program: a group‐based trajectory modeling analysis

  . Addiction, 117(8), 2254-2263. doi:10.1111/add.15878
• Eaton, C. B., Schaefer, L. F., Duryea, J., Driban, J. B., Lo, G. H., Roberts, M. B., Haugen, I. K., Lu, B., Nevitt, M. C., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., & McAlindon, T. (2022). Prevalence, Incidence, and Progression of Radiographic and Symptomatic Hand Osteoarthritis: The Osteoarthritis Initiative. Arthritis & rheumatology (Hoboken, N.J.), 74(6), 992-1000.
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  To describe the prevalence, incidence, and progression of radiographic and symptomatic hand osteoarthritis (OA), and to evaluate differences according to age, sex, race, and other risk factors.
• Gondal, F. R., Bilal, J., & Kent Kwoh, C. (2022). Tanezumab for the treatment of osteoarthritis pain. Drugs of today (Barcelona, Spain : 1998), 58(4), 187-200.
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  Tanezumab is a novel humanized IgG2 monoclonal antibody that works by selectively targeting, binding to and inhibiting nerve growth factor (NGF). NGF is upregulated in response to injury and inflammation, and preclinical data indicate it plays a role in pain signaling by inducing peripheral and central sensitization. Tanezumab potentially reduces sensitization and pain by blocking the interaction between NGF and the tropomyosin receptor kinase A (TrkA), and it has been studied extensively for the treatment of pain in patients with osteoarthritis (OA). In 2017, tanezumab was granted fast track designation in the U.S. for the treatment of chronic pain in patients with OA, as well as for the treatment of chronic low-back pain. This review discusses the mechanism of action, preclinical data and phase I, II and III studies of efficacy and safety of tanezumab in patients with OA.
• Harris, R. J., Parimi, N., Cawthon, P. M., Strotmeyer, E. S., Boudreau, R. M., Brach, J. S., Kwoh, C. K., & Cauley, J. A. (2022). Associations of components of sarcopenia with risk of fracture in the Osteoporotic Fractures in Men (MrOS) study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 33(8), 1815-1821.
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  Our aim was to evaluate the associations between the individual components of sarcopenia and fracture types. In this cohort, the risk of experiencing any clinical, hip, or major osteoporotic fracture is greater in men with slow walking speed in comparison to normal walking speed.
• Harris, R., Strotmeyer, E. S., Sharma, L., Kwoh, C. K., Brach, J. S., Boudreau, R., & Cauley, J. A. (2022). The Association between Severity of Radiographic Knee OA and Recurrent Falls in middle aged and older adults: The Osteoarthritis Initiative. The journals of gerontology. Series A, Biological sciences and medical sciences.
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  Knee osteoarthritis(KOA) is the most prevalent type of OA and a leading cause of disability in the United States. Falls are a major public health concern in older adults. Our aim was to examine how the severity of radiographic KOA impacts recurrent falls in a cohort of middle and older aged individuals enrolled in the Osteoarthritis Initiative (OAI).
• Ievers-Landis, C. E., Burant, C., Drotar, D., Morgan, L., Trapl, E. S., & Kwoh, C. K. (2003). Social support, knowledge, and self-efficacy as correlates of osteoporosis preventive behaviors among preadolescent females. Journal of pediatric psychology, 28(5), 335-45.
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  To develop and test a model based on Bandura's social cognitive theory to predict healthy lifestyle behaviors for the prevention of osteoporosis.
• Jarraya, M., Roemer, F., Kwoh, C. K., & Guermazi, A. (2022). Crystal arthropathies and osteoarthritis-where is the link?. Skeletal radiology.
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  Osteoarthritis (OA) is one of the leading causes of disability worldwide. As our understanding of OA progressively has moved from a purely mechanical "wear and tear" concept toward a complex multi-tissue condition in which inflammation plays a central role, the possible role of crystal-induced inflammation in OA incidence and progression may be relevant. In addition to gout, which affects 4% of the US population, basic calcium phosphate and calcium pyrophosphate deposition both may induce joint inflammation and may play a role in pain in OA. This narrative review article discusses the possible mechanisms underlying the associations between crystal-induced arthropathies and OA, and the important implications of these for clinical practice and future research.
• Kwoh, C. K., Dagnino, J., Ibrahim, S. A., Hausmann, L., Quinones, C., Hannon, M., & Vina, E. R. (2021). The Role of Knowledge and Attitudes About Non-steroidal Anti-inflammatory Drugs in Determining Treatment Use. ACR Open Rheumatology.
• Kwoh, C. K., Seitz, W. H., Evans, P. J., Hou, J., Bena, J., Norman, C., Jenkins, L., Grandy, E. L., & Li, Z. (2022). A preliminary study of radioulnar wrist compression in improving patient-reported outcomes of carpal tunnel syndrome https://doi.org/10.1186/s12891-022-05943-0. BMC Musculoskeletal Disorder.
• Li, J., Fu, S., Gong, Z., Zhu, Z., Zeng, D., Cao, P., Lin, T., Chen, T., Wang, X., Lartey, R., Kwoh, C. K., Guermazi, A., Roemer, F. W., Hunter, D. J., Ma, J., & Ding, C. (2022). MRI-based Texture Analysis of Infrapatellar Fat Pad to Predict Knee Osteoarthritis Incidence. Radiology, 304(3), 611-621.
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  Background Infrapatellar fat pad (IPFP) quality has been implicated as a marker for predicting knee osteoarthritis (KOA); however, no valid quantification for subtle IPFP abnormalities has been established. Purpose To investigate whether MRI-based three-dimensional texture analysis of IPFP abnormalities could help predict incident radiographic KOA. Materials and Methods In this prospective nested case-control study, 690 participants whose knees were at risk for KOA were included from the Pivotal Osteoarthritis Initiative MRI Analyses incident osteoarthritis cohort. All knees had a Kellgren-Lawrence grade of 1 or less at baseline. During the 4-year follow-up, case participants were matched 1:1 to control participants, with incident radiographic KOA as the outcome. MRI scans were segmented at the incident time point of KOA (hereafter, P0), 1 year before P0 (hereafter, P-1), and baseline. MRI-based three-dimensional texture analysis was performed to extract IPFP texture features. Least absolute shrinkage and selection operator and multivariable logistic regressions were applied in the development cohort and evaluated in the test cohort. The area under the receiver operating characteristic curve (AUC) was used to evaluate the discriminative value of the clinical score, IPFP texture score, and MRI Osteoarthritis Knee Score. Results Participants were allocated to development ( = 500, 340 women; mean age, 60 years) and test ( = 190, 120 women; mean age, 61 years) cohorts. In both cohorts, IPFP texture scores (AUC ≥0.75 for all) showed greater discrimination than clinical scores (AUC ≤0.69 for all) at baseline, P-1, and P0, with significant differences in pairwise comparisons ( ≤ .002 for all). Greater predictive and concurrent validities of IPFP texture scores (AUC ≥0.75 for all) compared with MRI Osteoarthritis Knee Scores (AUC ≤0.66 for all) were also demonstrated ( < .001 for all). Conclusion MRI-based three-dimensional texture of the infrapatellar fat pad was associated with future development of knee osteoarthritis. ClinicalTrials.gov registration no.: NCT00080171 © RSNA, 2022 See also the editorial by Fischer in this issue.
• Li, Z. M., Grandy, E. L., Jenkins, L., Norman, C., Bena, J., Hou, J., Evans, P. J., Seitz, W. H., & Kwoh, C. K. (2022). A preliminary study of radioulnar wrist compression in improving patient-reported outcomes of carpal tunnel syndrome. BMC musculoskeletal disorders, 23(1), 971.
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  Previous studies have shown radioulnar wrist compression augments carpal arch space. This study investigated the effects of radioulnar wrist compression on patient-reported outcomes associated with carpal tunnel syndrome. Subjects underwent thrice-daily (15 min each time 45 min daily) wrist compression over 4 weeks with an additional four weeks of follow-up without treatment. Primary outcomes included Boston Carpal Tunnel Questionnaire symptom and functional severity scales (SSS and FSS) and symptoms of numbness/tingling based on Visual Analog Scales. Our results showed that radioulnar wrist compression improved SSS by 0.55 points after 2 weeks (p 
• Lo, G. H., Richard, M. J., Cauley, J. A., Driban, J. B., Strayhorn, M., MacKay, J., Harkey, M. S., McAlindon, T. E., Jansen, M., Green, S., White, D. L., & Kwoh, C. K. (2022). A novel approach to studying early knee osteoarthritis illustrates that bilateral medial tibiofemoral osteoarthritis is a heritable phenotype: an offspring study. Rheumatology international, 42(6), 1063-1072.
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  To assess the potential of studying offspring of people with and without knee osteoarthritis to understand the risk factors and heritability for knee osteoarthritis. We selected two groups of Osteoarthritis Initiative (OAI) participants from one clinical site: (1) participants with bilateral radiographic medial tibiofemoral osteoarthritis and (2) those without tibiofemoral osteoarthritis. We then invited biological offspring ≥ 18 years old to complete an online survey that inquired about osteoarthritis risk factors and symptoms. Among the survey respondents, we recruited ten offspring of members from each group for a clinic visit with bilateral knee posterior-anterior radiographs and magnetic resonance imaging of the right knee. We established contact with 269/413 (65%) eligible OAI participants. Most (227/269, 84%) had ≥ 1 eligible biological offspring, and 213 (94%) were willing to share information about the new family study with their offspring. Our survey was completed by 188 offspring from 110 OAI participants: mean age of 43.0 (10.4) years, mean body mass index of 23.7 (5.9) kg/m, 65% female. Offspring obesity (OR = 2.7, 95% CI 1.0-7.3), hypertension (OR = 3.7, 95% CI 1.2-11.3), and Heberden's nodes (OR = 3.6, 95% CI 1.0-13.2) were associated with parental osteoarthritis status; however, adjusted models were not statistically significant. Radiographic tibiofemoral osteoarthritis (16/18 knees vs. 2/20 knees) and meniscal abnormalities (7/9 vs. 2/10 index knees) were more common among offspring with parental osteoarthritis status than not. We established the potential of a novel offspring study design within the OAI, and our results are consistent with bilateral radiographic medial tibiofemoral osteoarthritis being a heritable phenotype of osteoarthritis.
• Lo, G. H., Vinod, S., Richard, M. J., Harkey, M. S., McAlindon, T. E., Kriska, A. M., Rockette-Wagner, B., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Driban, J. B. (2022). Association Between Walking for Exercise and Symptomatic and Structural Progression in Individuals With Knee Osteoarthritis: Data From the Osteoarthritis Initiative Cohort. Arthritis & rheumatology (Hoboken, N.J.), 74(10), 1660-1667.
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  To assess the relationship between walking for exercise and symptomatic and structural disease progression in individuals with knee osteoarthritis (OA).
• Lo-Ciganic, W. H., Donohue, J. M., Yang, Q., Huang, J. L., Chang, C. Y., Weiss, J. C., Guo, J., Zhang, H. H., Cochran, G., Gordon, A. J., Malone, D. C., Kwoh, C. K., Wilson, D. L., Kuza, C. C., & Gellad, W. F. (2022). Developing and validating a machine-learning algorithm to predict opioid overdose in Medicaid beneficiaries in two US states: a prognostic modelling study. The Lancet. Digital health, 4(6), e455-e465.
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  Little is known about whether machine-learning algorithms developed to predict opioid overdose using earlier years and from a single state will perform as well when applied to other populations. We aimed to develop a machine-learning algorithm to predict 3-month risk of opioid overdose using Pennsylvania Medicaid data and externally validated it in two data sources (ie, later years of Pennsylvania Medicaid data and data from a different state).
• Lo-Ciganic, W. H., Hincapie-Castillo, J., Wang, T., Ge, Y., Jones, B. L., Huang, J. L., Chang, C. Y., Wilson, D. L., Lee, J. K., Reisfield, G. M., Kwoh, C. K., Delcher, C., Nguyen, K. A., Zhou, L., Shorr, R. I., Guo, J., Marcum, Z. A., Harle, C. A., Park, H., , Winterstein, A., et al. (2022). Dosing profiles of concurrent opioid and benzodiazepine use associated with overdose risk among US Medicare beneficiaries: group-based multi-trajectory models. Addiction (Abingdon, England), 117(7), 1982-1997.
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  One-third of opioid (OPI) overdose deaths involve concurrent benzodiazepine (BZD) use. Little is known about concurrent opioid and benzodiazepine use (OPI-BZD) most associated with overdose risk. We aimed to examine associations between OPI-BZD dose and duration trajectories, and subsequent OPI or BZD overdose in US Medicare.
• Roemer, F. W., Jarraya, M., Collins, J. E., Kwoh, C. K., Hayashi, D., Hunter, D. J., & Guermazi, A. (2022). Structural phenotypes of knee osteoarthritis: potential clinical and research relevance. Skeletal radiology.
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  A joint contains many different tissues that can exhibit pathological changes, providing many potential targets for treatment. Researchers are increasingly suggesting that osteoarthritis (OA) comprises several phenotypes or subpopulations. Consequently, a treatment for OA that targets only one pathophysiologic abnormality is unlikely to be similarly efficacious in preventing or delaying the progression of all the different phenotypes of structural OA. Five structural phenotypes have been proposed, namely the inflammatory, meniscus-cartilage, subchondral bone, and atrophic and hypertrophic phenotypes. The inflammatory phenotype is characterized by marked synovitis and/or joint effusion, while the meniscus-cartilage phenotype exhibits severe meniscal and cartilage damage. Large bone marrow lesions characterize the subchondral bone phenotype. The hypertrophic and atrophic OA phenotype are defined based on the presence large osteophytes or absence of any osteophytes, respectively, in the presence of concomitant cartilage damage. Limitations of the concept of structural phenotyping are that they are not mutually exclusive and that more than one phenotype may be present. It must be acknowledged that a wide range of views exist on how best to operationalize the concept of structural OA phenotypes and that the concept of structural phenotypic characterization is still in its infancy. Structural phenotypic stratification, however, may result in more targeted trial populations with successful outcomes and practitioners need to be aware of the heterogeneity of the disease to personalize their treatment recommendations for an individual patient. Radiologists should be able to define a joint at risk for progression based on the predominant phenotype present at different disease stages.
• Sawitzke, A. D., Jackson, C. G., Carlson, K., Bizien, M. D., Leiner, M., Reda, D. J., Sindowski, T., Hanrahan, C., Spencer, R. G., Kwoh, C. K., Lee, S. J., Hose, K., Robin, L., Cain, D. W., Taylor, M. D., Bangerter, N., Finco, M., & Clegg, D. O. (2022). Effect of Pulsed Low-Intensity Ultrasonography on Symptom Relief and Tibiofemoral Articular Cartilage Thickness Among Veterans Affairs Enrollees With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA network open, 5(3), e220632.
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  Osteoarthritis (OA) is a major cause of disability in the US, with no approved treatments to slow progression, but animal models suggest that pulsed low-intensity ultrasonography (PLIUS) may promote cartilage growth.
• Vina, E. R., Tsoukas, P. H., Abdollahi, S., Mody, N., Roth, S. C., Redford, A. H., & Kwoh, C. K. (2022). Racial and ethnic differences in the pharmacologic management of osteoarthritis: rapid systematic review. Therapeutic advances in musculoskeletal disease, 14, 1759720X221105011.
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  Racial and ethnic disparities in osteoarthritis (OA) patients' disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments.
• Wirth, W., Maschek, S., Wisser, A., Guermazi, A., Hunter, D. J., Kwoh, C. K., Nevitt, M. C., Eckstein, F., & Roemer, F. W. (2022). MRI-based semi-quantitative grading allows to specifically select knees with subsequent cartilage thickness loss. Arthritis care & research.
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  To investigate which MRI-based articular pathologies are predictive of subsequent medial femorotibial compartment quantitative cartilage thickness loss and therefore suitable for enrichment of clinical trials with participants showing a high likelihood for structural progression.
• Ashbeck, E. L., Bedrick, E. J., & Kwoh, C. K. (2021).

  The “placebo effect” in osteoarthritis clinical trials: challenging the narrative

  . Osteoarthritis and Cartilage, 29, S13-S14. doi:10.1016/j.joca.2021.02.033
• Bilal, J., Riaz, I. B., Naqvi, S. A., Bhattacharjee, S., Obert, M. R., Sadiq, M., Abd El Aziz, M. A., Nooman, Y., Prokop, L. J., Ge, L., Murad, M. H., Bryce, A. H., McBane, R. D., & Kwoh, C. K. (2021). Janus Kinase Inhibitors and Risk of Venous Thromboembolism: A Systematic Review and Meta-analysis. Mayo Clinic proceedings, 96(7), 1861-1873.
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  To assess the risk of venous thromboembolism (VTE) in patients treated with Janus kinase (JAK) inhibitors in clinical trials.
• Chang, J., Ding, C., Hunter, D. J., Kent Kwoh, C., Lu, M., Zhao, Y., Zheng, S., & Zhu, Z. (2021).

  Irregular types of proximal tibiofibular joint increase the risk of total knee replacement: Data from the osteoarthritis initiative

  . Journal of Orthopaedic Research, 40(8), 1787-1793. doi:10.1002/jor.25204
• Driban, J. B., Lo, G. H., Roberts, M. B., Harkey, M. S., Schaefer, L., Haugen, I. K., Smith, S. E., Duryea, J., Lu, B., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & McAlindon, T. E. (2021). Sports with a Bat or Racket are Not Associated with Thumb-base Osteoarthritis. Journal of athletic training.
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  Repetitive joint use is a risk factor for osteoarthritis, which is a leading cause of disability. Sports requiring a bat or racket to perform repetitive high-velocity impacts may increase the risk of thumb-base osteoarthritis. However, this hypothesis remains untested.
• Hunter, D. J., Deveza, L. A., Collins, J. E., Losina, E., Nevitt, M. C., Roemer, F. W., Guermazi, A., Bowes, M. A., Dam, E. B., Eckstein, F., Lynch, J. A., Katz, J. N., Kwoh, C. K., Hoffmann, S., & Kraus, V. B. (2021). Multivariable modeling of biomarker data from the phase 1 Foundation for the NIH Osteoarthritis Biomarkers Consortium. Arthritis care & research.
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  To determine the optimal combination of imaging and biochemical biomarkers to predict knee osteoarthritis (OA) progression.
• MacKay, J., Guermazi, A., Kwoh, C. K., See, P. L., Jarraya, M., Li, L., Hannon, M. J., Fujii, T., & Roemer, F. W. (2021). MRI-defined Osteophyte Presence and Concomitant Cartilage Damage in Knees with Incident Tibiofemoral Osteoarthritis: Data From The Pivotal Osteoarthritis Initiative Magnetic Resonance Imaging Analyses (POMA) Study. Arthritis care & research.
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  To describe compartmental frequencies of MRI-defined osteophytes and co-localized cartilage damage and evaluate the associations of osteophyte (OP) size with any ipsicompartmental cartilage damage in knees with incident tibiofemoral radiographic knee osteoarthritis (ROA).
• Martinez, J. A., Taljanovic, M. S., Witte, R. S., Nuncio Zuniga, A. A., Wertheim, B. C., Kwoh, C. K., Goldstein, B. A., Roe, D. J., & Chalasani, P. (2021). Shear wave elastography detects novel imaging biomarkers of aromatase inhibitor-induced joint pain: a pilot study. Journal of ultrasonography, 21(84), 1-6.
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  To determine whether differences in joint and tendon stiffness as measured by ultrasound shear wave elastography are present in breast cancer patients with aromatase inhibitor-associated arthralgias compared to age-comparable healthy control women.
• Mathiessen, A., Ashbeck, E. L., Huang, E., Bedrick, E. J., Kwoh, C. K., & Duryea, J. (2021). Cartilage Topography Assessment with Local Area Cartilage Segmentation (LACS) for Knee MRI. Arthritis care & research.
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  Local-Area Cartilage Segmentation (LACS) software was developed to segment medial femur (MF) cartilage on MRI. Our current objectives were to 1) extend LACS to the lateral femur (LF), medial tibia (MT), and lateral tibia (LT), 2) compare LACS to an established manual segmentation method, and 3) visualize cartilage responsiveness over each cartilage plate.
• McClendon, J., Essien, U. R., Youk, A., Ibrahim, S. A., Vina, E., Kwoh, C. K., & Hausmann, L. R. (2021). Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination. Arthritis care & research, 73(1), 11-17.
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  Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain.
• Roemer, F. W., Guermazi, A., Hannon, M. J., Fujii, T., Omoumi, P., Hunter, D. J., Eckstein, F., & Kwoh, C. K. (2021). Presence of MRI-defined inflammation particularly in overweight and obese women increases risk of radiographic knee osteoarthritis: the POMA Study. Arthritis care & research.
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  Aims were to assess 1.) whether odds for incident radiographic osteoarthritis (ROA) differ between men and women in regard to body mass index (BMI) and inflammatory magnetic resonance imaging (MRI) markers one and two years prior and 2.) whether presence of inflammation on MRI differs between normal-weight, and overweight/obese persons that develop ROA up to four years prior.
• Roth, M., Emmanuel, K., Wirth, W., Kwoh, C. K., Hunter, D. J., Hannon, M. J., & Eckstein, F. (2021). Changes in Medial Meniscal Three-Dimensional Position and Morphology As Predictors of Knee Replacement in Rapidly Progressing Knee Osteoarthritis: Data From the Osteoarthritis Initiative. Arthritis care & research, 73(7), 1031-1037.
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  To assess whether quantitative changes in the meniscus predict progression from early knee osteoarthritis (OA) to knee replacement (KR).
• Smith, S. E., Shilpa, P., Maetani, T., Kwoh, C. K., Hosseinzadeh, S., Duryea, J., & Collins, J. E. (2021). Association of quantitative measures of effusion-synovitis and hoffa-synovitis with radiographic and pain progression: Data from the FNIH OA biomarkers consortium. Osteoarthritis and Cartilage Open, 3(1), 100138. doi:10.1016/j.ocarto.2021.100138
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  Abstract Objective To validate a semi-automated software method of quantifying knee osteoarthritis (KOA) related effusion-synovitis (ES) and Hoffa-synovitis (HS) on MRI. Materials and methods 301 subjects were randomly selected from the FNIH sub cohort, a nested case control study within the Osteoarthritis Initiative (OAI), and distributed into 4 groups based on pain and radiographic progression. Measurements of ES and HS volume were made by 2 readers. Criterion validation was assessed through comparison with the MRI Osteoarthritis Knee Score (MOAKS) and the Spearman correlation coefficient r value. Reader reliability was measured on a subset of 30 subjects and intra-class correlation coefficients (ICCs). Clinical validity was assessed based on case control status using logistic regression and the area under the curve (AUC). Results ES volume was highly correlated with MOAKS Scores (r ​= ​0.74), as was the HS measure but to a lesser extent (r ​= ​0.55). For ES, the intra-reader and intra-reader precision ICCs were 0.83 and 0.95 respectively and 0.98 and 0.96 for HS. For clinical validity, we found similar AUC values when comparing the software method to MOAKS. The average reader time was less than 15 ​min per knee for both ES and HS. Conclusion We have demonstrated the validity of an efficient, accurate, and rapid ES and HS measurement method for KOA using MRI. To our knowledge, this is the first such software to measure both ES and HS. This method will offer an objective and efficient tool for clinical trials and other epidemiologic studies of KOA.
• Villatoro-Villar, M., & Kwoh, C. K. (2021). Bisphosphonates, Bone and Joint Pain. Current osteoporosis reports, 19(4), 417-428.
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  Bisphosphonates (BPs) have an established role in a number of diseases including osteoporosis, but the role of BPs for treating symptomatic conditions other than bone metastases is less clear. We review recent data on the efficacy of BPs in the treatment of symptomatic bone and joint pain with osteoarthritis (OA) as an example.
• Vina, E. R., Hannon, M. J., Quinones, C., Hausmann, L. R., Ibrahim, S. A., Dagnino, J., & Kwoh, C. K. (2021). The Role of Knowledge and Attitudes About Nonsteroidal Anti-inflammatory Drugs in Determining Treatment Use. ACR open rheumatology, 3(3), 154-163.
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  The objective of this study was to evaluate how patient knowledge and beliefs regarding nonsteroidal anti-inflammatory drugs (NSAIDs) may influence the use of NSAIDs for osteoarthritis (OA).
• Vina, E. R., Quinones, C., Hausmann, L. R., Ibrahim, S. A., & Kwoh, C. K. (2021). Association of Patients' Familiarity and Perceptions of Efficacy and Risks With the Use of Opioid Medications in the Management of Osteoarthritis. The Journal of rheumatology, 48(12), 1863-1870.
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  While opioids are known to cause unintended adverse effects, they are being utilized by a number of patients with osteoarthritis (OA). The aim of this study was to evaluate the association of patient familiarity and perceptions regarding efficacy and risks with opioid medication use for OA.
• Vina, E. R., Youk, A. O., Quinones, C., Kwoh, C. K., Ibrahim, S. A., & Hausmann, L. R. (2021). Use of Complementary and Alternative Therapy for Knee Osteoarthritis: Race and Gender Variations. ACR open rheumatology, 3(9), 660-667.
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  To evaluate race and gender variations in complementary and alternative medicine (CAM) use for knee osteoarthritis (OA) (unadjusted and adjusted for demographic and clinical factors).
• Zhao, Y., Zhu, Z., Chang, J., Wang, G., Zheng, S., Kwoh, C. K., Lynch, J., Hunter, D. J., & Ding, C. (2021). Predictive value of the morphology of proximal tibiofibular joint for total knee replacement in patients with knee osteoarthritis. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 39(6), 1289-1296.
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  The association between proximal tibiofibular joint (PTFJ) and knee osteoarthritis (OA) has been understudied. The objective of this study was to determine whether the morphology of PTFJ has predictive value for the risk of total knee replacement (TKR). Case knees from Osteoarthritis Initiative participants with TKR at 24-60 months follow up (cases) were 1:1 matched with control knees (no TKR throughout 60 months) by baseline age, sex, and Kellgren-Lawrence grade. PTFJ morphological parameters, including coronal inclination angle (angle α), sagittal inclination angle (angle β), fibular contacting area (S), load-bearing area (Sτ), lateral stress-bolstering area (Sφ), and posterior stress-bolstering area (Sυ) were assessed using coronal and sagittal magnetic resonance imaging (MRI), respectively. Associations of the morphological measures at baseline and the time point before TKR (T ) and their changes with TKR risks were examined using conditional logistic regression analyses. Two hundred and twenty-three knees of 193 participants received TKR between 12 and 60 months and therefore were matched with 223 control knees. Of these, 173 paired knees had MRI readings available both at baseline and T time point. While baseline angle α was positively associated with TKR risk, other measures at baseline and all measures at T were not significantly associated with TKR risk. Changes in S, Sτ, and Sυ were significantly and negatively associated with the risk of TKR (ΔS, odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.19-0.76; ΔSτ, OR = 0.37, 95% CI: 0.16-0.87; ΔSυ, OR = 0.22, 95% CI: 0.08-0.62, respectively). This data shows that morphological changes of PTFJ predict the risk of TKR, suggesting PTFJ may play a role in knee OA.
• Zhou, L., Bhattacharjee, S., Kwoh, C. K., Malone, D. C., Tighe, P. J., Reisfield, G. M., Slack, M., Wilson, D. L., & Lo-Ciganic, W. H. (2021). Association Between Dual Trajectories of Opioid and Gabapentinoid Use and Healthcare Expenditures Among US Medicare Beneficiaries. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 24(2), 196-205.
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  Little is known about relationships between opioid- and gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients' opioid and gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare.
• Zhou, L., Bhattacharjee, S., Kwoh, C. K., Tighe, P. J., Reisfield, G. M., Malone, D. C., Slack, M., Wilson, D. L., Chang, C. Y., & Lo-Ciganic, W. H. (2021). Dual-trajectories of opioid and gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study. Addiction (Abingdon, England), 116(4), 819-830.
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  Little is known about opioid and gabapentinoid (OPI-GABA) use duration and dose patterns' associations with adverse outcome risks. We examined associations between OPI-GABA dose and duration trajectories and subsequent drug overdose.
• Bhattacharjee, S., Chang, C., Kwoh, C. K., Lo‐Ciganic, W., Malone, D. C., Reisfield, G. M., Slack, M., Tighe, P. J., Wilson, D. L., Zhou, L., Bhattacharjee, S., Chang, C., Kwoh, C. K., Lo‐Ciganic, W., Malone, D. C., Reisfield, G. M., Slack, M., Tighe, P. J., Wilson, D. L., & Zhou, L. (2020).

  Dual‐trajectories of opioid and gabapentinoid use and risk of subsequent drug overdose among Medicare beneficiaries in the United States: a retrospective cohort study

  . Addiction, 116(4), 819-830. doi:10.1111/add.15189
• Chien, H. C., Kao Yang, Y. H., Kwoh, C. K., Chalasani, P., Wilson, D. L., & Lo-Ciganic, W. H. (2020). Aromatase Inhibitors and Risk of Arthritis and Carpal Tunnel Syndrome among Taiwanese Women with Breast Cancer: A Nationwide Claims Data Analysis. Journal of clinical medicine, 9(2).
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  Tamoxifen or aromatase inhibitor (AI) therapy may prevent breast cancer recurrence, however, adverse effects may lead to treatment discontinuation. Evidence regarding the occurrence of AI-associated musculoskeletal problems among Asians is scarce. We identified women with breast cancer-initiating tamoxifen or AIs from the Taiwan National Health Insurance Research Database (2007-2012). Using multivariable cause-specific hazard models, we examined the association between endocrine therapy and the risk of any arthritis and carpal tunnel syndrome, adjusting for age, prior cancer treatment, and other health status factors. Among 32,055 eligible women with breast cancer (mean age = 52.6 ± 11.5 years), 87.4% initiated tamoxifen, 3.9% initiated anastrozole, 8.0% initiated letrozole, and 0.7% initiated exemestane. AI users had a higher 1-year cumulative incidence for any arthritis (13.0% vs. 8.2%, < 0.0001) and carpal tunnel syndrome (1.4% vs. 0.8%, = 0.008). Compared to tamoxifen users, AI users had a higher risk of any arthritis [adjusted hazard ratio (aHR) = 1.21, 95%CI = 1.09-1.34] and carpal tunnel syndrome (aHR = 1.68, 95%CI = 1.22-2.32). No significant difference was observed in the risks of any arthritis and carpal tunnel syndrome across different AIs. Taxane use was not associated with any arthritis (aHR = 0.92, 95%CI = 0.81-1.05) or carpal tunnel syndrome (aHR = 0.97, 95%CI = 0.67-1.40) compared to other chemotherapies. Taiwanese women with breast cancer-initiating AIs had an increased risk of arthritis and carpal tunnel syndrome compared to those who initiated tamoxifen.
• Guermazi, A., Neogi, T., Katz, J. N., Kwoh, C. K., Conaghan, P. G., Felson, D. T., & Roemer, F. W. (2020). Intra-articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-related Pain: Considerations and Controversies with a Focus on Imaging- Scientific Expert Panel. Radiology, 297(3), 503-512.
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  Current management of osteoarthritis (OA) is primarily focused on symptom control. Intra-articular corticosteroid (IACS) injections are often used for pain management of hip and knee OA in patients who have not responded to oral or topical analgesics. Recent case series suggested that negative structural outcomes including accelerated OA progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received IACS injections. This expert panel report reviews the current understanding of pain in OA, summarizes current international guidelines regarding indications for IACS injection, and considers preinterventional safety measures, including imaging. Potential profiles of those who would likely benefit from IACS injection and a suggestion for an updated patient consent form are presented. As of today, there is no established recommendation or consensus regarding imaging, clinical, or laboratory markers before an IACS injection to screen for OA-related imaging abnormalities. Repeating radiographs before each subsequent IACS injection remains controversial. The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of accelerated OA or joint destruction after IACS injections are needed. However, given the relatively rare incidence of these adverse outcomes, any clinical trial would be challenging in design and a large number of patients would need to be included.
• Kolasinski, S. L., Neogi, T., Hochberg, M. C., Oatis, C., Guyatt, G., Block, J., Callahan, L., Copenhaver, C., Dodge, C., Felson, D., Gellar, K., Harvey, W. F., Hawker, G., Herzig, E., Kwoh, C. K., Nelson, A. E., Samuels, J., Scanzello, C., White, D., , Wise, B., et al. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & rheumatology (Hoboken, N.J.).
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  To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA.
• Kwoh, C. K. (2020). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-162. Epub 2020 Jan 6..
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  250. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-162. Epub 2020 Jan 6.PMID: 31908149
• Kwoh, C. K. (2020). Aromatase Inhibitors and Risk of Arthritis and Carpal Tunnel Syndrome among Taiwanese Women with Breast Cancer: A Nationwide Claims Data Analysis.. Free PMC Article.
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  248. Chien HC, Kao Yang YH, Kwoh CK, Chalasani P, Wilson DL, Lo-Ciganic WH.Chien HC, et al. Aromatase Inhibitors and Risk of Arthritis and Carpal Tunnel Syndrome among Taiwanese Women with Breast Cancer: A Nationwide Claims Data Analysis. J Clin Med. 2020 Feb 19;9(2):566. J Clin Med. 2020.PMID: 32092973Free PMC article.
• Kwoh, C. K. (2020). Changes in Medial Meniscal 3D Position and Morphology Predict Knee Replacement in Rapidly Progressing Knee Osteoarthritis - Data from the Osteoarthritis Initiative (OAI).. Arthritis Care Res (Hoboken).
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  Roth M, Emmanuel K, Wirth W, Kwoh CK, Hunter DJ, Hannon MJ, Eckstein F. Changes in Medial Meniscal 3D Position and Morphology Predict Knee Replacement in Rapidly Progressing Knee Osteoarthritis - Data from the Osteoarthritis Initiative (OAI). Arthritis Care Res (Hoboken). 2020 Mar 20. Online ahead of print.PMID: 32198847
• Kwoh, C. K. (2020). Eric P. Gall, MD, MACP, MACR, 1940-2020. Arthritis care & research, 72(8), 1039-1040.
• Kwoh, C. K. (2020). Evidence that Swimming May Be Protective of Knee Osteoarthritis: Data from the Osteoarthritis Initiative.. PM R. 2020 Jun;12(6):529-537..
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  Lo GH, Ikpeama UE, Driban JB, Kriska AM, McAlindon TE, Petersen NJ, Storti KL, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, Suarez-Almazor ME. Evidence that Swimming May Be Protective of Knee Osteoarthritis: Data from the Osteoarthritis Initiative.PM R. 2020 Jun;12(6):529-537. Epub 2019 Dec 4.PMID: 31628825
• Kwoh, C. K. (2020). Football Increases Future Risk of Symptomatic Radiographic Knee Osteoarthritis. Med Sci Sports Exerc. 2020 Apr;52(4):795-800.
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  Lo GH, McAlindon TE, Kriska AM, Price LL, Rockette-Wagner BJ, Mandl LA, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, Driban JB. Football Increases Future Risk of Symptomatic Radiographic Knee Osteoarthritis.Med Sci Sports Exerc. 2020 Apr;52(4):795-800. PMID: 31652246
• Kwoh, C. K. (2020). In Memoriam: Eric Gall. Arthritis Care Res (Hoboken).
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  Kwoh CK. In Memoriam: Eric Gall.. Arthritis Care Res (Hoboken). 2020 Apr 15. Online ahead of print.PMID: 32293105
• Kwoh, C. K. (2020). Lack of evidence that beta blocker use reduces knee pain, areas of joint pain, or analgesic use among individuals with symptomatic knee osteoarthritis. Osteoarthritis Cartilage.. 2020 Jan;28(1):53-61. Epub 2019.
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  Zhou L, Kwoh CK, Ran D, Ashbeck EL, Lo-Ciganic WH. Lack of evidence that beta blocker use reduces knee pain, areas of joint pain, or analgesic use among individuals with symptomatic knee osteoarthritis. Osteoarthritis Cartilage. 2020 Jan;28(1):53-61. Epub 2019 Sep 14.PMID: 31526877
• Kwoh, C. K. (2020). Nonsteroidal Anti-Inflammatory Drug Use in Chronic Arthritis Pain: Variations by Ethnicity.. Am J Med. 2020 Jun;133(6):733-740.
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  Vina ER, Hannon MJ, Masood HS, Hausmann LRM, Ibrahim SA, Dagnino J, Arellano A, Kwoh CK. Nonsteroidal Anti-Inflammatory Drug Use in Chronic Arthritis Pain: Variations by Ethnicity. Am J Med. 2020 Jun;133(6):733-740. Epub 2019 Dec 17. PMID: 31862331
• Kwoh, C. K. (2020). Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity.. 2020 Mar 1;21(3):501-510.
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  Tighe CA, Youk A, Ibrahim SA, Weiner DK, Vina ER, Kwoh CK, Gallagher RM, Bramoweth AD, Hausmann LRM. Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity.Pain Med. 2020 Mar 1;21(3):501-510. PMID: 31504838
• Kwoh, C. K. (2020). Predicting knee replacement in participants eligible for disease-modifying osteoarthritis drug treatment with structural endpoints.. Osteoarthritis Cartilage. 2020 Jun;28(6):782-791.
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  Kwoh CK, Guehring H, Aydemir A, Hannon MJ, Eckstein F, Hochberg MC. Predicting knee replacement in participants eligible for disease-modifying osteoarthritis drug treatment with structural endpoints. Osteoarthritis Cartilage. 2020 Jun;28(6):782-791. Epub 2020 Apr 2. PMID: 32247871
• Kwoh, C. K. (2020). Qualitative and quantitative measures of prefemoral and quadriceps fat pads are associated with incident radiographic osteoarthritis: data from the Osteoarthritis Initiative.Osteoarthritis Cartilage.. Osteoarthritis Cartilage. 2020 Apr;28(4):453-461.
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  Li J, Zhu Z, Li Y, Cao P, Han W, Tang S, Li D, Kwoh CK, Guermazi A, Hunter DJ, Ding C. Qualitative and quantitative measures of prefemoral and quadriceps fat pads are associated with incident radiographic osteoarthritis: data from the Osteoarthritis Initiative.Osteoarthritis Cartilage. 2020 Apr;28(4):453-461. Epub 2020 Feb 12.PMID: 32061711
• Kwoh, C. K. (2020). The morphology of proximal tibiofibular joint (PTFJ) predicts incident radiographic osteoarthritis: data from Osteoarthritis Initiative.Osteoarthritis Cartilage.. 2020 Feb;28(2):208-214. Epub 2019 Nov 13.
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  Chang J, Zhu Z, Han W, Zhao Y, Kwoh CK, Lynch JA, Hunter DJ, Ding C. The morphology of proximal tibiofibular joint (PTFJ) predicts incident radiographic osteoarthritis: data from Osteoarthritis Initiative.Osteoarthritis Cartilage. 2020 Feb;28(2):208-214. Epub 2019 Nov 13.PMID: 31733306
• Kwoh, C. K. (2020). Using machine learning to predict risk of incident opioid use disorder among fee-for-service Medicare beneficiaries: A prognostic study.. PLoS One.
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  Lo-Ciganic WH, Huang JL, Zhang HH, Weiss JC, Kwoh CK, Donohue JM, Gordon AJ, Cochran G, Malone DC, Kuza CC, Gellad WF. Using machine learning to predict risk of incident opioid use disorder among fee-for-service Medicare beneficiaries: A prognostic study. PLoS One. 2020 Jul 17;15(7):e0235981. eCollection 2020.PMID: 32678860
• Kwoh, C. K. (2020). Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women.. Clin Orthop Relat Res..
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  Vina ER, Ran D, Ashbeck EL, Kwoh CK. Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women.Clin Orthop Relat Res. 2020 Jul;478(7):1453. PMID: 31633588
• Kwoh, C. K., Guehring, H., Aydemir, A., Hannon, M. J., Eckstein, F., & Hochberg, M. C. (2020). Predicting knee replacement in participants eligible for disease-modifying osteoarthritis drug treatment with structural endpoints. Osteoarthritis and cartilage, 28(6), 782-791.
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  Evaluate associations between 2-year change in radiographic or quantitative magnetic resonance imaging (qMRI) structural measures, and knee replacement (KR), within a subsequent 7-year follow-up period.
• Li, J., Zhu, Z., Li, Y., Cao, P., Han, W., Tang, S., Li, D., Kwoh, C. K., Guermazi, A., Hunter, D. J., & Ding, C. (2020). Qualitative and quantitative measures of prefemoral and quadriceps fat pads are associated with incident radiographic osteoarthritis: data from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 28(4), 453-461.
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  To determine if qualitative and quantitative measures of prefemoral fat pad (PFP) and quadriceps fat pad (QFP) are associated with incident radiographic osteoarthritis (iROA) over 4 years in the Osteoarthritis Initiative (OAI) study.
• Lo-Ciganic, W. H., Huang, J. L., Zhang, H. H., Weiss, J. C., Kwoh, C. K., Donohue, J. M., Gordon, A. J., Cochran, G., Malone, D. C., Kuza, C. C., & Gellad, W. F. (2020). Using machine learning to predict risk of incident opioid use disorder among fee-for-service Medicare beneficiaries: A prognostic study. PloS one, 15(7), e0235981.
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  To develop and validate a machine-learning algorithm to improve prediction of incident OUD diagnosis among Medicare beneficiaries with ≥1 opioid prescriptions.
• Roemer, F. W., Collins, J., Kwoh, C. K., Hannon, M. J., Neogi, T., Felson, D. T., Hunter, D. J., Lynch, J. A., & Guermazi, A. (2020). MRI-based screening for structural definition of eligibility in clinical DMOAD trials: Rapid OsteoArthritis MRI Eligibility Score (ROAMES). Osteoarthritis and cartilage, 28(1), 71-81.
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  Our aim was to introduce a simplified MRI instrument, Rapid OsteoArthritis MRI Eligibility Score (ROAMES), for defining structural eligibility of patients for inclusion in disease-modifying osteoarthritis drug trials using a tri-compartmental anatomic approach that enables stratification of knees into different structural phenotypes and includes diagnoses of exclusion. We also aimed to define overlap between phenotypes and determine reliability.
• Schlenk, E. A., Fitzgerald, G. K., Rogers, J. C., Kwoh, C. K., & Sereika, S. M. (2020). Promoting Physical Activity in Older Adults With Knee Osteoarthritis and Hypertension: A Randomized Controlled Trial. Journal of aging and physical activity, 29(2), 207-218.
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  A 6-month self-efficacy intervention was compared with attention-control intervention on physical activity, clinical outcomes, and mediators immediate postintervention and 6-month postintervention in 182 older adults with knee osteoarthritis and hypertension using a randomized controlled trial design. The intervention group received six weekly individual physical therapy sessions for lower-extremity exercise and fitness walking and nine biweekly nurse telephone counseling sessions. The attention-control group received six weekly and nine biweekly nurse telephone sessions on health topics. Lower-extremity exercise was assessed by e-diary; fitness walking was assessed by accelerometer and e-diary; blood pressure was assessed by automated monitor; function was assessed by performance-based tests and questionnaires; and pain, self-efficacy, and outcome expectancy were assessed by questionnaires. Self-reported lower-extremity exercise and fitness walking, function, pain, self-efficacy, and outcome expectancy showed significant group or group by time effects favoring intervention. The intervention did not improve physical activity by accelerometer and blood pressure. Mean minutes of fitness walking fell short of the 150 min/week goal.
• Zhou, L., Kwoh, C. K., Ran, D., Ashbeck, E. L., & Lo-Ciganic, W. H. (2020). Lack of evidence that beta blocker use reduces knee pain, areas of joint pain, or analgesic use among individuals with symptomatic knee osteoarthritis. Osteoarthritis and cartilage, 28(1), 53-61.
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  The potential for beta blocker use to reduce joint pain and analgesic use in osteoarthritis (OA) patients has not been well established. The objective of this study was to estimate the association between beta blocker use and knee pain, areas of joint pain, and analgesic use among participants with symptomatic knee OA.
• Zhu, Z., Zheng, S., Zhao, Y., Wang, G., Lynch, J. A., Kwoh, C. K., Hunter, D. J., Ding, C., & Chang, J. (2020). Predictive value of the morphology of proximal tibiofibular joint for total knee replacement in patients with knee osteoarthritis.. Journal of orthopaedic research : official publication of the Orthopaedic Research Society. doi:10.1002/jor.24862
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  The association between proximal tibiofibular joint (PTFJ) and knee osteoarthritis (OA) has been understudied. The objective of this study was to determine whether the morphology of PTFJ has predictive value for the risk of total knee replacement (TKR). Case knees from Osteoarthritis Initiative participants with TKR at 24-60 months follow up (cases) were 1:1 matched with control knees (no TKR throughout 60 months) by baseline age, sex, and Kellgren-Lawrence grade. PTFJ morphological parameters, including coronal inclination angle (angle α), sagittal inclination angle (angle β), fibular contacting area (S), load-bearing area (Sτ), lateral stress-bolstering area (Sφ), and posterior stress-bolstering area (Sυ) were assessed using coronal and sagittal magnetic resonance imaging (MRI), respectively. Associations of the morphological measures at baseline and the time point before TKR (T0 ) and their changes with TKR risks were examined using conditional logistic regression analyses. Two hundred and twenty-three knees of 193 participants received TKR between 12 and 60 months and therefore were matched with 223 control knees. Of these, 173 paired knees had MRI readings available both at baseline and T0 time point. While baseline angle α was positively associated with TKR risk, other measures at baseline and all measures at T0 were not significantly associated with TKR risk. Changes in S, Sτ, and Sυ were significantly and negatively associated with the risk of TKR (ΔS, odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.19-0.76; ΔSτ, OR = 0.37, 95% CI: 0.16-0.87; ΔSυ, OR = 0.22, 95% CI: 0.08-0.62, respectively). This data shows that morphological changes of PTFJ predict the risk of TKR, suggesting PTFJ may play a role in knee OA.
• Ashbeck, E. L., Guermazi, A., Hu, C., Kwoh, C. K., Roemer, F. W., & Sharma, L. (2019).

  MRI-DETECTED STRUCTURAL ABNORMALITIES AND DEVELOPMENT OF INCIDENT RADIOGRAPHIC KNEE OSTEOARTHRITIS OVER 10 YEARS OF FOLLOW-UP

  . Annals of the Rheumatic Diseases, 78, 174-175. doi:10.1136/annrheumdis-2019-eular.4423
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  Background Structural joint pathology on MRI has been found in knees without radiographic evidence of osteoarthritis (OA). We have previously shown that structural abnormalities on MRI may be precursors of disease and associated with the detection of incident radiographic knee OA (ROA) up to 2 years later, and in some circumstances up to seven years later. The prognostic value of structural abnormalities on MRI for knee OA, however, is unknown. Objectives Estimate the probability of incident ROA over 10 years of follow-up, according to structural abnormalities detected on baseline MRIs. Methods A subcohort of participants (862 knees, one knee/person) from the Osteoarthritis Initiative (OAI) with at least one knee at risk of developing ROA (i.e., Kellgren-Lawrence (KL) 0,1 at baseline) was randomly selected. MRI-detected structural features of the knee were assessed by expert readers using the MRI Osteoarthritis Knee Score (MOAKS). Participants underwent bilateral posteroanterior fixed-flexion weight-bearing knee radiography at baseline and annually through year 4, and then every two years until year 10. Radiographs were centrally read for KL grade, with ROA defined as KL≥2. Survival was estimated with the Turnbull non-parametric maximum likelihood estimator, a generalization of Kaplan Meier curves for interval censored data. Survival curves were compared using a log rank permutation test available in the R package interval. Hazard ratios were estimated using Cox models fit using the R package icenReg, designed for interval censored data. Features were considered one at a time, with no adjustments. Results Knees with any of the following structural abnormalities had higher estimated probabilities for the development of radiographic OA within two, four and 10 years of follow-up: effusion-synovitis, Hoffa-synovitis, bone marrow lesions in the medial compartment and whole knee, surface area and full thickness cartilage damage in the medial compartment and whole knee, and medial meniscal extrusion (Table 1). Differences in the probability for the development of ROA within two, four, and 10 years of follow-up were significant (pointwise 95% confidence intervals did not include 0), between knees without the abnormality and knees in the most severe category for all features, with one exception at the two-year follow-up. All of these abnormalities were significantly associated with time to ROA over 10 years of follow-up. Conclusion Our results demonstrate the prognostic value of effusion-synovitis, Hoffa-synovitis, bone marrow lesions, cartilage damage, and meniscal extrusion for the development of ROA up to 10 years later. Future directions include developing a predictive model that incorporates multiple features. Disclosure of Interests C. Kent Kwoh Grant/research support from: EMD Serono and Abbvie, Consultant for: EMD Serono, Fidia, Regulus, GSK, Taiwan Lipopsome Company, Inc, Kolon Tissue Gene, Express Scripts, Frank Roemer Shareholder of: Boston Imaging Core Lab (BICL), LLC., Leena Sharma: None declared, Erin Ashbeck Consultant for: EMD Serono, Chengcheng Hu: None declared, Ali Guermazi Shareholder of: Boston Imaging Core Lab (BICL), LLC., Consultant for: Pfizer, AstraZeneca, MerckSerono, TissueGene, Galapagos and Roche
• Berlinberg, A., Ashbeck, E. L., Roemer, F. W., Guermazi, A., Hunter, D. J., Westra, J., Trost, J., & Kwoh, C. K. (2019). Diagnostic performance of knee physical exam and participant-reported symptoms for MRI-detected effusion-synovitis among participants with early or late stage knee osteoarthritis: data from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 27(1), 80-89.
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  Evaluate the diagnostic performance of knee physical exam findings and participant-reported symptoms for MRI-detected effusion-synovitis (ES) among knees with early and late-stage osteoarthritis (OA).
• Bilal, J., Berlinberg, A., Riaz, I. B., Faridi, W., Bhattacharjee, S., Ortega, G., Murad, M. H., Wang, Z., Prokop, L. J., Alhifany, A. A., & Kwoh, C. K. (2019). Risk of Infections and Cancer in Patients With Rheumatologic Diseases Receiving Interleukin Inhibitors: A Systematic Review and Meta-analysis. JAMA network open, 2(10), e1913102.
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  The safety profile of interleukin (IL) inhibitors is not well established.
• Chang, J., Zhu, Z., Han, W., Zhao, Y., Kwoh, C. K., Lynch, J. A., Hunter, D. J., & Ding, C. (2019). The morphology of proximal tibiofibular joint (PTFJ) predicts incident radiographic osteoarthritis: data from Osteoarthritis Initiative. Osteoarthritis and cartilage.
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  To determine whether the morphology of proximal tibiofibular joint (PTFJ) is associated with increased risk of incident radiographic osteoarthritis (iROA) over 4 years in the OA Initiative (OAI) study.
• Dagnino, J., Hannon, M. J., Kwoh, C. K., & Vina, E. R. (2019).

  THU0624 UNDERSTANDING ETHNIC DIFFERENCES IN THE UTILIZATION OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS FOR OSTEOARTHRITIS

  . Annals of the Rheumatic Diseases, 78, 605-605. doi:10.1136/annrheumdis-2019-eular.4401
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  Background: The prevalence of arthritis-attributable activity limitation, work limitation and severe pain are significantly higher among Hispanics than among non-Hispanic Whites (NHWs) in the US. While Hispanics are less likely to report regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), reasons for this decreased NSAID use are unknown. It is also unclear whether there are ethnic differences in the use of both over-the-counter (OTC) and prescription NSAIDs. Objectives: To determine: 1) if there are ethnic differences in the use of OTC and prescription oral NSAIDs for knee/hip osteoarthritis (OA); 2) if there are differences in familiarity with and perceptions of efficacy and risk of NSAIDs between Hispanics and NHWs; and 3) if patient attitudes/beliefs about NSAIDs mediate observed ethnic differences in the use of NSAIDS for OA. Methods: Participants ≥50 years of age with chronic frequent pain due to knee/hip OA completed structured interviews. Data on sociodemographic characteristics, clinical information, actual use of oral NSAIDs for OA treatment (last 6 months), and familiarity with NSAIDs (3 items, yes/no response) were collected. Perceptions of efficacy (4 items) and risk (3 items) of NSAIDs were evaluated using five-category ordinal response scale questions. Responses were averaged, with higher values indicating higher perception of efficacy/risk. Fisher’s exact or Wilcoxon-Mann-Whitney tests were conducted to determine if knowledge and perceptions about NSAIDs differed by ethnicity. Multivariable logistic regression models were built to determine if ethnic differences in NSAID use were mediated by knowledge and perceptions about the medication. Results: Among knee/hip OA patients, Hispanics (n=130), in comparison to NHWs (n=204), were younger (mean age 61.8 vs. 65.7) and less likely to have an annual income of ≥$40K (21.6% vs. 56.5%). Hispanics, compared to NHWs, had lower odds of using an OTC NSAID (OR 0.57, 95% CI 0.36-0.90) but greater odds of using a prescription NSAID (OR 1.66, 95% CI 1.04-2.64) for OA. Hispanics, compared to NHWs, were also less likely to ever hear about OTC and prescription oral NSAID to treat OA or have a good understanding of either oral NSAID type as a treatment for OA (Table 1). Mean [SD] perceived efficacy of OTC and prescription oral NSAIDs were slightly lower among Hispanics than NHWs (2.91 [0.98] vs. 3.12 [0.88], p=0.0565; 3.03 [1.02] vs. 3.34 [0.87], p=0.0047; respectively). Mean [SD] perceived risk of prescription NSAIDs was lower among Hispanics than NHWs (2.44 [1.03] vs. 2.82 [1.01], p=0.0012). After adjustment for all familiarity with OTC NSAIDs questions, and perceived efficacy and risk of OTC oral NSAIDs scores, the association between OTC NSAID use and ethnicity was attenuated and no longer significant (OR 1.01, 95%CI 0.54-1.89). After adjustment for familiarity with and perceptions of efficacy and risk of prescription NSAIDs, the association between prescription NSAID use and ethnicity remained significant (OR 2.62, 95%CI 1.51-4.54). Conclusion: Among patients with knee or hip OA, Hispanics were less likely than NHWs to utilize an OTC oral NSAID as treatment for arthritis. They were also less familiar with the use of NSAIDs for OA treatment and less likely to believe in their efficacy. Patient familiarity and perceptions of OTC oral NSAIDs may mediate ethnic differences in the use of NSAIDs for knee/hip OA. Disclosure of Interests: Ernest Vina Grant/research support from: Astrazeneca, Consultant for: Astrazeneca, Michael Hannon Employee of: Pinney Associates, Jazmin Dagnino: None declared, C. Kent Kwoh Grant/research support from: Abbvie, EMD Serono, Consultant for: Astellas, EMD Serono, Thusane, Express Scripts, Novartis
• Driban, J. B., Dunlop, D. D., Eaton, C. B., Hawker, G. A., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Lo, G. H., Mcalindon, T. E., Nevitt, M. C., Price, L. L., & Song, J. (2019).

  Validation of a new symptom outcome for knee osteoarthritis: the Ambulation Adjusted Score for Knee pain.

  . Clinical rheumatology, 38(3), 851-858. doi:10.1007/s10067-018-4352-3
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  Validation of a symptom measure for early knee OA may help identify new treatments and modifiable risk factors. Symptom measures that consider pain in the context of activity level may provide better discrimination than pain alone. Therefore, we aimed to compare sensitivity to change for radiographic progression between Ambulation Adjusted Score for Knee pain (AASK), which accounts for self-reported ambulation, and Western Ontario McMaster Osteoarthritis (WOMAC) knee pain score..Participants were assessed annually up to 48 months using WOMAC, Physical Activity Scale for the Elderly (PASE) ambulation, and knee radiographs. AASK was defined as ((WOMAC pain) + 1)/((average daily hours of walking) + 1). Radiographs were scored for Kellgren-Lawrence (KL) grade. Linear regression, stratified by OA status, evaluated relationships between changes in AASK and WOMAC pain and KL grade over time..For 4191 people (8030 knees), the mean age was 61.2 (+ 9.2) years old and BMI was 28.6 (+ 4.8) kg/m2; 58% female. Over 40% of knees had WOMAC pain scores of 0; by design, no knees had AASK scores of 0. Annual changes in AASK were more sensitive to changes in KL than changes in WOMAC in those without baseline OA (0.20 and 0.16 change per unit KL change, p = 0.005 and 0.070 respectively), but performed similarly in knees with OA..AASK is simple to assess using existing validated questionnaires. AASK performs well in individuals with and without OA and should be considered in clinical trials and observational studies of early knee OA.
• Dunlop, D. D., Song, J., Hootman, J. M., Nevitt, M. C., Semanik, P. A., Lee, J., Sharma, L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., & Chang, R. W. (2019). One Hour a Week: Moving to Prevent Disability in Adults With Lower Extremity Joint Symptoms. American journal of preventive medicine, 56(5), 664-672.
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  Physical activity guidelines recommend minimum thresholds. This study sought to identify evidence-based thresholds to maintain disability-free status over 4years among adults with lower extremity joint symptoms.
• Lo, G. H., Ikpeama, U. E., Driban, J. B., Kriska, A. M., McAlindon, T. E., Petersen, N. J., Storti, K. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Suarez-Almazor, M. E. (2019). Evidence that Swimming May Be Protective of Knee Osteoarthritis: Data from the Osteoarthritis Initiative. PM & R : the journal of injury, function, and rehabilitation.
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  To date, there have not been any epidemiologic studies that have evaluated the association between swimming over a lifetime and knee health.
• Lo, G. H., McAlindon, T. E., Kriska, A. M., Price, L. L., Rockette-Wagner, B. J., Mandl, L. A., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Driban, J. B. (2019). Football Increases Future Risk for Symptomatic Radiographic Knee Osteoarthritis. Medicine and science in sports and exercise.
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  Male youth in the United States commonly participate in gridiron (American) football. There are little data substantiating current popular opinion that it is associated with knee pain or osteoarthritis (OA) later in life. We aimed to evaluate the relationship of football with these outcomes in the Osteoarthritis Initiative (OAI).
• Lo-Ciganic, W. H., Huang, J. L., Zhang, H. H., Weiss, J. C., Wu, Y., Kwoh, C. K., Donohue, J. M., Cochran, G., Gordon, A. J., Malone, D. C., Kuza, C. C., & Gellad, W. F. (2019). Evaluation of Machine-Learning Algorithms for Predicting Opioid Overdose Risk Among Medicare Beneficiaries With Opioid Prescriptions. JAMA network open, 2(3), e190968.
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  Current approaches to identifying individuals at high risk for opioid overdose target many patients who are not truly at high risk.
• Rashid, H., & Kwoh, C. K. (2019). Should Platelet-Rich Plasma or Stem Cell Therapy Be Used to Treat Osteoarthritis?. Rheumatic diseases clinics of North America, 45(3), 417-438.
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  Osteoarthritis is the most common form of arthritis and unfortunately lacks disease-modifying treatments. This has led to a growing demand for more effective nonoperative treatment options. Platelet-rich plasma and mesenchymal stem cell therapy offer the potential to modify the natural course of knee osteoarthritis using cell-based technology. Because of the lack of high-quality evidence and the large degree of heterogeneity, in terms of study designs and measured outcomes, the use of platelet-rich plasma or mesenchymal stem cell therapy to treat knee osteoarthritis cannot be recommended at this time.
• Sharma, L., Kwoh, K., Lee, J. J., Cauley, J., Jackson, R., Hochberg, M., Chang, A. H., Eaton, C., Nevitt, M., Song, J., Almagor, O., & Chmiel, J. S. (2019). Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis. Annals of the rheumatic diseases, 78(10), 1412-1419.
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  Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings.
• Tighe, C. A., Youk, A., Ibrahim, S. A., Weiner, D. K., Vina, E. R., Kwoh, C. K., Gallagher, R. M., Bramoweth, A. D., & Hausmann, L. R. (2019). Pain Catastrophizing and Arthritis Self-Efficacy as Mediators of Sleep Disturbance and Osteoarthritis Symptom Severity. Pain medicine (Malden, Mass.).
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  Sleep and pain-related experiences are consistently associated, but the pathways linking these experiences are not well understood. We evaluated whether pain catastrophizing and arthritis self-efficacy mediate the association between sleep disturbance and osteoarthritis (OA) symptom severity in patients with knee OA.
• Vina, E. R., Hannon, M. J., Hausmann, L. R., Ibrahim, S. A., Dagnino, J., Arellano, A., & Kwoh, C. K. (2019). Modifiable Determinants of Exercise Use in a Diverse Ethnic Population With Osteoarthritis. Arthritis care & research, 71(11), 1495-1503.
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  To determine the extent of ethnic differences in the use of exercise for therapy and identify relevant modifiable determinants of exercise use among patients with knee/hip osteoarthritis (OA).
• Vina, E. R., Hannon, M. J., Masood, H., Hausmann, L. R., Ibrahim, S. A., Dagnino, J., Arellano, A., & Kwoh, C. K. (2019). Non-steroidal Anti-inflammatory Drug Use in Chronic Arthritis Pain: Variations by Ethnicity. The American journal of medicine.
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  Determine if there are ethnic differences in the use of over-the-counter (OTC) and prescription oral non-steroidal anti-inflammatory drugs (NSAIDs), and if observed ethnic differences persist after adjustment for sociodemographic and clinical factors METHODS: Knee/hip osteoarthritis study participants were identified. Surveys were administered to collect sociodemographics, clinical information, and oral treatment methods for arthritis. Multivariable logistic regression models were created using a fully conditional method.
• Vina, E. R., Hausmann, L. R., Obrosky, D. S., Youk, A., Ibrahim, S. A., Weiner, D. K., Gallagher, R. M., & Kwoh, C. K. (2019). Social & psychological factors associated with oral analgesic use in knee osteoarthritis management. Osteoarthritis and cartilage, 27(7), 1018-1025.
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  Determine modifiable social and psychological health factors that are associated with use of oral opioid and non-opioid medications for OA.
• Vina, E. R., Ran, D., Ashbeck, E. L., & Kwoh, C. K. (2019). Widespread Pain Is Associated with Increased Risk of No Clinical Improvement After TKA in Women. Clinical orthopaedics and related research.
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  When conservative treatments do not work, TKA may be the best option for patients with knee osteoarthritis, although a relatively large proportion of individuals do not have clinically important improvement after TKA. Evidence also suggests that women are less likely to benefit from TKA than men, but the reasons are unclear. Widespread pain disproportionately affects women and has been associated with worse outcomes after joint arthroplasty, yet it is unknown if the effect of widespread pain on TKA outcomes differs by patient gender.
• Wang, K., Ding, C., Hannon, M. J., Chen, Z., Kwoh, C. K., & Hunter, D. J. (2019). Quantitative Signal Intensity Alteration in Infrapatellar Fat Pad Predicts Incident Radiographic Osteoarthritis: The Osteoarthritis Initiative. Arthritis care & research, 71(1), 30-38.
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  To determine whether infrapatellar fat pad (IPFP) signal intensity measures are predictive of incident radiographic osteoarthritis (ROA) over 4 years in the Osteoarthritis Initiative study.
• Zhou, L., Bhattacharjee, S., Kwoh, C. K., Tighe, P. J., Malone, D. C., Slack, M., Wilson, D. L., Brown, J. D., & Lo-Ciganic, W. H. (2019). Trends, Patient and Prescriber Characteristics in Gabapentinoid Use in a Sample of United States Ambulatory Care Visits from 2003 to 2016. Journal of clinical medicine, 9(1).
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  Increasing gabapentinoid use has raised concerns of misuse and abuse in the United States (US). Little is known about the characteristics of gabapentinoid use in general clinical practice over time. This cross-sectional study used data from the National Ambulatory Medical Care Survey. We examined the trends of patient and prescriber characteristics and the diagnoses associated with US ambulatory care visits involving gabapentinoids for adult visits from 2003 to 2016. Using multivariable logistic regression, we estimated the adjusted proportion of gabapentinoid-involved visits among all visits and tested for trend significance. Among the weighted estimate of 260.1 million gabapentinoid-involved visits (aged 18-64 years: 61.8%; female: 61.9%; white: 85.5%), the adjusted annual proportion of gabapentinoid-involved visits nearly quadrupled from 2003 to 2016 (9.1 to 34.9 per 1000 visits; < 0.0001), driven mainly by gabapentin. Nearly half had concurrent use with opioids (32.9%) or benzodiazepines (15.3%). Primary care physicians (45.8%), neurologists (8.2%), surgeons (6.2%), and psychiatrists (4.8%) prescribed two-thirds of the gabapentinoids. Most (96.6%) of the gabapentinoid visits did not have an approved indication for gabapentinoids among the first three diagnoses. Among US ambulatory care visits from 2003 to 2016, gabapentinoid use increased substantially, commonly prescribed by primary care physicians.
• Bricca, A., Wirth, W., Juhl, C. B., Kemnitz, J., Hunter, D. J., Kwoh, C. K., Eckstein, F., & Culvenor, A. G. (2018). Moderate physical activity may prevent cartilage loss in women with knee osteoarthritis: data from the Osteoarthritis Initiative. Arthritis care & research.
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  To examine the impact of physical activity (PA) on cartilage thickness loss in knee osteoarthritis (KOA).
• Eckstein, F., Emmanuel, K., Hunter, D. J., Kwoh, C. K., Roth, M., & Wirth, W. (2018).

  Sensitivity to change and association of three-dimensional meniscal measures with radiographic joint space width loss in rapid clinical progression of knee osteoarthritis.

  . European radiology, 28(5), 1844-1853. doi:10.1007/s00330-017-5140-1
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  To determine whether 3D meniscal measures had similar sensitivity to longitudinal change as cartilage thickness; to what extent these measures are associated with longitudinal joint space width (JSW) change; and whether the latter associations differ between minimum (mJSW) and fixed-location JSW..Two-year changes in medial meniscal position and morphology, cartilage thickness (MRI) and minimum and fixed-location JSW (radiography) were determined in 35 Osteoarthritis Initiative knees [12 men, age: 67 (51-77) years; 23 women, age: 65 (54-78) years], progressing from baseline Kellgren-Lawrence grade ≤2 to knee replacement within 3-5 years. Multiple linear regression assessed the features contributing to JSW change..Meniscal measures, cartilage thickness and JSW displayed similar sensitivity to change (standardised response mean≤|0.76|). Meniscal changes were strongly associated with JSW change (r≤|0.66|), adding ≤20% to its variance in addition to cartilage thickness change. Fixed-location JSW change (multiple r2=72%) was more strongly related to cartilage and meniscal change than mJSW (61%). Meniscal morphology explained more of fixed-location JSW and meniscal position more of mJSW..Meniscal measures provide independent information in explaining the variance of radiographic JSW change. Fixed-location JSW appears to be more reflective of structural change than mJSW and, hence, a potentially superior measure of structural progression..• 3D positional/morphological meniscal measures change in rapidly progressing knees. • Similar sensitivity to 2-year change of quantitative meniscal/cartilage measures in rapid progression. • Changes in meniscal measures are strongly associated with radiographic JSW change. • Meniscal change provides information to explain JSW variance independent of cartilage. • Fixed-location JSW reflects structural disease stage more closely than minimum JSW.
• Gilbert, A. L., Lee, J., Song, J., Semanik, P. A., Ehrlich-Jones, L. S., Kwoh, C. K., Dunlop, D. D., & Chang, R. W. (2018). Relationship Between Self-Reported Restless Sleep and Objectively Measured Physical Activity in Adults With Knee Osteoarthritis. Arthritis care & research.
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  Despite the numerous health benefits of physical activity, inactivity is endemic among adults with knee osteoarthritis (OA). Because sleep quality may be a target in order to improve physical activity behavior, we investigated the cross-sectional relationship between restless sleep and physical activity in participants with or at risk for knee OA.
• Hausmann, L. R., Ibrahim, S. A., Kwoh, C. K., Youk, A., Obrosky, D. S., Weiner, D. K., Vina, E., Gallagher, R. M., Mauro, G. T., & Parks, A. (2018). Rationale and design of the Staying Positive with Arthritis (SPA) Study: A randomized controlled trial testing the impact of a positive psychology intervention on racial disparities in pain. Contemporary clinical trials, 64, 243-253.
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  Knee osteoarthritis is a painful, disabling condition that disproportionately affects African Americans. Existing arthritis treatments yield small to moderate improvements in pain and have not been effective at reducing racial disparities in the management of pain. The biopsychosocial model of pain and evidence from the positive psychology literature suggest that increasing positive psychological skills (e.g., gratitude, kindness) could improve pain and functioning and reduce disparities in osteoarthritis pain management. Activities to cultivate positive psychological skills have been developed and validated; however, they have not been tested in patients with osteoarthritis, their effects on racial differences in health outcomes have not been examined, and evidence of their effects on health outcomes in patients with other chronic illnesses is of limited quality. In this article we describe the rationale and design of Staying Positive with Arthritis (SPA) study, a randomized controlled trial in which 180 African American and 180 White primary care patients with chronic pain from knee osteoarthritis will be randomized to a 6-week program of either positive skill-building activities or neutral control activities. The primary outcomes will be self-reported pain and functioning as measured by the WOMAC Osteoarthritis Index. We will assess these primary outcomes and potential, exploratory psychosocial mediating variables at an in-person baseline visit and by telephone at 1, 3, and 6months following completion of the assigned program. If effective, the SPA program would be a novel, theoretically-informed psychosocial intervention to improve quality and equity of care in the management of chronic pain from osteoarthritis.
• Hausmann, L. R., Youk, A., Kwoh, C. K., Gallagher, R. M., Weiner, D. K., Vina, E. R., Obrosky, D. S., Mauro, G. T., McInnes, S., & Ibrahim, S. A. (2018). Effect of a Positive Psychological Intervention on Pain and Functional Difficulty Among Adults With Osteoarthritis: A Randomized Clinical Trial. JAMA network open, 1(5), e182533.
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  Positive psychological interventions for improving health have received increasing attention recently. Evidence on the impact of such interventions on pain, and racial disparities in pain, is limited.
• Hausmann, L., Youk, A., Kwoh, C. K., Gallagher, R., Weiner, D., Vina, E. R., Obrosky, D. S., Mauro, G., McInnes, S., & Ibrahim, S. A. (2018). Effect of a positive psychological intervention on pain and functional difficulty among adults with osteoarthritis: a randomized clinical trial. JAMA Network Open, 1(5), e182533. doi:10.1001/jamanetworkopen.2018.2533
• Kwoh, C. K., & Vina, E. R. (2018).

  Epidemiology of osteoarthritis: literature update.

  . Current opinion in rheumatology, 30(2), 160-167. doi:10.1097/bor.0000000000000479
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  The purpose of this review is to highlight recent studies of osteoarthritis epidemiology, including research on prevalence, disease impact, and potential risk factors..Osteoarthritis is highly prevalent in the United States and around the globe. It is a leading cause of disability and can negatively impact people's physical and mental well being. Healthcare resources and costs associated with managing the disease can be substantial. There is increasing evidence that there are different osteoarthritis phenotypes that reflect different mechanisms of the disease. Various person-level risk factors are recognized, including sociodemographic characteristics (e.g. female sex, African-American race), genetic predispositions, obesity, diet-related factors, and high bone density/mass. Joint-level risk factors include specific bone/joint shapes, thigh flexor muscle weakness, joint malalignment, participation in certain occupational/sports activities, and joint injury. Recent studies have enhanced our understanding of preradiographic lesions associated with osteoarthritis..Application of these new findings may allow us to develop innovative strategies and novel therapies with the purpose of preventing new disease onset and minimizing disease progression.
• Kwoh, C. K., Ashbeck, E. L., Hannon, M. J., Wax, S., & Kraines, J. (2018).

  On the way to knee replacement: trajectory and correlation of knee oa mri cartilage thickness, radiographic joint space width, and womac knee pain in the oai

  . Annals of the Rheumatic Diseases, 77, 1131-1131. doi:10.1136/annrheumdis-2018-eular.5262
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  Background Symptoms and structure are both important outcomes in osteoarthritis. However, prior knee osteoarthritis studies have found either poor or no correlation between structural and symptom outcomes. Objectives 1) Estimate the trajectory of mean WOMAC pain scores, medial minimum JSW (mJSW), and quantitative total tibiofemoral joint (TFJ) cartilage thickness in the five years leading up to knee replacement (KR), in KR case and control knees; 2) Estimate the correlation between change in WOMAC pain scores and change in structural measures prior to KR. Methods Osteoarthritis Initiative participants with at least one knee that met common eligibility criteria for DMOAD RCTs up to the 4 year follow-up visit were selected for analysis. Eligibility criteria included Kellgren and Lawrence grade of 2 or 3, medial mJSW ≥2.5 mm, and knee pain at its worst in the past 30 days (4–9 on a 10-point scale, or 0–3 with pain medication). Quantitative MRI (qMRI) cartilage thickness across the TFJ was measured on 3 Tesla MRI. Medial mJSW was measured on fixed flexion weight-bearing radiographs. WOMAC questionnaires were administered annually, and pain scores were scaled 0–100. Mean pain scores and structural measures at each annual visit were estimated with 95% confidence intervals (CI) using mixed effects models. Correlations between changes in structure and WOMAC pain scores were estimated using Spearman correlation coefficients (r), with negative coefficients indicating a correlation between loss of cartilage and increase in pain. Results WOMAC scores and medial mJSW measures were available for 91 cases (KR knees) and 1833 controls, with knees contributing an average of 4.5 WOMAC observations and 3.7 medial mJSW observations to the longitudinal analysis. TFJ cartilage thickness measures were available in 86 cases and 524 controls, with knees contributing an average of 3.1 observations. Over 4 years of observation, among knees that went on to KR, the greatest annual change in mean WOMAC pain (10.8; 95% CI: 7.2, 14.4) and cartilage thickness (−0.100 mm; 95% CI: −0.118,–0.082) occurred between the two visits most proximal to KR, while the decrease in mean medial mJSW in the final year (−0.408; 95% CI: −0.545,–0.270) was similar to the rate of loss in prior years (figure 1). Average pain and structure was relatively stable among knees that did not undergo KR. Estimated correlation was moderate between one year change in WOMAC pain and TFJ cartilage thickness among case knees over the year prior to KR (n=52, r=−0.46), with lower correlations at earlier time points based on a more limited sample. Among control knees, the estimated correlation between annual change in WOMAC pain and structure was negligible at all time points (r Conclusions Loss of TFJ cartilage thickness and pain progression were most pronounced over the year prior to knee replacement. Over this time frame, pain progression was moderately correlated with loss of TFJ cartilage, though not with loss of medial mJSW. Disclosure of Interest C. K. Kwoh Grant/research support from: Merck KGaA and Abbvie, Consultant for: Astellas, Thusane and Fidia, E. Ashbeck Grant/research support from: Merck KGaA, M. Hannon Grant/research support from: Merck KGaA, S. Wax Employee of: EMD Serono, Inc, J. Kraines Employee of: EMD Serono, Inc
• Kwoh, C. K., Hausmann, L. R., Ibrahim, S. A., Obrosky, D. S., Vina, E. R., Weiner, D. K., & Youk, A. O. (2018).

  Examining modifiable psychological & social health factors associated with use of osteoarthritis oral analgesic treatment

  . Annals of the Rheumatic Diseases, 77, 157-157. doi:10.1136/annrheumdis-2018-eular.3813
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  Background EULAR recommends the use of non-opioid oral medicines (acetaminophen, NSAIDs, or COX-2 inhibitors) for the management of knee osteoarthritis (OA). Opioids are also recommended when these other therapies fail. There are known demographic and clinical differences in OA treatment use. Patients’ social and psychological health may also influence use of medications, yet their association with the utilisation of opioid or non-opioid oral OA treatments is unknown. Objectives Determine which modifiable social and psychological health factors are associated with use of oral opioid and non-opioid medications for OA. Methods Baseline data from a randomised controlled trial that examined the effects of a positive psychological intervention on pain in veterans with knee OA were used. For our study, patients were categorised based on self-reported use of the following oral medications for OA at baseline: opioids (with/without other oral analgesic treatments), non-opioid analgesics, and no oral analgesic treatment. We used χ2 or analysis of variance to compare sociodemographic, clinical, social, and psychological health variables by baseline OA treatment use. We used multinomial logistic regression models to estimate adjusted relative risk ratios (RRRs) of using an opioid or a non-opioid analgesic (vs. no oral analgesic treatment), comparing patients by levels of social support (Medical Outcomes Study), health literacy (‘How confident are you filling out medical forms by yourself’), and depressive symptoms (Patient Health Questionnaire-8). All models were adjusted for age, sex, race, income, OA symptom severity (WOMAC), self-reported Charlson comorbidity index, and body mass index. Results In this sample, 30.6% (n=110) reported taking opioid analgesics for OA, 54.2% (n=195) reported non-opioid use, and 15.3% (n=55) reported no oral analgesic use. Compared to the other groups, those taking opioids were younger (mean age 62.5 vs 64.3 vs 67.1, respectively, p=0.002) and had higher mean WOMAC scores (54.5 vs 45.7 vs 42.7, p The table 1 shows the associations between the social and psychological health measures with oral analgesic use, adjusted for sociodemographic and clinical factors. Having moderate-severe depression was associated with higher risk of opioid analgesic use compared to no oral analgesic use (RRR 2.96, 95% CI: 1.08 to 8.07) when adjusted for sociodemographic and clinical factors. Depression level was not significantly associated with non-opioid oral medication use, compared to no oral analgesic medication use, in a similarly adjusted model. Neither social support nor health literacy was associated with opioid or non-opioid oral analgesic use in fully adjusted models. Conclusions Knee OA patients with more severe depression symptoms, compared to those without, were more likely to report using opioid (vs. non-opioid) analgesics for OA. Social support and health literacy were not significantly associated with oral analgesic use for OA when sociodemographic and clinical factors were accounted for. Disclosure of Interest E. Vina: None declared, L. Hausmann: None declared, D. Obrosky: None declared, A. Youk: None declared, D. Weiner: None declared, S. Ibrahim: None declared, C. Kwoh Grant/research support from: Abbvie, EMD Serono, Consultant for: Astellas, EMD Serono, Thusane, Express Scripts, Novartis
• Lo, G. H., Musa, S. M., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., Petersen, N. J., Storti, K. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Suarez-Almazor, M. E. (2018). Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clinical rheumatology, 37(9), 2497-2504.
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  Higher levels of moderate to vigorous physical activity improve all-cause mortality and cardiovascular events. However, the effect of running, a moderate to vigorous activity, in those with knee osteoarthritis (OA), a common arthritis that occurs with aging, a high-risk group for mortality and cardiovascular events, is unclear. Therefore, we aimed to evaluate the association of self-selected running on OA symptom and structure progression in people with knee OA. This nested cohort study within the Osteoarthritis Initiative (OAI) (2004-2014) included those at least 50 years old with OA in at least one knee. Runners were defined using a self-administered questionnaire at the 96-month visit. At baseline and 48-months, symptoms were assessed and radiographs were scored for Kellgren-Lawrence (KL) grade (2-4) and medial Joint Space Narrowing (JSN) score (0-3). We evaluated the association of self-selected running with outcomes: KL worsening, medial JSN worsening, new knee pain, and improved knee pain over 48 months, adjusting for baseline age, sex, body mass index (BMI), KL score, contralateral KL score, contralateral knee pain, and injury. If data were not available at the 48-month visit, then they were imputed from the 36-month visit. One thousand two hundred three participants had a mean age of 63.2 (7.9) years, BMI of 29.5 (4.6) kg/m, 45.3% male, and 11.5% runners. Data from 8% of participants required imputation. Adjusted odds ratios for KL grade worsening and new frequent knee pain were 0.9 (0.6-1.3) and 0.9 (0.6-1.6) respectively. Adjusted odds ratio for frequent knee pain resolution was 1.7 (1.0-2.8). Among individuals 50 years old and older with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression. Therefore, self-selected running, which is likely influenced by knee symptoms and may result in lower intensity and shorter duration sessions of exercise, need not be discouraged in people with knee OA.
• Lo, G. H., Schneider, E., Driban, J. B., Price, L. L., Hunter, D. J., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., Lynch, J. A., McAlindon, T. E., & , O. I. (2018). Periarticular bone predicts knee osteoarthritis progression: Data from the Osteoarthritis Initiative. Seminars in arthritis and rheumatism, 48(2), 155-161.
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  Osteoarthritis (OA) is a disease with a substantial public health burden. Quantitative assessments of periarticular bone may be a biomarker capable of monitoring early disease progression. The purpose of this study was to evaluate whether measures of periarticular bone associate with longitudinal structural progression.
• Lo, G. H., Song, J., McAlindon, T. E., Hawker, G. A., Driban, J. B., Price, L. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Dunlop, D. D. (2018). Validation of a new symptom outcome for knee osteoarthritis: the Ambulation Adjusted Score for Knee pain. Clinical rheumatology.
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  Validation of a symptom measure for early knee OA may help identify new treatments and modifiable risk factors. Symptom measures that consider pain in the context of activity level may provide better discrimination than pain alone. Therefore, we aimed to compare sensitivity to change for radiographic progression between Ambulation Adjusted Score for Knee pain (AASK), which accounts for self-reported ambulation, and Western Ontario McMaster Osteoarthritis (WOMAC) knee pain score.
• Ratzlaff, C., Ashbeck, E. L., Guermazi, A., Roemer, F. W., Duryea, J., & Kwoh, C. K. (2018). A quantitative metric for knee osteoarthritis: reference values of joint space loss. Osteoarthritis and cartilage, 26(9), 1215-1224.
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  Knee osteoarthritis (OA) onset and progression has been defined with transitions in Kellgren-Lawrence (KL) grade or Osteoarthritis Research Society International (OARSI) Joint Space Narrowing (JSN) grade. We quantitatively describe one-year transitions in KL grade and JSN, using fixed joint space width (fJSW), among knees with or at risk of OA.
• Rego-Pérez, I., Blanco, F. J., Roemer, F. W., Guermazi, A., Ran, D., Ashbeck, E. L., Fernández-Moreno, M., Oreiro, N., Hannon, M. J., Hunter, D. J., & Kwoh, C. K. (2018). Mitochondrial DNA haplogroups associated with MRI-detected structural damage in early knee osteoarthritis. Osteoarthritis and cartilage, 26(11), 1562-1569.
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  Magnetic resonance imaging (MRI)-detected structural features are associated with increased risk of radiographic osteoarthritis (ROA). Specific mitochondrial DNA (mtDNA) haplogroups have been associated with incident ROA. Our objective was to compare the presence of MRI-detected structural features across mtDNA haplogroups among knees that developed incident ROA.
• Roemer, F. W., Kwoh, C. K., Fujii, T., Hannon, M. J., Boudreau, R. M., Hunter, D. J., Eckstein, F., John, M. R., & Guermazi, A. (2018). From Early Radiographic Knee Osteoarthritis to Joint Arthroplasty: Determinants of Structural Progression and Symptoms. Arthritis care & research, 70(12), 1778-1786.
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  To assess structural progression in knees with no/mild radiographic osteoarthritis (OA) (i.e., Kellgren/Lawrence [K/L] grades 0-2) that will undergo knee replacement during a 5-year period; to assess differences in structural damage on magnetic resonance imaging (MRI) in knees with no/mild radiographic OA versus those with severe radiographic OA (i.e., K/L grades 3 and 4) at baseline; and to assess differences in pain levels between those groups.
• Roemer, F. W., Kwoh, C. K., Hayashi, D., Felson, D. T., & Guermazi, A. (2018). The role of radiography and MRI for eligibility assessment in DMOAD trials of knee OA. Nature reviews. Rheumatology, 14(6), 372-380.
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  Currently, no disease-modifying osteoarthritis drugs (DMOADs) have been approved. Past clinical trials have failed for several reasons, including the commonly applied definition of eligibility based on radiographic assessment of joint structure. In the context of precision medicine, finding the appropriate patient for a specific treatment approach will be of increasing relevance. Phenotypic stratification by use of imaging at the time of determining eligibility for clinical trials will be paramount and cannot be achieved using radiography alone. Furthermore, identification of joints at high risk of rapid progression of osteoarthritis is needed in order to enable a more efficient DMOAD trial design. In addition, joints at high risk of collapse need to be excluded at screening. The use of MRI might offer advantages over radiography in this context. Technological advances and simplified image assessment address many of the commonly perceived barriers to the application of MRI to assessment of eligibility for DMOAD clinical trials.
• Vina, E. R., Ran, D., Ashbeck, E. L., & Kwoh, C. K. (2018). Natural history of pain and disability among African-Americans and Whites with or at risk for knee osteoarthritis: A longitudinal study. Osteoarthritis and cartilage, 26(4), 471-479.
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  Compare knee pain and disability between African Americans (AAs) and Whites (WHs), with or at risk of knee osteoarthritis (KOA), over 9 years, and evaluate racial disparities in KOA-related symptoms across socioeconomic and clinical characteristics.
• Vina, E. R., Ran, D., Ashbeck, E. L., Ratzlaff, C., & Kwoh, C. K. (2018). Race, sex, and risk factors in radiographic worsening of knee osteoarthritis. Seminars in arthritis and rheumatism, 47(4), 464-471.
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  Characterize radiographic worsening in knee osteoarthritis (KOA) by race and sex over 4 years and evaluate the role of established risk factors in observed race/sex differences.
• Wang, K., Ding, C., Chen, Z., Hannon, M. J., Hunter, D. J., & Kwoh, C. K. (2018).

  Signal intensity alteration within infrapatellar fat pad predicts total knee arthroplasty within four years: data from the osteoarthritis initiative

  . Annals of the Rheumatic Diseases, 76, 123-123. doi:10.1136/annrheumdis-2017-eular.1163
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  Background Osteoarthritis (OA) is a common joint disease that frequently affects the knee and is the leading cause of total knee arthroplasty (TKA) in Western countries. The most common reason for TKA is to ease pain and disability. Investigation on prognostic factors associated with TKA could be a possible way to find therapeutic targets to slow disease progression and delay the time for knee replacement. Objectives To investigate whether infrapatellar fat pad (IPFP) signal intensity (SI) alteration predicts the occurrence of TKA in patients with knee OA over 4 years. Methods Participants with symptomatic knee OA were selected from the Osteoarthritis Initiative (OAI) study. Case knees (n=127) were defined as those that received TKA during 4 years follow-up visit. They were matched by gender, age and radiographic status measured at baseline with a control knee. We used T2 weighted MR images to measure IPFP SI alteration using a newly developed algorithm in MATLAB. The measurements were assessed at OAI baseline (BL), T0 (the visit when TKA was reported), 1 year prior to T0 (T1). Conditional logistic regression was used to assess the relationship between cases and control knees and assess the risk of TKA in regard to SI alteration. Results Participants (n=237) were mostly female (57%), with average age of 63.7±8.5 years old and mean BMI of 29.5±4.7 kg/m 2 . In multivariable analysis, standard deviation of IPFP SI [sDev (IPFP)] and the ratio of high SI region volume to whole IPFP volume [Percentage (H)] measured at BL were significantly associated with TKA after adjustment for BMI, knee bending activities, self-reported knee injury and surgery history (HR: 3.5, 95% CI 1.1 to 11.4; HR: 8.9, 95% CI 1.2 to 67.2). IPFP SI alterations measured at T1 including sDev (IPFP), Percentage (H) and clustering effect of high SI [Clustering factor (H)] were significantly associated with TKA (HR: 4.0, 95% CI 1.2 to 13.2; HR 10.9, 95% CI 1.9, 63.6; HR: 1.8, 95% CI 1.1 to 2.9). All measurements including mean value of IPFP SI [Mean (IPFP)], sDev (IPFP), mean value of IPFP high SI [Mean (H)], standard deviation of IPFP high SI [sDev (H)], median value of IPFP high SI [Median (H)], upper quartile value of IPFP high SI [UQ (H)], Percentage (H), Clustering factor (H) were significantly associated with TKA at T0. Conclusions IPFP SI is an important predictor for TKA in knee OA patients. Targeting IPFP SI could be a potential way to reduce the need for future TKA. Acknowledgements Special thanks go to the participants who made this study possible, the OAI investigators, staff, participants and the funding of POMA study. Disclosure of Interest None declared
• Wang, K., Ding, C., Hannon, M. J., Chen, Z., Kwoh, C. K., Lynch, J., & Hunter, D. J. (2018). Signal intensity alteration within infrapatellar fat pad predicts knee replacement within 5 years: data from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 26(10), 1345-1350.
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  To investigate whether infrapatellar fat pad (IPFP) signal intensity (SI) alteration predicts the occurrence of knee replacement (KR) in knee osteoarthritis (OA) patients over 5 years.
• Almagor, O., Cauley, J., Chang, A. H., Chmiel, J. S., Eaton, C., Hochberg, M., Jackson, R. D., Kwoh, C. K., Moisio, K. C., Nevitt, M., & Sharma, L. (2017).

  Varus Thrust and Incident and Progressive Knee Osteoarthritis

  . Arthritis & Rheumatology, 69(11), 2136-2143. doi:10.1002/art.40224
• Driban, J. B., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kriska, A. M., Kwoh, C. K., Lo, G. H., Mcalindon, T. E., Nevitt, M. C., Petersen, N. J., Souza, R. B., Storti, K. L., & Suarez-almazor, M. E. (2017).

  Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative.

  . Arthritis care & research, 69(2), 183-191. doi:10.1002/acr.22939
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  Regular physical activity, including running, is recommended based on known cardiovascular and mortality benefits. However, controversy exists regarding whether running can be harmful to knees. The purpose of this study is to evaluate the relationship of running with knee pain, radiographic osteoarthritis (OA), and symptomatic OA..This was a retrospective cross-sectional study of Osteoarthritis Initiative participants (2004-2014) with knee radiograph readings, symptom assessments, and completed lifetime physical activity surveys. Using logistic regression, we evaluated the association of history of leisure running with the outcomes of frequent knee pain, radiographic OA, and symptomatic OA. Symptomatic OA required at least 1 knee with both radiographic OA and pain..Of 2,637 participants, 55.8% were female, the mean ± SD age was 64.3 ± 8.9 years, and the mean ± SD body mass index was 28.5 ± 4.9 kg/m2 ; 29.5% of these participants ran at some time in their lives. Unadjusted odds ratios of pain, radiographic OA, and symptomatic OA for those prior runners and current runners compared to those who never ran were 0.83 and 0.71 (P for trend = 0.002), 0.83 and 0.78 (P for trend = 0.01), and 0.81 and 0.64 (P for trend = 0.0006), respectively. Adjusted models were similar, except radiographic OA results were attenuated..There is no increased risk of symptomatic knee OA among self-selected runners compared with nonrunners in a cohort recruited from the community. In those without OA, running does not appear to be detrimental to the knees.
• Duggan, D. J., Felson, D. T., Hochberg, M. C., Jackson, R. D., Jordan, J. M., Kwoh, C. K., Lewis, C. E., Liu, Y., Mcculloch, C. E., Mitchell, B. D., Nevitt, M. C., Renner, J. B., Torner, J. C., Yau, M. S., & Yerges-armstrong, L. M. (2017).

  Genome-Wide Association Study of Radiographic Knee Osteoarthritis in North American Caucasians.

  . Arthritis & rheumatology (Hoboken, N.J.), 69(2), 343-351. doi:10.1002/art.39932
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  A major barrier to genetic studies of osteoarthritis (OA) is the need to obtain large numbers of individuals with standardized radiographic evaluations for OA. To address this gap, we performed a genome-wide association study (GWAS) of radiographically defined tibiofemoral knee OA in 3,898 cases and 3,168 controls from 4 well-characterized North American cohorts, and we performed replication analysis of previously reported OA loci..We performed meta-analysis using a 2-stage design. Stage 1 (discovery) consisted of a GWAS meta-analysis of radiographic knee OA carried out in the Osteoarthritis Initiative and the Johnston County Osteoarthritis Project. Knee OA was defined as definite osteophytes and possible joint space narrowing or total joint replacement in one or both knees. Stage 2 (validation) was performed in the Multicenter Osteoarthritis Study and the Genetics of Osteoarthritis study. We genotyped lead meta-analysis variants (P ≤ 1 × 10-4 ) from stage 1 and tested the association between these variants and knee OA. We then combined results from all cohorts in a meta-analysis..Lead variants from stage 1, representing 49 unique loci, were analyzed in stage 2; none met genome-wide significance in the combined analysis of stage 1 and stage 2. We validated 1 locus (rs4867568 near LSP1P3) with nominal significance (P 
• Eyles, J. P., Hunter, D. J., Kwoh, C. K., Makovey, J., Teoh, L. S., & Williams, M. J. (2017).

  Observational study of the impact of an individualized multidisciplinary chronic care program for hip and knee osteoarthritis treatment on willingness for surgery.

  . International journal of rheumatic diseases, 20(10), 1383-1392. doi:10.1111/1756-185x.12950
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  To determine the impact of an osteoarthritis-specific multidisciplinary conservative care program (OACCP) on willingness for surgery (WFS) and to identify changes and factors in our cohort that influence and predict willingness for surgery..Consecutive OACCP participants with hip or knee OA, with WFS (willing, unsure or unwilling) data for at least two appointments were included. The proportions of unwilling versus willing/unsure patients at baseline and last appointment were compared using McNemar's test. Logistic regression was used to analyze baseline age, gender, main language, educational status, living situation, number of comorbidities, index joint, non-index joint osteoarthritis, completion of program, baseline and change in pain, function, depression, body mass index and 6-min walk test (6MWT) for association with changing WFS..At baseline 203/409 were unwilling for surgery while by final appointment 234/409 were unwilling (P = 0.002). Of the 206 initially willing/unsure participants, 63/206 (30.6%) became unwilling by final appointment. Index joint, completion of program, baseline and change in pain, self-reported function and 6MWT were independently associated with becoming unwilling. Final model from multivariate logistic regression analysis regarding becoming unwilling included baseline pain (P < 0.001), change in pain (P < 0.001), completion of program (P < 0.001) and age (P = 0.004)..A conservative OA-specific treatment program that improves pain and function can reduce willingness for surgery among participants with hip or knee OA. The strongest determinants of this reduction in willingness were baseline and change in pain, completion of the program and participant age.
• Gallagher, R. M., Hannon, M. J., Hausmann, L. R., Ibrahim, S. A., Kwoh, C. K., Parks, A. C., Weiner, D. K., & Youk, A. O. (2017).

  Erratum: Testing a positive psychological intervention for osteoarthritis

  . [Pain Med, (2017)] doi: 10.1093/pm/pnx141. doi:10.1093/PM/PNX192
• Hausmann, L. R., Youk, A., Kwoh, C. K., Ibrahim, S. A., Hannon, M. J., Weiner, D. K., Gallagher, R. M., & Parks, A. (2017). Testing a Positive Psychological Intervention for Osteoarthritis. Pain medicine (Malden, Mass.), 18(10), 1908-1920.
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  Osteoarthritis is a leading cause of disability for which there is no cure. Psychosocial-oriented treatments are underexplored. We developed and tested an intervention to build positive psychological skills (e.g., gratitude) to reduce osteoarthritis symptom severity, including pain and functioning, and to improve psychosocial well-being in patients with knee or hip osteoarthritis.
• Lo-Ciganic, W. H., Floden, L., Lee, J. K., Ashbeck, E. L., Zhou, L., Chinthammit, C., Purdy, A. W., & Kwoh, C. K. (2017). Analgesic use and risk of recurrent falls in participants with or at risk of knee osteoarthritis: data from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 25(9), 1390-1398.
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  Few studies have compared the risk of recurrent falls across different types of analgesic use, and with limited adjustment for potential confounders (e.g., pain/depression severity). We assessed analgesic use and the subsequent risk of recurrent falls, among participants with or at risk of knee osteoarthritis (OA).
• Roemer, F. W., Kwoh, C. K., Hannon, M. J., Hunter, D. J., Eckstein, F., Grago, J., Boudreau, R. M., Englund, M., & Guermazi, A. (2017). Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. Eur Radiol, 1, 404-413.
• Roth, M., Emmanuel, K., Wirth, W., Kwoh, C. K., Hunter, D. J., & Eckstein, F. (2017). Sensitivity to change and association of three-dimensional meniscal measures with radiographic joint space width loss in rapid clinical progression of knee osteoarthritis. European radiology.
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  To determine whether 3D meniscal measures had similar sensitivity to longitudinal change as cartilage thickness; to what extent these measures are associated with longitudinal joint space width (JSW) change; and whether the latter associations differ between minimum (mJSW) and fixed-location JSW.
• Sharma, L., Chang, A. H., Jackson, R. D., Nevitt, M., Moisio, K. C., Hochberg, M., Eaton, C., Kwoh, C. K., Almagor, O., Cauley, J., & Chmiel, J. S. (2017). Varus Thrust and Incident and Progressive Knee Osteoarthritis. Arthritis & rheumatology (Hoboken, N.J.), 69(11), 2136-2143.
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  To determine if varus thrust, a bowing out of the knee during gait (i.e., the first appearance or worsening of varus alignment during stance), is associated with incident and progressive knee osteoarthritis (OA), we undertook an Osteoarthritis Initiative ancillary study. We further considered hypothesized associations adjusted for static alignment, anticipating some attenuation.
• Sharma, L., Hochberg, M., Nevitt, M., Guermazi, A., Roemer, F., Crema, M. D., Eaton, C., Jackson, R., Kwoh, K., Cauley, J., Almagor, O., & Chmiel, J. S. (2017). Knee tissue lesions and prediction of incident knee osteoarthritis over 7 years in a cohort of persons at higher risk. Osteoarthritis and cartilage, 25(7), 1068-1075.
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  Among high risk individuals, whether knee lesions in tissues involved in osteoarthritis (OA) can improve prediction of knee OA is unclear. We hypothesized that models predicting (1) incident osteophytes and (2) incident osteophytes and joint space narrowing can be improved by including symptoms or function, and further improved by lesion status.
• Song, J., Gilbert, A. L., Chang, R. W., Pellegrini, C. A., Ehrlich-Jones, L. S., Lee, J., Pinto, D., Semanik, P. A., Sharma, L., Kwoh, C. K., Jackson, R. D., & Dunlop, D. D. (2017). Do Inactive Older Adults Who Increase Physical Activity Experience Less Disability: Evidence From the Osteoarthritis Initiative. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 23(1), 26-32.
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  Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults.
• Vina, E. R., & Kwoh, C. K. (2017). Epidemiology of osteoarthritis: literature update. Current opinion in rheumatology.
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  The purpose of this review is to highlight recent studies of osteoarthritis epidemiology, including research on prevalence, disease impact, and potential risk factors.
• Wirth, W., Hunter, D. J., Nevitt, M. C., Sharma, L., Kwoh, C. K., Ladel, C., & Eckstein, F. (2017). Predictive and concurrent validity of cartilage thickness change as a marker of knee osteoarthritis progression: data from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 25(12), 2063-2071.
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  To investigate the predictive and concurrent validity of magnetic resonance imaging (MRI)-based cartilage thickness change between baseline (BL) and year-two (Y2) follow-up (predictive validity) and between Y2 and Y4 follow-up (concurrent validity) for symptomatic and radiographic knee osteoarthritis (OA) progression during Y2→Y4.
• Wise, B. L., Niu, J., Guermazi, A., Liu, F., Heilmeier, U., Ku, E., Lynch, J. A., Zhang, Y., Felson, D. T., Kwoh, C. K., & Lane, N. E. (2017).

  Magnetic resonance imaging lesions are more severe and cartilage T2 relaxation time measurements are higher in isolated lateral compartment radiographic knee osteoarthritis than in isolated medial compartment disease - data from the Osteoarthritis Initiative.

  . Osteoarthritis and cartilage, 25(1), 85-93. doi:10.1016/j.joca.2016.08.002
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  Isolated lateral compartment tibiofemoral radiographic osteoarthritis (IL-ROA) is an understudied form of knee osteoarthritis (OA). The objective of the present study was to characterize Magnetic Resonance Imaging (MRI) abnormalities and MR-T2 relaxation time measurements associated with IL-ROA and with isolated medial compartment ROA (IM-ROA) compared with knees without OA..200 case subjects with IL-ROA (Kellgren/Lawrence (K/L) grade≥2 and joint space narrowing (JSN) > 0 in the lateral compartment but JSN = 0 in the medial compartment) were randomly selected from the Osteoarthritis Initiative baseline visit. 200 cases with IM-ROA and 200 controls were frequency matched to the IL-ROA cases. Cases and controls were analyzed for odds of having a subregion with >10% cartilage area affected, with ≥25% bone marrow lesions (BML), with meniscal tear or maceration, and for association with cartilage T2 values..IL-ROA was more strongly associated with ipsilateral MRI knee pathologies than IM-ROA (IL-ROA: OR = 135.2 for size of cartilage lesion, 95% CI 42.7-427.4; OR = 145.4 for large size BML, 95% CI 41.5-509.5; OR = 176 for meniscal tears, 95% CI 59.8-517.7; IM-ROA: OR = 28.4 for size of cartilage lesion, 95% CI 14.7-54.7; OR = 38.1 for size of BML, 95% CI 12.7-114; OR = 37.0 for meniscal tears, 95% CI 12-113.6). Cartilage T2 values were higher in both tibial and medial femoral compartments in IL-ROA, but in IM-ROA were only significantly different from controls in the medial femur..IL-ROA knees show a greater prevalence and severity of MRI lesions and higher cartilage T2 values than IM-ROA knees compared with controls.
• Atukorala, I., Kwoh, C. K., Guermazi, A., Roemer, F. W., Boudreau, R. M., Hannon, M. J., & Hunter, D. J. (2016). Synovitis in knee osteoarthritis: a precursor of disease?. Annals of the rheumatic diseases, 75(2), 390-5.
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  It is unknown whether joint inflammation precedes other articular tissue damage in osteoarthritis. Therefore, this study aims to determine if synovitis precedes the development of radiographic knee osteoarthritis (ROA).
• Collins, J. E., Losina, E., Nevitt, M. C., Roemer, F. W., Guermazi, A., Lynch, J. A., Katz, J. N., Kwoh, C. K., Kraus, V. B., & Hunter, D. J. (2016). Semi-Quantitative Imaging Biomarkers of Knee Osteoarthritis Progression. Arthritis & Rheumatology.
• Demehri, S., Guermazi, A., & Kwoh, C. K. (2016).

  Diagnosis and Longitudinal Assessment of Osteoarthritis: Review of Available Imaging Techniques.

  . Rheumatic diseases clinics of North America, 42(4), 607-620. doi:10.1016/j.rdc.2016.07.004
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  Osteoarthritis (OA) is a major chronic and global health care problem. Recent technological advances in imaging and postprocessing techniques have enhanced the understanding and characterization of the pathophysiology of this chronic and prevalent disease. Although plain radiograph remains the modality of choice for initial assessment of OA, recent studies have shown that advanced cross-sectional imaging can improve the early detection, grading, structural damage quantification, and risk stratification of OA. This article discusses the currently available evidence regarding both the conventional and novel imaging modalities that can be used for evaluation of patients with OA and its longitudinal assessment.
• Domsic, R. T., Nihtyanova, S. I., Wisniewski, S. R., Fine, M. J., Lucas, M., Kwoh, C. K., Denton, C. P., & Medsger, T. A. (2016). Derivation and external validation of a 5-year mortality prediction rule for patients with early diffuse cutaneous systemic sclerosis. Arthritis & rheumatology (Hoboken, N.J.).
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  Although diffuse systemic sclerosis (SSc) is associated with a reduction in life expectancy, there are no validated, prognostic models for 5-year mortality in diffuse SSc. The objective of this study was to derive and validate a 5-year mortality prediction rule for early diffuse SSc patients.
• Domsic, R. T., Nihtyanova, S. I., Wisniewski, S. R., Fine, M. J., Lucas, M., Kwoh, C. K., Denton, C. P., & Medsger, T. A. (2016). Reply for "Derivation and External Validation of a Prediction Rule for Five-Year Mortality in Patients with Early Diffuse Cutaneous Scleroderma". Arthritis & rheumatology (Hoboken, N.J.).
• Eckstein, F., Boudreau, R., Wang, Z., Hannon, M. J., Duryea, J., Wirth, W., Cotofana, S., Guermazi, A., Roemer, F., Nevitt, M., John, M. R., Ladel, C., Sharma, L., Hunter, D. J., & Kwoh, C. K. (2016). Comparison of radiographic joint space width and magnetic resonance imaging for prediction of knee replacement: A longitudinal case-control study from the Osteoarthritis Initiative. European radiology.
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  To evaluate whether change in fixed-location measures of radiographic joint space width (JSW) and cartilage thickness by MRI predict knee replacement.
• Farrokhi, S., Chen, Y., Piva, S. R., Fitzgerald, G. K., Jeong, J., & Kwoh, C. K. (2016). The Influence of Knee Pain Location on Symptoms, Functional Status and Knee-related Quality of Life in Older Adults with Chronic Knee Pain: Data from the Osteoarthritis Initiative. The Clinical journal of pain.
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  To evaluate whether knee pain location can influence symptoms, functional status and knee-related quality of life in older adults with chronic knee pain.
• Hafezi-Nejad, N., Guermazi, A., Roemer, F. W., Hunter, D. J., Dam, E. B., Zikria, B., Kwoh, C. K., & Demehri, S. (2016). Prediction of medial tibiofemoral compartment joint space loss progression using volumetric cartilage measurements: Data from the FNIH OA biomarkers consortium. European radiology.
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  Investigating the association between baseline cartilage volume measurements (and initial 24th month volume loss) with medial compartment Joint-Space-Loss (JSL) progression (>0.7 mm) during 24-48th months of study.
• Kwoh, C. K., Ashbeck, E., Ran, D., & Vina, E. R. (2016).

  SAT0445 Race and Sex Differences in Radiographic Progression of Knee Osteoarthritis

  . Annals of the Rheumatic Diseases, 75(Suppl 2), 832-833. doi:10.1136/annrheumdis-2016-eular.2996
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  Background Knee osteoarthritis (KOA) is more common in African-Americans (AAs) than Whites (WHs) in the United States. The prevalence and severity of osteophytes, bone sclerosis and joint space narrowing (JSN) are also greater among AAs than among WHs. Radiographic KOA features between the two races may also vary according to sex. Objectives To determine if the pattern of radiographic progression in KOA varies by race and sex Methods Knees of AAs and WHs with minimal or no radiographic KOA (Kellgren-Lawrence [K-L] grades 0 or 1) at baseline in the Osteoarthritis Initiative (OAI) were selected for analysis. Serial fixed-flexion knee x-rays through the 96 month visit were scored for K-L grade and tibiofemoral JSN based on Osteoarthritis Research Society International grade. A subset, enriched for those that developed radiographic KOA, were assessed for joint space width (JSW) using digital imaging software. Mixed models for repeated measures were used to estimate race- and sex-specific mean JSW and 95% confidence interval at fixed locations in the medial (x=0.250mm) and lateral (x=0.725mm) compartments, as well as average annual loss in fixed JSW (fJSW). Generalized estimating equation logistic regression models were used to estimate the effect of race and sex on: summary radiographic grade progression (defined by any increase in K-L grade ≥1), and JSN progression (defined by any increase in OARSI grade ≥1) in the medial and lateral compartments. Models were adjusted for time to progression, baseline age, body mass index (BMI), family history of joint replacement, bony enlargements in the distal interphalangeal joints, frequent knee-bending, and history of knee injury or surgery. Results 3,776 knees were studied from 695 WH men, 932 WH women, 93 AA men, and 168 AA women, with mean age of 59 years and BMI of 28 kg/m 2 . Mean baseline medial fJSW was as follows: 6.53 in WH men, 5.43 in WH women, 6.51 in AA men, and 5.48 in AA women. Figure 1 displays the race and sex-specific mean medial fJSW during the study period, after adjustment, with 95% CIs. Annual medial fJSW loss (mm/year) over 8 years was significantly greater in AA men (-0.13) than in all other subgroups (-0.07 WH men, -0.06 WH women, -0.07 AA women, p In the adjusted models, odds of radiographic K-L grade progression were significantly higher in AA men (adjusted odds ratio [aOR] 2.18, 95%CI [1.22–3.91], p=0.009) and in WH men (aOR 1.53, 95% CI [1.18–1.98], p=0.002), in comparison to WH women. The odds did not significantly differ between AA and WH women (p=0.476). In fully adjusted models, the odds of having OARSI grade progression in medial JSN was slightly higher in AA women in comparison to WH women (aOR 1.38, 95% CI [0.91–3.46]), p=0.090), though this was not significant. Compared to WH women, WH men had greater odds of lateral JSN progression (aOR 2.25, 95% CI [1.29–3.92], p=0.004). There was no significant difference in lateral JSN progression among AA women (p=0.542) and AA men (p=0.509), in comparison to WH women. Conclusions Compared to WHs and AA women, AA men were more likely to have radiographic knee OA progression over time. Loss of JSW and progression of JSN in specific compartments may vary based on race and sex. Further research to characterize and identify causes of differential KOA progression by race and sex is warranted. Disclosure of Interest None declared
• Lo, G. H., Driban, J. B., Kriska, A. M., McAlindon, T. E., Souza, R. B., Petersen, N. J., Storti, K. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Suarez-Almazor, M. E. (2016). History of Running is Not Associated with Higher Risk of Symptomatic Knee Osteoarthritis: A Cross-Sectional Study from the Osteoarthritis Initiative. Arthritis care & research.
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  Regular physical activity, including running, is recommended based on known cardiovascular and mortality benefits. However, controversy exists regarding whether running can be harmful to knees. The purpose of this study is to evaluate the relationship of running with knee pain, radiographic osteoarthritis, and symptomatic osteoarthritis.
• Lo, G. H., McAlindon, T. E., Hawker, G. A., Driban, J. B., Price, L. L., Song, J., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Dunlop, D. D. (2016). Addressing Concerns Regarding a Newly Proposed Knee Osteoarthritis Composite Symptom Score. Arthritis & rheumatology (Hoboken, N.J.).
• Roemer, F. W., Guermazi, A., Collins, J. E., Losina, E., Nevitt, M. C., Lynch, J. A., Katz, J. N., Kwoh, C. K., Kraus, V. B., & Hunter, D. J. (2016). Semi-quantitative MRI biomarkers of knee osteoarthritis progression in the FNIH biomarkers consortium cohort - Methodologic aspects and definition of change. BMC musculoskeletal disorders, 17(1), 466.
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  To describe the scoring methodology and MRI assessments used to evaluate the cross-sectional features observed in cases and controls, to define change over time for different MRI features, and to report the extent of changes over a 24-month period in the Foundation for National Institutes of Health Osteoarthritis Biomarkers Consortium study nested within the larger Osteoarthritis Initiative (OAI) Study.
• Roemer, F. W., Hunter, D. J., Crema, M. D., Kwoh, C. K., Ochoa-Albiztegui, E., & Guermazi, A. (2016). An illustrative overview of semi-quantitative MRI scoring of knee osteoarthritis: lessons learned from longitudinal observational studies. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 24(2), 274-89.
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  To introduce the most popular magnetic resonance imaging (MRI) osteoarthritis (OA) semi-quantitative (SQ) scoring systems to a broader audience with a focus on the most commonly applied scores, i.e., the MOAKS and WORMS system and illustrate similarities and differences.
• Roemer, F. W., Kwoh, C. K., Hannon, M. J., Hunter, D. J., Eckstein, F., Grago, J., Boudreau, R. M., Englund, M., & Guermazi, A. (2016). Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. European radiology.
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  To assess whether partial meniscectomy is associated with increased risk of radiographic osteoarthritis (ROA) and worsening cartilage damage in the following year.
• Schlenk, E. A., Bilt, J. V., Lo-Ciganic, W., Jacob, M. E., Woody, S. E., Conroy, M. B., Kwoh, C. K., Albert, S. M., Boudreau, R., Newman, A. B., & Zgibor, J. C. (2016). Pilot Enhancement of the Arthritis Foundation Exercise Program with a Healthy Aging Program. Research in gerontological nursing.
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  Older adults with arthritis or joint pain were targeted for a pilot program enhancing the Arthritis Foundation Exercise Program with the 10 Keys™ to Healthy Aging Program. Using a one-group, pre-post design, feasibility was examined and improvements in preventive behaviors, arthritis outcomes, and cardiometabolic outcomes were explored. A 10-week program was developed, instructors were recruited and trained, and four sites and 51 participants were recruited. Measures included attendance, adherence, satisfaction, preventive behaviors, Western Ontario and McMaster Universities Osteoarthritis Index (pain and stiffness), glucose, and cholesterol. Three fourths of participants attended >50% of the sessions. At 6 and 12 months, more than one half performed the exercises 1 to 2 days per week, whereas 28% and 14% exercised 3 to 7 days per week, respectively. Participants (92%) rated the program as excellent/very good. Nonsignificant changes were observed in expected directions. Effect sizes were small for arthritis and cardiometabolic outcomes. This program engaged community partners, demonstrated feasibility, and showed improvements in some preventive behaviors and health risk profiles. [Res Gerontol Nurs. 2015; x(x):xx-xx.].
• Sharma, L., Nevitt, M., Hochberg, M., Guermazi, A., Roemer, F. W., Crema, M., Eaton, C., Jackson, R., Kwoh, K., Cauley, J., Almagor, O., & Chmiel, J. S. (2016). Clinical significance of worsening versus stable preradiographic MRI lesions in a cohort study of persons at higher risk for knee osteoarthritis. Annals of the rheumatic diseases.
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  Whether preradiographic lesions in knees at risk for osteoarthritis are incidental versus disease is unclear. We hypothesised, in persons without but at higher risk for knee osteoarthritis, that: 12-48 month MRI lesion status worsening is associated with 12-48 month incident radiographic osteoarthritis (objective component of clinical definition of knee osteoarthritis) and 48-84 month persistent symptoms.
• Taljanovic, M. S., Melville, D. M., Gimber, L. H., Scalcione, L. R., Miller, M. D., Kwoh, C. K., & Klauser, A. S. (2016). High-Resolution US of Rheumatologic Diseases. Radiographics : a review publication of the Radiological Society of North America, Inc, 35(7), 2026-48.
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  For the past 15 years, high-resolution ultrasonography (US) is being routinely and increasingly used for initial evaluation and treatment follow-up of rheumatologic diseases. This imaging technique is performed by using high-frequency linear transducers and has proved to be a powerful diagnostic tool in evaluation of articular erosions, simple and complex joint and bursal effusions, tendon sheath effusions, and synovitis, with results comparable to those of magnetic resonance imaging, excluding detection of bone marrow edema. Crystal deposition diseases including gouty arthropathy and calcium pyrophosphate deposition disease (CPPD) have characteristic appearances at US, enabling differentiation between these two diseases and from inflammatory arthropathies. Enthesopathy, which frequently accompanies psoriatic and reactive arthritis, also has a characteristic appearance at high-resolution US, distinguishing these two entities from other inflammatory and metabolic arthropathies. The presence of Doppler signal in examined joints, bursae, and tendon sheaths indicates active synovitis. Microbubble echo contrast agents augment detection of tissue vascularity and may act in the future as a drug delivery vehicle. Frequently, joint, tendon sheath, and bursal fluid aspirations and therapeutic injections are performed under US guidance. The authors describe the high-resolution US technique including gray-scale, color or power Doppler, and contrast agent-enhanced US that is used in evaluation of rheumatologic diseases of the wrist and hand and the ankle and foot in their routine clinical practice. This article demonstrates imaging findings of normal joints, rheumatoid arthritis, gouty arthritis, CPPD, psoriatic and reactive arthritis, and osteoarthritis. (©)RSNA, 2015.
• Teoh, L. S., Eyles, J. P., Makovey, J., Williams, M., Kwoh, C. K., & Hunter, D. J. (2016). Observational study of the impact of an individualized multidisciplinary chronic care program for hip and knee osteoarthritis treatment on willingness for surgery. International journal of rheumatic diseases.
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  To determine the impact of an osteoarthritis-specific multidisciplinary conservative care program (OACCP) on willingness for surgery (WFS) and to identify changes and factors in our cohort that influence and predict willingness for surgery.
• Vina, E. R., Hannon, M. J., & Kwoh, C. K. (2016). Improvement following total knee replacement surgery: Exploring preoperative symptoms and change in preoperative symptoms. Seminars in arthritis and rheumatism.
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  To determine whether changes in preoperative osteoarthritis (OA) symptoms are associated with improvement after total knee replacement (TKR) and to identify predictors of clinically significant improvement.
• Vina, E. R., Ran, D., Ashbeck, E. L., Ibrahim, S. A., Hannon, M. J., Zhou, J. J., & Kwoh, C. K. (2016). Patient preferences for total knee replacement surgery: Relationship to clinical outcomes and stability of patient preferences over 2 years. Seminars in arthritis and rheumatism. doi:10.1016/j.semarthrit.2016.03.012
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  Evaluate the relationship between patient preferences for total knee replacement (TKR) with receipt of TKR, and assess participant characteristics that may influence change in willingness to undergo TKR.
• Vina, E. R., Ran, D., Ashbeck, E. L., Kaur, M., & Kwoh, C. K. (2016). Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Healthcare Access Matters. Arthritis care & research.
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  Determine if severity of osteoarthritis-related knee pain is associated with willingness to undergo total knee replacement (TKR) and if this association is confounded or modified by components of socioeconomic status and healthcare coverage.
• Vina, E. R., Ran, D., Ashbeck, E. L., Kaur, M., & Kwoh, C. K. (2016). Relationship between knee pain and patient preferences for joint replacement: healthcare access matters. Arthritis Care Res (Hoboken). doi:10.1002/acr.23084
• Vina, E. R., Richardson, D., Medvedeva, E., Kent Kwoh, C., Collier, A., & Ibrahim, S. A. (2016). Does a Patient-centered Educational Intervention Affect African-American Access to Knee Replacement? A Randomized Trial. Clinical orthopaedics and related research. doi:10.1007/s11999-016-4834-z
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  A TKA is the most effective and cost-effective surgical option for moderate to severe osteoarthritis (OA) of the knee. Yet, black patients are less willing to undergo knee replacement surgery than white patients. Decision aids help people understand treatment options and consider the personal importance of possible benefits and harms of treatments, including TKA.
• Wise, B. L., Niu, J., Guermazi, A., Liu, F., Heilmeier, U., Ku, E., Lynch, J. A., Zhang, Y., Felson, D. T., Kwoh, C. K., & Lane, N. E. (2016). Magnetic resonance imaging lesions are more severe and cartilage T2 relaxation time measurements are higher in isolated lateral compartment radiographic knee osteoarthritis than in isolated medial compartment disease - data from the Osteoarthritis Initiative. Osteoarthritis and cartilage.
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  Isolated lateral compartment tibiofemoral radiographic osteoarthritis (IL-ROA) is an understudied form of knee osteoarthritis (OA). The objective of the present study was to characterize Magnetic Resonance Imaging (MRI) abnormalities and MR-T2 relaxation time measurements associated with IL-ROA and with isolated medial compartment ROA (IM-ROA) compared with knees without OA.
• Yau, M. S., Yerges-Armstrong, L. M., Liu, Y., Lewis, C. E., Duggan, D. J., Renner, J. B., Torner, J., Felson, D. T., McCulloch, C. E., Kwoh, C. K., Nevitt, M. C., Hochberg, M. C., Mitchell, B. D., Jordan, J. M., & Jackson, R. D. (2016). Genome-wide Association Study of Radiographic Knee Osteoarthritis in North American Caucasians. Arthritis & rheumatology (Hoboken, N.J.).
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  A major barrier to genetic studies of OA is the need to obtain large numbers of individuals with standardized radiographic evaluations for OA. To address this gap, we performed a genome-wide association study (GWAS) of radiographically-defined tibiofemoral knee OA in 3,898 cases and 3,168 controls from four well-characterized North American cohorts, and replication analysis of published OA loci.
• Zgibor, J. C., Schlenk, E. A., Vater, L., Kola, S., Bilt, J. V., Woody, S., Jacob, M. E., Lo-Ciganic, W., Brenckle, A., Brandenstein, J., Kwoh, C. K., Boudreau, R., Albert, S., Conroy, M., Rodgers, E., & Newman, A. B. (2016). Partnership Building and Implementation of an Integrated Healthy-Aging Program. Progress in community health partnerships : research, education, and action, 10(1), 123-132.
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  Evidence-based interventions exist for prevention of chronic disease in older adults. Partnering with community organizations may provide a mechanism for disseminating these interventions.
• Atukorala, I., Kwoh, C. K., Guermazi, A., Roemer, F., Boudreau, R., Hannon, M. J., & Hunter, D. J. (2015). Response to: 'Synovitis in knee osteoarthritis: a precursor or concomitant feature?' by Zeng et al. Annals of the rheumatic diseases, 74(10), e59.
• Busse, J. W., Bartlett, S. J., Dougados, M., Johnston, B. C., Guyatt, G. H., Kirwan, J. R., Kwoh, K., Maxwell, L. J., Moore, A., Singh, J. A., Stevens, R., Strand, V., Suarez-Almazor, M. E., Tugwell, P., & Wells, G. A. (2015). Optimal Strategies for Reporting Pain in Clinical Trials and Systematic Reviews: Recommendations from an OMERACT 12 Workshop. The Journal of rheumatology.
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  Pain is a patient-important outcome, but current reporting in randomized controlled trials and systematic reviews is often suboptimal, impeding clinical interpretation and decision making.
• Johnson, V. L., Kwoh, C. K., Guermazi, A., Roemer, F., Boudreau, R. M., Fujii, T., Hannon, M. J., & Hunter, D. J. (2015). Loss of anterior cruciate ligament integrity and the development of radiographic knee osteoarthritis: a sub-study of the osteoarthritis initiative. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 23(6), 882-7.
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  The aim of this study was to determine whether loss of ACL integrity in an older cohort precedes the onset of radiographic OA (ROA).
• Kwoh, C. K., Vina, E. R., Cloonan, Y. K., Hannon, M. J., Boudreau, R. M., & Ibrahim, S. A. (2015). Determinants of patient preferences for total knee replacement: African-Americans and whites. Arthritis research & therapy, 17, 348.
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  Patient preferences contribute to marked racial disparities in the utilization of total knee replacement (TKR). The objectives of this study were to identify the determinants of knee osteoarthritis (OA) patients' preferences regarding TKR by race and to identify the variables that may mediate racial differences in willingness to undergo TKR.
• Lee, J., Chang, R. W., Ehrlich-Jones, L., Kwoh, C. K., Nevitt, M., Semanik, P. A., Sharma, L., Sohn, M. W., Song, J., & Dunlop, D. D. (2015). Sedentary behavior and physical function: objective evidence from the Osteoarthritis Initiative. Arthritis care & research, 67(3), 366-73.
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  Investigate the relationship between sedentary behavior and physical function in adults with knee osteoarthritis (OA), controlling for moderate-vigorous physical activity (MVPA) levels.
• Lo, G. H., McAlindon, T. E., Hawker, G. A., Driban, J. B., Price, L. L., Song, J., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Dunlop, D. D. (2015). Symptom assessment in knee osteoarthritis needs to account for physical activity level. Arthritis & rheumatology (Hoboken, N.J.), 67(11), 2897-904.
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  Pain is not always correlated with severity of radiographic osteoarthritis (OA), possibly because people modify activities to manage symptoms. Measures of symptoms that consider pain in the context of activity level may therefore provide greater discrimination than a measure of pain alone. We undertook this study to compare discrimination provided by a measure of pain alone with that provided by combined measures of pain in the context of physical activity across radiographic OA severity levels.
• Roemer, F. W., Jarraya, M., Kwoh, C. K., Hannon, M. J., Boudreau, R. M., Green, S. M., Jakicic, J. M., Moore, C., & Guermazi, A. (2015). Brief report: symmetricity of radiographic and MRI-detected structural joint damage in persons with knee pain--the Joints on Glucosamine (JOG) Study. Osteoarthritis and cartilage, 23(8), 1343-7.
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  Most MRI-based osteoarthritis (OA) studies have focused on a single knee per person and thus, data on bilaterality is sparse. Study aim was to describe symmetricity of MRI-detected OA features in a cohort of subjects with knee pain.
• Roemer, F. W., Kwoh, C. K., Hannon, M. J., Hunter, D. J., Eckstein, F., Fujii, T., Boudreau, R. M., & Guermazi, A. (2015). What comes first? Multitissue involvement leading to radiographic osteoarthritis: magnetic resonance imaging-based trajectory analysis over four years in the osteoarthritis initiative. Arthritis & rheumatology (Hoboken, N.J.), 67(8), 2085-96.
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  To assess whether the presence of structural osteoarthritis (OA) features over as many as 4 years prior to incident radiographic OA increases the risk of radiographic OA in a nested, case-control design.
• Roemer, F. W., Kwoh, C. K., Hannon, M. J., Hunter, D. J., Eckstein, F., Wang, Z., Boudreau, R. M., John, M. R., Nevitt, M. C., & Guermazi, A. (2015). Can structural joint damage measured with MR imaging be used to predict knee replacement in the following year?. Radiology, 274(3), 810-20.
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  To assess whether magnetic resonance (MR) imaging-based cross-sectional measures of structural joint damage can be used to predict knee replacement during the following year.
• Semanik, P. A., Lee, J., Song, J., Chang, R. W., Sohn, M. W., Ehrlich-Jones, L. S., Ainsworth, B. E., Nevitt, M. M., Kwoh, C. K., & Dunlop, D. D. (2015). Accelerometer-Monitored Sedentary Behavior and Observed Physical Function Loss. American Journal of Public Health, 105(3), 560-66.
• Shea, M. K., Kritchevsky, S. B., Hsu, F. C., Nevitt, M., Booth, S. L., Kwoh, C. K., McAlindon, T. E., Vermeer, C., Drummen, N., Harris, T. B., Womack, C., Loeser, R. F., & , H. A. (2015). The association between vitamin K status and knee osteoarthritis features in older adults: the Health, Aging and Body Composition Study. Osteoarthritis and cartilage, 23(3), 370-8.
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  Vitamin K-dependent (VKD) proteins, including the mineralization inhibitor matrix-gla protein (MGP), are found in joint tissues including cartilage and bone. Previous studies suggest low vitamin K status is associated with higher osteoarthritis (OA) prevalence and incidence.
• Taljanovic, M. S., Melville, D. M., Gimber, L. H., Scalcione, L. R., Miller, M. D., Kwoh, C. K., & Klauser, A. S. (2015). High-Resolution US of Rheumatologic Diseases. Radiographics, 35(7), 2026-48.
• Vina, E. R., Hausmann, L. R., Utset, T. O., Masi, C. M., Liang, K. P., & Kwoh, C. K. (2015). Perceptions of racism in healthcare among patients with systemic lupus erythematosus: a cross-sectional study. Lupus science & medicine, 2(1), e000110.
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  Racial disparities in the clinical outcomes of systemic lupus erythematosus (SLE) exist. Perceived racial discrimination may contribute to disparities in health.
• Allen, K. D., Golightly, Y. M., Callahan, L. F., Helmick, C. G., Ibrahim, S. A., Kwoh, C. K., Renner, J. B., & Jordan, J. M. (2014). Race and sex differences in willingness to undergo total joint replacement: the Johnston County Osteoarthritis Project. Arthritis care & research, 66(8), 1193-202.
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  Using data from the community-based Johnston County Osteoarthritis Project, we examined race and sex variations in willingness to undergo, and perceptions regarding, total joint replacement (TJR).
• Bathon, J. M., Chang, R. W., Dunlop, D. D., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Mysiw, W. J., Nevitt, M. C., Semanik, P. A., Sharma, L., & Song, J. (2014).

  Relation of physical activity time to incident disability in community dwelling adults with or at risk of knee arthritis: prospective cohort study.

  . BMJ (Clinical research ed.), 348(apr28 6), g2472. doi:10.1136/bmj.g2472
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  To investigate whether objectively measured time spent in light intensity physical activity is related to incident disability and to disability progression..Prospective multisite cohort study from September 2008 to December 2012..Baltimore, Maryland; Columbus, Ohio; Pittsburgh, Pennsylvania; and Pawtucket, Rhode Island, USA..Disability onset cohort of 1680 community dwelling adults aged 49 years or older with knee osteoarthritis or risk factors for knee osteoarthritis; the disability progression cohort included 1814 adults..Physical activity was measured by accelerometer monitoring. Disability was ascertained from limitations in instrumental and basic activities of daily living at baseline and two years. The primary outcome was incident disability. The secondary outcome was progression of disability defined by a more severe level (no limitations, limitations to instrumental activities only, 1-2 basic activities, or ≥3 basic activities) at two years compared with baseline..Greater time spent in light intensity activities had a significant inverse association with incident disability. Less incident disability and less disability progression were each significantly related to increasing quartile categories of daily time spent in light intensity physical activities (hazard ratios for disability onset 1.00, 0.62, 0.47, and 0.58, P for trend=0.007; hazard ratios for progression 1.00, 0.59, 0.50, and 0.53, P for trend=0.003) with control for socioeconomic factors (age, sex, race/ethnicity, education, income) and health factors (comorbidities, depressive symptoms, obesity, smoking, lower extremity pain and function, and knee assessments: osteoarthritis severity, pain, symptoms, prior injury). This finding was independent of time spent in moderate-vigorous activities..These prospective data showed an association between greater daily time spent in light intensity physical activities and reduced risk of onset and progression of disability in adults with osteoarthritis of the knee or risk factors for knee osteoarthritis. An increase in daily physical activity time may reduce the risk of disability, even if the intensity of that additional activity is not increased.
• Bloecker, K., Guermazi, A., Wirth, W., Kwoh, C. K., Resch, H., Hunter, D. J., Eckstein, F., & , O. i. (2014). Correlation of semiquantitative vs quantitative MRI meniscus measures in osteoarthritic knees: results from the Osteoarthritis Initiative. Skeletal radiology, 43(2), 227-32.
• Curtis, J. R., Kwoh, C. K., Rizzoli, A. J., & Welz, J. A. (2014). A Multistakeholder Approach to Improving Quality in Rheumatoid Arthritis: Proceedings from the Rheumatoid Arthritis Quality Expert Medical Panel. American health & drug benefits, 7(8 Suppl 4), S51-61.
• Dannhauer, T., Sattler, M., Wirth, W., Hunter, D. J., Kwoh, C. K., & Eckstein, F. (2014). Longitudinal sensitivity to change of MRI-based muscle cross-sectional area versus isometric strength analysis in osteoarthritic knees with and without structural progression: pilot data from the Osteoarthritis Initiative. Magma (New York, N.Y.), 27(4), 339-47.
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  Biomechanical measurement of muscle strength represents established technology in evaluating limb function. Yet, analysis of longitudinal change suffers from relatively large between-measurement variability. Here, we determine the sensitivity to change of magnetic resonance imaging (MRI)-based measurement of thigh muscle anatomical cross sectional areas (ACSAs) versus isometric strength in limbs with and without structural progressive knee osteoarthritis (KOA), with focus on the quadriceps.
• Domsic, R. T., Nihtyanova, S. I., Wisniewski, S. R., Fine, M. J., Lucas, M., Kwoh, C. K., Denton, C. P., & Medsger, T. A. (2014). Derivation and validation of a prediction rule for two-year mortality in early diffuse cutaneous systemic sclerosis. Arthritis & rheumatology (Hoboken, N.J.), 66(6), 1616-24.
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  Systemic sclerosis (SSc) is associated with a reduction in life expectancy, but there are no validated prognostic models for determining short-term mortality. The objective of this study was to derive and validate a prediction rule for 2-year mortality in patients with early diffuse cutaneous SSc (dcSSc).
• Eckstein, F., & Kwoh, C. K. (2014). Imaging in rheumatology in 2013. From images to data to theory. Nature reviews. Rheumatology, 10(2), 69-70.
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  2013 has witnessed the maturation of imaging science with rheumatology research, in part due to large, public databases. Using imaging in osteoarthritis (OA) as an example, breakthroughs include further elucidation of the relationship between obesity and OA, and identification of the importance of bone and meniscus shape in OA development.
• Eckstein, F., Boudreau, R. M., Wang, Z., Hannon, M. J., Wirth, W., Cotofana, S., Guermazi, A., Roemer, F., Nevitt, M., John, M. R., Ladel, C., Sharma, L., Hunter, D. J., Kwoh, C. K., & , O. i. (2014). Trajectory of cartilage loss within 4 years of knee replacement--a nested case-control study from the osteoarthritis initiative. Osteoarthritis and cartilage, 22(10), 1542-9.
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  Knee replacement (KR) represents a clinically important endpoint of knee osteoarthritis (KOA). Here we examine the 4-year trajectory of femoro-tibial cartilage thickness loss prior to KR vs non-replaced controls.
• Eckstein, F., Kwoh, C. K., & Link, T. M. (2014).

  Imaging research results from the osteoarthritis initiative (OAI): a review and lessons learned 10 years after start of enrolment.

  . Annals of the rheumatic diseases, 73(7), 1289-300. doi:10.1136/annrheumdis-2014-205310
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  The Osteoarthritis Initiative (OAI) is a multicentre, prospective, observational, cohort study of knee osteoarthritis (OA) that began recruitment in 2004. The OAI provides public access to clinical and image data, enabling researchers to examine risk factors/predictors and the natural history of knee OA incidence and progression, and the qualification of imaging and other biomarkers. In this narrative review, we report imaging findings and lessons learned 10 years after enrolment has started. A literature search for full text articles published from the OAI was performed up to 31 December 2013 using Pubmed and the OAI web page. We summarise the rationale, design and imaging protocol of the OAI, and the history of OAI publications. We review studies from early partial, and later full OAI public data releases. The latter are structured by imaging method and tissue, reviewing radiography and then MRI findings on cartilage morphology, cartilage lesions and composition (T2), bone, meniscus, muscle and adipose tissue. Finally, analyses directly comparing findings from MRI and radiography are summarised. Ten years after the first participants were enrolled and first papers published, the OAI has become an invaluable resource to the OA research community. It has fuelled novel methodological approaches of analysing images, and has provided a wealth of information on OA pathophysiology. Continued collection and public release of long-term observations will help imaging measures to gain scientific and regulatory acceptance as 'prognostic' or 'efficacy of intervention' biomarkers, potentially enabling shorter and more efficient clinical trials that can test structure-modifying therapeutic interventions (NCT00080171).
• Hausmann, L. R., Parks, A., Youk, A. O., & Kwoh, C. K. (2014). Reduction of bodily pain in response to an online positive activities intervention. The journal of pain, 15(5), 560-7.
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  Inducing temporary positive states reduces pain and increases pain tolerance in laboratory studies. We tested whether completing positive activities in one's daily life produces long-term reductions in self-reported bodily pain in a randomized controlled trial of an online positive activities intervention. Participants recruited via the Web were randomly assigned to complete 0, 2, 4, or 6 positive activities administered online over a 6-week period. Follow-up assessments were collected at the end of 6 weeks and at 1, 3, and 6 months postintervention. We used linear mixed effects models to examine whether the intervention reduced pain over time among those who had a score
• Hayashi, D., Guermazi, A., & Kwoh, C. K. (2014). Clinical and translational potential of MRI evaluation in knee osteoarthritis. Current rheumatology reports, 16(1), 391.
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  Magnetic resonance imaging (MRI) has become an increasingly important imaging technique in osteoarthritis (OA) research, and is widely used in the ongoing endeavor to understand the pathogenesis of OA and to develop structure and disease-modifying OA drugs. MRI offers semiquantitative, quantitative and compositional evaluation of knee OA, and enables visualization of tissues that are not seen by radiography, including but not limited to cartilage, meniscus, bone marrow lesions, synovitis, and muscles. It is now recognized that contrast-enhanced MRI enables more accurate evaluation of synovitis than MRI without contrast. Because of its ability to visualize multiple pain-related tissue pathology in three dimensions, MRI is the best modality for imaging of OA.
• Hwang, Y. G., & Kwoh, C. K. (2014). The METEOR trial: no rush to repair a torn meniscus. Cleveland Clinic journal of medicine, 81(4), 226-32.
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  It is uncertain whether arthroscopic partial meniscectomy is better than physical therapy in patients who have a symptomatic torn meniscus on top of osteoarthritis of the knee. The Meniscal Repair in Osteoarthritis Research (METEOR) trial concluded that physical therapy is acceptable at first, and that surgery is not routinely needed. In patients assigned to physical therapy who eventually needed surgery, the delay resulting from a trial of conservative management did not impair outcomes at 12 months from the initial presentation. Here, we analyze the background, design, findings, and clinical implications of the METEOR trial.
• Jarraya, M., Hayashi, D., Guermazi, A., Kwoh, C. K., Hannon, M. J., Moore, C. E., Jakicic, J. M., Green, S. M., & Roemer, F. W. (2014). Susceptibility artifacts detected on 3T MRI of the knee: frequency, change over time and associations with radiographic findings: data from the joints on glucosamine study. Osteoarthritis and cartilage, 22(10), 1499-503.
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  To determine the prevalence of intraarticular susceptibility artifacts and to detect longitudinal changes in the artifacts, on 3T magnetic resonance imaging (MRI) of the knee in a cohort of patients with knee pain, and to assess the association of susceptibility artifacts with radiographic intraarticular calcifications.
• Kwoh, C. K., Roemer, F. W., Hannon, M. J., Moore, C. E., Jakicic, J. M., Guermazi, A., Green, S. M., Evans, R. W., & Boudreau, R. (2014). Effect of oral glucosamine on joint structure in individuals with chronic knee pain: a randomized, placebo-controlled clinical trial. Arthritis & rheumatology (Hoboken, N.J.), 66(4), 930-9.
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  To determine the short-term efficacy of oral glucosamine supplementation by evaluating structural lesions in the knee joints, as assessed using 3T magnetic resonance imaging (MRI).
• Sharma, L., Chmiel, J. S., Almagor, O., Dunlop, D., Guermazi, A., Bathon, J. M., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Mysiw, W. J., Crema, M. D., Roemer, F. W., & Nevitt, M. C. (2014). Significance of preradiographic magnetic resonance imaging lesions in persons at increased risk of knee osteoarthritis. Arthritis & rheumatology (Hoboken, N.J.), 66(7), 1811-9.
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  Little is known about early knee osteoarthritis (OA). The significance of lesions on magnetic resonance imaging (MRI) in older persons without radiographic OA is unclear. Our objectives were to determine the extent of tissue pathology by MRI and evaluate its significance by testing the following hypotheses: cartilage damage, bone marrow lesions, and meniscal damage are associated with prevalent frequent knee symptoms and incident persistent symptoms; bone marrow lesions and meniscal damage are associated with incident tibiofemoral (TF) cartilage damage; and bone marrow lesions are associated with incident patellofemoral (PF) cartilage damage.
• Vina, E. R., Utset, T. O., Hannon, M. J., Masi, C. M., Roberts, N., & Kwoh, C. K. (2014). Racial differences in treatment preferences among lupus patients: a two-site study. Clinical and experimental rheumatology, 32(5), 680-8.
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  To identify the demographic, clinical and psychosocial characteristics associated with racial differences in willingness to receive cyclophosphamide (CYC) or participate in a research clinical trial (RCT) among patients with systemic lupus erythematosus (SLE).
• Yerges-Armstrong, L. M., Yau, M. S., Liu, Y., Krishnan, S., Renner, J. B., Eaton, C. B., Kwoh, C. K., Nevitt, M. C., Duggan, D. J., Mitchell, B. D., Jordan, J. M., Hochberg, M. C., & Jackson, R. D. (2014). Association analysis of BMD-associated SNPs with knee osteoarthritis. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 29(6), 1373-9.
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  Osteoarthritis (OA) risk is widely recognized to be heritable but few loci have been identified. Observational studies have identified higher systemic bone mineral density (BMD) to be associated with an increased risk of radiographic knee osteoarthritis. With this in mind, we sought to evaluate whether well-established genetic loci for variance in BMD are associated with risk for radiographic OA in the Osteoarthritis Initiative (OAI) and the Johnston County Osteoarthritis (JoCo) Project. Cases had at least one knee with definite radiographic OA, defined as the presence of definite osteophytes with or without joint space narrowing (Kellgren-Lawrence [KL] grade ≥ 2) and controls were absent for definite radiographic OA in both knees (KL grade ≤ 1 bilaterally). There were 2014 and 658 Caucasian cases, respectively, in the OAI and JoCo Studies, and 953 and 823 controls. Single nucleotide polymorphisms (SNPs) were identified for association analysis from the literature. Genotyping was carried out on Illumina 2.5M and 1M arrays in Genetic Components of Knee OA (GeCKO) and JoCo, respectively and imputation was done. Association analyses were carried out separately in each cohort with adjustments for age, body mass index (BMI), and sex, and then parameter estimates were combined across the two cohorts by meta-analysis. We identified four SNPs significantly associated with prevalent radiographic knee OA. The strongest signal (p = 0.0009; OR = 1.22; 95% CI, 1.08-1.37) maps to 12q3, which contains a gene coding for SP7. Additional loci map to 7p14.1 (TXNDC3), 11q13.2 (LRP5), and 11p14.1 (LIN7C). For all four loci the allele associated with higher BMD was associated with higher odds of OA. A BMD risk allele score was not significantly associated with OA risk. This meta-analysis demonstrates that several genomewide association studies (GWAS)-identified BMD SNPs are nominally associated with prevalent radiographic knee OA and further supports the hypothesis that BMD, or its determinants, may be a risk factor contributing to OA development. © 2014 American Society for Bone and Mineral Research.
• Zhang, F. F., Driban, J. B., Lo, G. H., Price, L. L., Booth, S., Eaton, C. B., Lu, B., Nevitt, M., Jackson, B., Garganta, C., Hochberg, M. C., Kwoh, K., & McAlindon, T. E. (2014). Vitamin D deficiency is associated with progression of knee osteoarthritis. The Journal of nutrition, 144(12), 2002-8.
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  Knee osteoarthritis causes functional limitation and disability in the elderly. Vitamin D has biological functions on multiple knee joint structures and can play important roles in the progression of knee osteoarthritis. The metabolism of vitamin D is regulated by parathyroid hormone (PTH).
• Bloecker, K., Guermazi, A., Wirth, W., Benichou, O., Kwoh, C. K., Hunter, D. J., Englund, M., Resch, H., Eckstein, F., & , O. i. (2013). Tibial coverage, meniscus position, size and damage in knees discordant for joint space narrowing - data from the Osteoarthritis Initiative. Osteoarthritis and cartilage, 21(3), 419-27.
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  Meniscal extrusion is thought to be associated with less meniscus coverage of the tibial surface, but the association of radiographic disease stage with quantitative measures of tibial plateau coverage is unknown. We therefore compared quantitative and semi-quantitative measures of meniscus position and morphology in individuals with bilateral painful knees discordant on medial joint space narrowing (mJSN).
• Bloecker, K., Wirth, W., Hunter, D. J., Duryea, J., Guermazi, A., Kwoh, C. K., Resch, H., & Eckstein, F. (2013). Contribution of regional 3D meniscus and cartilage morphometry by MRI to joint space width in fixed flexion knee radiography--a between-knee comparison in subjects with unilateral joint space narrowing. European journal of radiology, 82(12), e832-9.
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  Radiographic joint space width (JSW) is considered the reference standard for demonstrating structural therapeutic benefits in knee osteoarthritis. Our objective was to determine the proportion by which 3D (regional) meniscus and cartilage measures explain between-knee differences of JSW in the fixed flexion radiographs.
• Boyan, B. D., Hart, D. A., Enoka, R. M., Nicolella, D. P., Resnick, E., Berkley, K. J., Sluka, K. A., Kwoh, C. K., Tosi, L. L., O'Connor, M. I., Coutts, R. D., & Kohrt, W. M. (2013). Hormonal modulation of connective tissue homeostasis and sex differences in risk for osteoarthritis of the knee. Biology of sex differences, 4(1), 3.
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  Young female athletes experience a higher incidence of ligament injuries than their male counterparts, females experience a higher incidence of joint hypermobility syndrome (a risk factor for osteoarthritis development), and post-menopausal females experience a higher prevalence of osteoarthritis than age-matched males. These observations indicate that fluctuating sex hormone levels in young females and loss of ovarian sex hormone production due to menopause likely contribute to observed sex differences in knee joint function and risk for loss of function. In studies of osteoarthritis, however, there is a general lack of appreciation for the heterogeneity of hormonal control in both women and men. Progress in this field is limited by the relatively few preclinical osteoarthritis models, and that most of the work with established models uses only male animals. To elucidate sex differences in osteoarthritis, it is important to examine sex hormone mechanisms in cells from knee tissues and the sexual dimorphism in the role of inflammation at the cell, tissue, and organ levels. There is a need to determine if the risk for loss of knee function and integrity in females is restricted to only the knee or if sex-specific changes in other tissues play a role. This paper discusses these gaps in knowledge and suggests remedies.
• Boyan, B. D., Tosi, L. L., Coutts, R. D., Enoka, R. M., Hart, D. A., Nicolella, D. P., Berkley, K. J., Sluka, K. A., Kwoh, C. K., O'Connor, M. I., Kohrt, W. M., & Resnick, E. (2013). Addressing the gaps: sex differences in osteoarthritis of the knee. Biology of sex differences, 4(1), 4.
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  An introduction to the accompanying three papers.
• Carbone, L. D., Satterfield, S., Liu, C., Kwoh, K. C., Neogi, T., Tolley, E., Nevitt, M., & , H. A. (2013). Assistive walking device use and knee osteoarthritis: results from the Health, Aging and Body Composition Study (Health ABC Study). Archives of physical medicine and rehabilitation, 94(2), 332-9.
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  To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee.
• Cotofana, S., Wyman, B. T., Benichou, O., Dreher, D., Nevitt, M., Gardiner, J., Wirth, W., Hitzl, W., Kwoh, C. K., Eckstein, F., Frobell, R. B., & , O. I. (2013). Relationship between knee pain and the presence, location, size and phenotype of femorotibial denuded areas of subchondral bone as visualized by MRI. Osteoarthritis and cartilage, 21(9), 1214-22.
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  Conflicting associations between imaging biomarkers and pain in knee osteoarthritis (OA) have been reported. A relation between pain and denuded areas of subchondral bone (dABs) has been suggested and this study explores this relationship further by relating the presence, phenotype, location and size of dABs to different measures of knee pain.
• Eckstein, F., Kwoh, C. K., Boudreau, R. M., Wang, Z., Hannon, M. J., Cotofana, S., Hudelmaier, M. I., Wirth, W., Guermazi, A., Nevitt, M. C., John, M. R., Hunter, D. J., & , O. i. (2013). Quantitative MRI measures of cartilage predict knee replacement: a case-control study from the Osteoarthritis Initiative. Annals of the rheumatic diseases, 72(5), 707-14.
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  Knee osteoarthritis commonly requires joint replacement, substantially reduces quality of life and increases healthcare utilisation and costs. This study aimed to identify whether quantitative measures of articular cartilage structure predict knee replacement, and to establish their utility as outcomes in clinical trials of disease-modifying therapy.
• Gao, S., Hausmann, L. R., Kwoh, K. C., Kwoh, C. K., & Lee, E. S. (2013).

  Racial disparities in the monitoring of patients on chronic opioid therapy.

  . Pain, 154(1), 46-52. doi:10.1016/j.pain.2012.07.034
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  Despite well-documented racial disparities in prescribing opioid medications for pain, little is known about whether there are disparities in the monitoring and follow-up treatment of patients who are prescribed opioid medications. We conducted a retrospective cohort study to examine whether there are racial differences in the use of recommended opioid monitoring and follow-up treatment practices. Our sample included 1646 white and 253 black patients who filled opioid prescriptions for noncancer pain for ≥ 90 consecutive days at the Veterans Affairs Pittsburgh Healthcare System pharmacy in fiscal years 2007 and 2008. Several opioid monitoring and follow-up treatment practices were extracted from electronic health records for a 12-month follow-up period. Findings indicated that 26.3% of patients had opioid agreements on file, pain was documented in 71.7% of primary care follow-up visits, urine drug tests were administered to 49.3% of patients, and 21.2% and 4.2% of patients were referred to pain and substance abuse specialists, respectively. Racial differences were observed in several of these practices. In adjusted comparisons, pain was documented less frequently for black patients than for white patients. Among those who had at least 1 urine drug test, black patients were subjected to more tests, especially if they were on higher doses of opioids. Compared with white patients, black patients were less likely to be referred to a pain specialist and more likely to be referred for substance abuse assessment. Addressing disparities in opioid monitoring and follow-up treatment practices may be a previously neglected route to reducing racial disparities in pain management.
• Hannon, M. J., Hanusa, B. H., Ibrahim, S. A., Kresevic, D. M., Kwoh, C. K., & Long, J. A. (2013).

  Willingness and access to joint replacement among African American patients with knee osteoarthritis: a randomized, controlled intervention.

  . Arthritis and rheumatism, 65(5), 1253-61. doi:10.1002/art.37899
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  African American patients are significantly less likely to undergo knee replacement for the management of knee osteoarthritis (OA). Racial difference in preference (willingness) has emerged as a key factor. This study was undertaken to examine the efficacy of a patient-centered educational intervention on patient willingness and the likelihood of receiving a referral to an orthopedic clinic..A total of 639 African American patients with moderate-to-severe knee OA from 3 Veterans Affairs primary care clinics were enrolled in a randomized, controlled trial with a 2 × 2 factorial design. Patients were shown a knee OA decision-aid video with or without brief counseling. The main outcome measures were change in patient willingness and receipt of a referral to an orthopedic clinic. Also assessed were whether patients discussed knee pain with their primary care provider or saw an orthopedic surgeon within 12 months of the intervention..At baseline, 67% of the participants were definitely/probably willing to consider knee replacement, with no difference among the groups. The intervention increased patient willingness (75%) in all groups at 1 month. For those who received the decision aid intervention alone, the gains were sustained for up to 3 months. By 12 months postintervention, patients who received any intervention were more likely to report engaging their provider in a discussion about knee pain (92% versus 85%), to receive a referral to an orthopedic surgeon (18% versus 13%), and for those with a referral, to attend an orthopedic consult (61% versus 50%)..An educational intervention significantly increased the willingness of African American patients to consider knee replacement. It also improved the likelihood of patient-provider discussion about knee pain and access to surgical evaluation.
• Hannon, M. J., Hausmann, L. R., Ibrahim, S. A., & Kwoh, C. K. (2013).

  Perceived Racial Discrimination in Health Care and Race Differences in Physician Trust

  . Race and Social Problems, 5(2), 113-120. doi:10.1007/s12552-013-9092-z
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  Racial discrimination in health care is more often perceived by racial minority patients than by whites. In this study, we explored whether two types of perceived racial discrimination, perceptions that the healthcare system is racially biased in general (perceived institutional racial discrimination) and perceptions that one has personally encountered racial discrimination while seeking health care (perceived interpersonal racial discrimination), mediated racial differences in patients’ trust in physicians. We examined this in a sample of black (N = 127) and white (N = 303) patients being treated in two Veterans Affairs orthopedic clinics for advanced osteoarthritis. Patients completed measures of perceived institutional and interpersonal racial discrimination in health care before meeting with an orthopedic surgeon and a measure of physician trust after the visit. Using a multiple mediator bootstrapping procedure, we tested whether perceived institutional and/or interpersonal racial discrimination mediated the association between race and trust. Compared to whites, blacks reported lower physician trust (M = 4.00 vs. 4.17, β = −0.15, 95 % CI = −0.25, −0.05), more perceived institutional racial discrimination (M = 3.13 vs. 2.60, β = 0.43, 95 % CI = 0.25, 0.61), and more perceived interpersonal racial discrimination (M = 1.94 vs. 1.21, β = 0.60, 95 % CI = 0.47, 0.74). Perceived interpersonal, but not institutional, racial discrimination mediated the race difference in physician trust and accounted for 55 % of the variance. Our finding that lower physician trust among black patients than white patients was explained by perceptions of interpersonal racial discrimination in health care suggests that issues of racial discrimination may need to be addressed in order to foster minority patients’ trust in physicians.
• Hayashi, D., Xu, L., Guermazi, A., Kwoh, C. K., Hannon, M. J., Jarraya, M., Green, S. M., Jakicic, J. M., Moore, C. E., & Roemer, F. W. (2013). Prevalence of MRI-detected mediopatellar plica in subjects with knee pain and the association with MRI-detected patellofemoral cartilage damage and bone marrow lesions: data from the Joints On Glucosamine study. BMC musculoskeletal disorders, 14, 292.
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  The mediopatellar plica is a synovial fold representing an embryonic remnant from the developmental process of the synovial cavity formation in the knee. We aimed to examine the frequency of MRI-detected mediopatellar plica and its cross-sectional association with MRI-detected cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ) in a cohort of subjects with knee pain.
• Kwoh, C. K. (2013). Clinical relevance of bone marrow lesions in OA. Nature reviews. Rheumatology, 9(1), 7-8.
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  Advances in imaging have improved our understanding of the relationship between pathology and the structural changes to joints affected by osteoarthritis. New research indicates that subchondral bone marrow lesions might represent a potential imaging biomarker to quantify such structural changes.
• Lee, J., Song, J., Hootman, J. M., Semanik, P. A., Chang, R. W., Sharma, L., van Horn, L., Bathon, J. M., Eaton, C. B., Hochberg, M. C., Jackson, R., Kwoh, C. K., Mysiw, W. J., Nevitt, M., & Dunlop, D. D. (2013). Obesity and other modifiable factors for physical inactivity measured by accelerometer in adults with knee osteoarthritis. Arthritis care & research, 65(1), 53-61.
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  To investigate the public health impact of obesity and other modifiable risk factors related to physical inactivity in adults with knee osteoarthritis (OA).
• Ruhdorfer, A., Dannhauer, T., Wirth, W., Hitzl, W., Kwoh, C. K., Guermazi, A., Hunter, D. J., Benichou, O., Eckstein, F., & , O. I. (2013). Thigh muscle cross-sectional areas and strength in advanced versus early painful osteoarthritis: an exploratory between-knee, within-person comparison in osteoarthritis initiative participants. Arthritis care & research, 65(7), 1034-42.
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  To compare cross-sectional and longitudinal side differences in thigh muscle anatomic cross-sectional areas (ACSAs), strength, and specific strength (strength/ACSA) between knees with early versus advanced painful radiographic osteoarthritis in the same person.
• Singh, J. A., Kwoh, C. K., Richardson, D., Chen, W., & Ibrahim, S. A. (2013). Sex and surgical outcomes and mortality after primary total knee arthroplasty: a risk-adjusted analysis. Arthritis care & research, 65(7), 1095-102.
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  Total knee arthroplasty (TKA) is a widely utilized and effective treatment option for end-stage knee osteoarthritis (OA). Knee OA is more prevalent among women compared to men, but there are limited data on the sex differences in surgical outcomes after primary TKA.
• Vina, E. R., Cloonan, Y. K., Ibrahim, S. A., Hannon, M. J., Boudreau, R. M., & Kwoh, C. K. (2013). Race, sex, and total knee replacement consideration: role of social support. Arthritis care & research, 65(7), 1103-11.
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  To determine whether there are racial differences in social support among patients with knee osteoarthritis (OA) and whether the impact of social support on patient preferences for total knee replacement (TKR) varies by race and sex.
• Vina, E. R., Green, S. L., Trivedi, T., Kwoh, C. K., & Utset, T. O. (2013). Correlates of sleep abnormalities in systemic lupus: a cross-sectional survey in an urban, academic center. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 19(1), 7-13.
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  Systemic lupus erythematosus (SLE) is a complex autoimmune disease that is associated with poor health-related quality-of-life outcomes.
• Wenger, A., Wirth, W., Hudelmaier, M., Noebauer-Huhmann, I., Trattnig, S., Bloecker, K., Frobell, R. B., Kwoh, C. K., Eckstein, F., & Englund, M. (2013). Meniscus body position, size, and shape in persons with and persons without radiographic knee osteoarthritis: quantitative analyses of knee magnetic resonance images from the osteoarthritis initiative. Arthritis and rheumatism, 65(7), 1804-11.
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  To quantitatively evaluate the position, size, and shape of the menisci in subjects with radiographic knee osteoarthritis (OA) compared to subjects without OA, using magnetic resonance imaging (MRI).
• Boyan, B. D., Tosi, L., Coutts, R., Enoka, R., Hart, D. A., Nicolella, D. P., Berkley, K., Sluka, K., Kwoh, K., O'Connor, M. I., & Kohrt, W. (2012). Sex differences in osteoarthritis of the knee. The Journal of the American Academy of Orthopaedic Surgeons, 20(10), 668-9.
• Brown, A., Hirsch, R., Laor, T., Hannon, M. J., Levesque, M. C., Starz, T., Francis, K., & Kwoh, C. K. (2012). Do patients with juvenile idiopathic arthritis in clinical remission have evidence of persistent inflammation on 3T magnetic resonance imaging?. Arthritis care & research, 64(12), 1846-54.
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  Up to 90% of adults with rheumatoid arthritis (RA) in clinical remission have persistent synovitis and/or bone marrow lesions (BMLs) on magnetic resonance imaging (MRI). MRI findings in patients with juvenile idiopathic arthritis (JIA) in clinical remission have not been described. We utilized 3T MRI with contrast enhancement to examine JIA patients with hand and/or wrist involvement who were in clinical remission and compared them with a cohort of adult RA patients.
• Conroy, M. B., Kwoh, C. K., Krishnan, E., Nevitt, M. C., Boudreau, R., Carbone, L. D., Chen, H., Harris, T. B., Newman, A. B., Goodpaster, B. H., & , H. A. (2012). Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis care & research, 64(1), 15-21.
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  To examine the relationship between knee osteoarthritis (OA) and muscle parameters in a biracial cohort of older adults.
• Eaton, C. B., Guermazi, A., Hunter, D. J., Kwoh, C. K., Li, L., Lo, G. H., Stein, V., & Zhang, Y. (2012).

  Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears.

  . Rheumatology international, 32(5), 1197-208. doi:10.1007/s00296-010-1749-y
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  Anterior cruciate ligament (ACL) tears are known to be a risk factor for incident knee osteoarthritis (OA). At the present time, it is unknown whether an incidental ACL tear in those with established knee OA alters the pattern of synovial joint damage. Therefore, our aim was to assess whether ACL tears in persons with knee OA are associated with specific patterns of cartilage loss, meniscal degeneration, and bone marrow lesion (BML) location. We included 160 participants from the progression subcohort of the Osteoarthritis Initiative (OAI) Study, an ongoing 4-year, multicenter study, focusing on knee OA. Regional cartilage morphometry measures including cartilage volume (mm(3)), denuded area, normalized cartilage volume, bone surface area, as well as location of meniscal pathology and BMLs in index knees on the same side were compared between those with and without ACL tears. Of the 160 subjects (51% women, age 62.1 (±9.9), BMI 30.3 (±4.7) kg/m(2)), 14.4% had an ACL tear. After adjusting for age, BMI and gender participants with ACL tears had significantly greater cartilage volume in the posterior lateral femur (P = 0.04) and the central medial tibia (0.001) compared to those without ACL tears. Normalized cartilage volume was not different between those with and without ACL tears. In addition, individuals with ACL tears had significantly larger bone surface areas in the medial tibia (P = 0,006), the central medial tibia (P = 0.008), the posterior lateral femur (P = 0.004), and the posterior medial femur (P = 0.04). Furthermore, participants with ACL tears showed significantly more meniscal derangement in the lateral posterior horn (P = 0.019) and significantly more BMLs in the lateral femur (P = 0.0025). We found clear evidence of predominant lateral tibiofemoral involvement, with OA-associated findings on MRI, including increased denuded area and bone surface area, BMLs, and meniscal derangement in knees of individuals with ACL tears compared to those without.
• Eckstein, F., Mc Culloch, C. E., Lynch, J. A., Nevitt, M., Kwoh, C. K., Maschek, S., Hudelmaier, M., Sharma, L., Wirth, W., & , O. I. (2012). How do short-term rates of femorotibial cartilage change compare to long-term changes? Four year follow-up data from the osteoarthritis initiative. Osteoarthritis and cartilage, 20(11), 1250-7.
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  To compare unbiased estimates of short- vs long-term cartilage loss in osteoarthritic knees.
• Guermazi, A., Hunter, D. J., Li, L., Benichou, O., Eckstein, F., Kwoh, C. K., Nevitt, M., & Hayashi, D. (2012). Different thresholds for detecting osteophytes and joint space narrowing exist between the site investigators and the centralized reader in a multicenter knee osteoarthritis study--data from the Osteoarthritis Initiative. Skeletal radiology, 41(2), 179-86.
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  To evaluate how the reading of knee radiographs by site investigators differs from that by an expert musculoskeletal radiologist who trained and validated them in a multicenter knee osteoarthritis (OA) study.
• Javaid, M. K., Kiran, A., Guermazi, A., Kwoh, C. K., Zaim, S., Carbone, L., Harris, T., McCulloch, C. E., Arden, N. K., Lane, N. E., Felson, D., Nevitt, M., & , H. A. (2012). Individual magnetic resonance imaging and radiographic features of knee osteoarthritis in subjects with unilateral knee pain: the health, aging, and body composition study. Arthritis and rheumatism, 64(10), 3246-55.
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  Strong associations between radiographic features of knee osteoarthritis (OA) and pain have been demonstrated in persons with unilateral knee symptoms. This study was undertaken to compare radiographic and magnetic resonance imaging (MRI) features of knee OA and assess their ability to discriminate between painful and nonpainful knees in persons with unilateral symptoms.
• Jones, D. L., Bhanegaonkar, A. J., Billings, A. A., Kriska, A. M., Irrgang, J. J., Crossett, L. S., & Kwoh, C. K. (2012). Differences between actual and expected leisure activities after total knee arthroplasty for osteoarthritis. The Journal of arthroplasty, 27(7), 1289-96.
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  This prospective cohort study determined the type, frequency, intensity, and duration of actual vs expected leisure activity among a cohort undergoing total knee arthroplasty. Data on actual and expected participation in 36 leisure activities were collected preoperatively and at 12 months in 90 patients with knee osteoarthritis. Despite high expectations, there were statistically and clinically significant differences between actual and expected activity at 12 months suggesting that expectations may not have been fulfilled. The differences were equivalent to walking 14 less miles per week than expected, which is more than the amount of activity recommended in national physical activity guidelines. Perhaps an educational intervention could be implemented to help patients establish appropriate and realistic leisure activity expectations before surgery.
• Nicolella, D. P., O'Connor, M. I., Enoka, R. M., Boyan, B. D., Hart, D. A., Resnick, E., Berkley, K. J., Sluka, K. A., Kwoh, C. K., Tosi, L. L., Coutts, R. D., Havill, L. M., & Kohrt, W. M. (2012). Mechanical contributors to sex differences in idiopathic knee osteoarthritis. Biology of sex differences, 3(1), 28.
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  The occurrence of knee osteoarthritis (OA) increases with age and is more common in women compared with men, especially after the age of 50 years. Recent work suggests that contact stress in the knee cartilage is a significant predictor of the risk for developing knee OA. Significant gaps in knowledge remain, however, as to how changes in musculoskeletal traits disturb the normal mechanical environment of the knee and contribute to sex differences in the initiation and progression of idiopathic knee OA. To illustrate this knowledge deficit, we summarize what is known about the influence of limb alignment, muscle function, and obesity on sex differences in knee OA. Observational data suggest that limb alignment can predict the development of radiographic signs of knee OA, potentially due to increased stresses and strains within the joint. However, these data do not indicate how limb alignment could contribute to sex differences in either the development or worsening of knee OA. Similarly, the strength of the knee extensor muscles is compromised in women who develop radiographic and symptomatic signs of knee OA, but the extent to which the decline in muscle function precedes the development of the disease is uncertain. Even less is known about how changes in muscle function might contribute to the worsening of knee OA. Conversely, obesity is a stronger predictor of developing knee OA symptoms in women than in men. The influence of obesity on developing knee OA symptoms is not associated with deviation in limb alignment, but BMI predicts the worsening of the symptoms only in individuals with neutral and valgus (knock-kneed) knees. It is more likely, however, that obesity modulates OA through a combination of systemic effects, particularly an increase in inflammatory cytokines, and mechanical factors within the joint. The absence of strong associations of these surrogate measures of the mechanical environment in the knee joint with sex differences in the development and progression of knee OA suggests that a more multifactorial and integrative approach in the study of this disease is needed. We identify gaps in knowledge related to mechanical influences on the sex differences in knee OA.
• Roemer, F. W., Kwoh, C. K., Hannon, M. J., Green, S. M., Jakicic, J. M., Boudreau, R., Crema, M. D., Moore, C. E., & Guermazi, A. (2012). Risk factors for magnetic resonance imaging-detected patellofemoral and tibiofemoral cartilage loss during a six-month period: the joints on glucosamine study. Arthritis and rheumatism, 64(6), 1888-98.
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  To assess several baseline risk factors that may predict patellofemoral and tibiofemoral cartilage loss during a 6-month period.
• Sattler, M., Dannhauer, T., Hudelmaier, M., Wirth, W., Sänger, A. M., Kwoh, C. K., Hunter, D. J., Eckstein, F., & , O. i. (2012). Side differences of thigh muscle cross-sectional areas and maximal isometric muscle force in bilateral knees with the same radiographic disease stage, but unilateral frequent pain - data from the osteoarthritis initiative. Osteoarthritis and cartilage, 20(6), 532-40.
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  To determine whether anatomical thigh muscle cross-sectional areas (MCSAs) and strength differ between osteoarthritis (OA) knees with frequent pain compared with contra-lateral knees without pain, and to examine the correlation between MCSAs and strength in painful vs painless knees.
• Sluka, K. A., Berkley, K. J., O'Connor, M. I., Nicolella, D. P., Enoka, R. M., Boyan, B. D., Hart, D. A., Resnick, E., Kwoh, C. K., Tosi, L. L., Coutts, R. D., & Kohrt, W. M. (2012). Neural and psychosocial contributions to sex differences in knee osteoarthritic pain. Biology of sex differences, 3(1), 26.
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  People with osteoarthritis (OA) can have significant pain that interferes with function and quality of life. Women with knee OA have greater pain and greater reductions in function and quality of life than men. In many cases, OA pain is directly related to sensitization and activation of nociceptors in the injured joint and correlates with the degree of joint effusion and synovial thickening. In some patients, however, the pain does not match the degree of injury and continues after removal of the nociceptors with a total joint replacement. Growth of new nociceptors, activation of nociceptors in the subchondral bone exposed after cartilage degradation, and nociceptors innervating synovium sensitized by inflammatory mediators could all augment the peripheral input to the central nervous system and result in pain. Enhanced central excitability and reduced central inhibition could lead to prolonged and enhanced pain that does not directly match the degree of injury. Psychosocial variables can influence pain and contribute to pain variability. This review explores the neural and psychosocial factors that contribute to knee OA pain with an emphasis on differences between the sexes and gaps in knowledge.
• Wenger, A., Englund, M., Wirth, W., Hudelmaier, M., Kwoh, K., Eckstein, F., & , O. I. (2012). Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study. European radiology, 22(1), 211-20.
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  To explore whether quantitative, three-dimensional measurements of meniscal position and size are associated with knee pain using a within-person, between-knee study design.
• Dunlop, D. D., Song, J., Semanik, P. A., Chang, R. W., Sharma, L., Bathon, J. M., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Mysiw, W. J., Nevitt, M. C., & Hootman, J. M. (2011). Objective physical activity measurement in the osteoarthritis initiative: Are guidelines being met?. Arthritis and rheumatism, 63(11), 3372-82.
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  Osteoarthritis (OA) clinical practice guidelines identify a substantial therapeutic role for physical activity, but objective information about the physical activity of this population is lacking. The aim of this study was to objectively measure levels of physical activity in adults with knee OA and report the prevalence of meeting public health physical activity guidelines.
• Hausmann, L. R., Hannon, M. J., Kresevic, D. M., Hanusa, B. H., Kwoh, C. K., & Ibrahim, S. A. (2011). Impact of perceived discrimination in healthcare on patient-provider communication. Medical care, 49(7), 626-33.
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  The impact of patients' perceptions of discrimination in healthcare on patient-provider interactions is unknown.
• Hausmann, L. R., Hanusa, B. H., Kresevic, D. M., Zickmund, S., Ling, B. S., Gordon, H. S., Kwoh, C. K., Mor, M. K., Hannon, M. J., Cohen, P. Z., Grant, R., & Ibrahim, S. A. (2011). Orthopedic communication about osteoarthritis treatment: Does patient race matter?. Arthritis care & research, 63(5), 635-42.
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  To understand racial disparities in the use of total joint replacement, we examined whether there were racial differences in patient-provider communication about treatment of chronic knee and hip osteoarthritis in a sample of African American and white patients referred to Veterans Affairs orthopedic clinics.
• Hayashi, D., Guermazi, A., Kwoh, C. K., Hannon, M. J., Moore, C., Jakicic, J. M., Green, S. M., & Roemer, F. W. (2011). Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: a comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State sequences. BMC musculoskeletal disorders, 12, 198.
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  Choice of appropriate MR pulse sequence is important for any research studies using imaging-derived data. The aim of this study was to compare semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts using intermediate-weighted (IW) fat-suppressed (fs) spin echo and Dual Echo Steady State (DESS) sequences on 3 T MRI.
• Marcum, Z. A., Perera, S., Donohue, J. M., Boudreau, R. M., Newman, A. B., Ruby, C. M., Studenski, S. A., Kwoh, C. K., Simonsick, E. M., Bauer, D. C., Satterfield, S., Hanlon, J. T., & , H. A. (2011). Analgesic use for knee and hip osteoarthritis in community-dwelling elders. Pain medicine (Malden, Mass.), 12(11), 1628-36.
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  To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA).
• Mosher, T. J., Zhang, Z., Reddy, R., Boudhar, S., Milestone, B. N., Morrison, W. B., Kwoh, C. K., Eckstein, F., Witschey, W. R., & Borthakur, A. (2011). Knee articular cartilage damage in osteoarthritis: analysis of MR image biomarker reproducibility in ACRIN-PA 4001 multicenter trial. Radiology, 258(3), 832-42.
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  To prospectively determine the reproducibility of quantitative magnetic resonance (MR) imaging biomarkers of the morphology and composition (spin lattice relaxation time in rotating frame [T1-ρ], T2) of knee cartilage in a multicenter multivendor trial involving patients with osteoarthritis (OA) and asymptomatic control subjects.
• Roemer, F. W., Kwoh, C. K., Hannon, M. J., Crema, M. D., Moore, C. E., Jakicic, J. M., Green, S. M., & Guermazi, A. (2011). Semiquantitative assessment of focal cartilage damage at 3T MRI: a comparative study of dual echo at steady state (DESS) and intermediate-weighted (IW) fat suppressed fast spin echo sequences. European journal of radiology, 80(2), e126-31.
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  The aim of the study was to compare semiquantitative assessment of focal cartilage damage using the dual echo at steady state (DESS)- and intermediate-weighted (IW) fat suppressed (fs) sequences at 3T MRI.
• Rosen, P., Spalding, S. J., Hannon, M. J., Boudreau, R. M., & Kwoh, C. K. (2011). Parent satisfaction with the electronic medical record in an academic pediatric rheumatology practice. Journal of medical Internet research, 13(2), e40.
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  Patient satisfaction has not been widely studied with respect to implementation of the electronic medical record (EMR). There are few reports of the impact of the EMR in pediatrics.
• Schlenk, E. A., Lias, J. L., Sereika, S. M., Dunbar-Jacob, J., & Kwoh, C. K. (2011). Improving physical activity and function in overweight and obese older adults with osteoarthritis of the knee: a feasibility study. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses, 36(1), 32-42.
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  Osteoarthritis of the knee, a prevalent condition in older adults, can impact physical function and ability to perform physical activity. This randomized controlled trial examined the effects of a 6-month self-efficacy-based, individually delivered, lower-extremity exercise and fitness walking intervention with 6-month follow-up on physical activity and function. The 26 subjects were mostly older (M = 63.2 years, SD = 9.8), White (83%), obese (BMI M = 33.3, SD = 6.0) women (96%). Physical activity was measured by diaries. Physical function was measured by the 6-minute walk, Short Physical Performance Battery (SPPB), and WOMAC Physical Function subscale. Exercise self-efficacy was assessed by a questionnaire. Results showed significant increases in self-reported performance of lower-extremity exercise and participation in fitness walking distance in the 6-minute walk, and SPPB scores from baseline to 6-month follow-up with a trend for improvement in self-efficacy. Results suggest that the intervention was feasible, acceptable, and improved physical activity and function.
• Singh, J. A., Kwoh, C. K., Boudreau, R. M., Lee, G. C., & Ibrahim, S. A. (2011). Hospital volume and surgical outcomes after elective hip/knee arthroplasty: a risk-adjusted analysis of a large regional database. Arthritis and rheumatism, 63(8), 2531-9.
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  To examine the relationship between hospital procedure volume and surgical outcomes following elective primary total hip arthroplasty/total knee arthroplasty (THA/TKA).
• Woollard, J. D., Gil, A. B., Sparto, P., Kwoh, C. K., Piva, S. R., Farrokhi, S., Powers, C. M., & Fitzgerald, G. K. (2011). Change in knee cartilage volume in individuals completing a therapeutic exercise program for knee osteoarthritis. The Journal of orthopaedic and sports physical therapy, 41(10), 708-22.
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  Prospective cohort study.
• Boudreau, R. M., Chu, C. R., Hannon, M. J., Kwoh, C. K., Nevitt, M. C., Newman, A. B., & Thompson, L. R. (2010).

  The association of osteoarthritis risk factors with localized, regional and diffuse knee pain.

  . Osteoarthritis and cartilage, 18(10), 1244-9. doi:10.1016/j.joca.2010.05.014
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  To identify determinants of different patterns of knee pain with a focus on risk factors for knee osteoarthritis (OA)..The Knee Pain Map is an interviewer-administered assessment that asks subjects to characterize their knee pain as localized, regional, or diffuse. A total of 2677 participants from the Osteoarthritis Initiative were studied. We used multinomial logistic regression to examine the relationship between risk factors for OA and knee pain patterns. We examined the bivariate and multivariate relationships of knee pain pattern with age, body mass index (BMI), sex, race, family history of total joint replacement, knee injury, knee surgery, and hand OA..We compared 2462 knees with pain to 1805 knees without pain. In the bivariate analysis, age, sex, BMI, injury, surgery, and hand OA were associated with at least one pain pattern. In the multivariate model, all of these variables remained significantly associated with at least one pattern. When compared to knees without pain, higher BMI, injury, and surgery were associated with all patterns. BMI had its strongest association with diffuse pain. Older age was less likely to be associated with localized pain while female sex was associated with regional pain..We have shown that specific OA risk factors are associated with different knee pain patterns. Better understanding of the relationship between OA risk factors and knee pain patterns may help to characterize the heterogeneous subsets of knee OA.
• Boudreau, R. M., Chu, C. R., Hannon, M. J., Kwoh, C. K., Nevitt, M. C., Newman, A. B., Thompson, L. R., Boudreau, R. M., Chu, C. R., Hannon, M. J., Kwoh, C. K., Nevitt, M. C., Newman, A. B., Thompson, L. R., Boudreau, R. M., Chu, C. R., Hannon, M. J., Kwoh, C. K., Nevitt, M. C., , Newman, A. B., et al. (2010).

  The association of osteoarthritis risk factors with localized, regional and diffuse knee pain.

  . Osteoarthritis and cartilage, 18(10), 1244-9. doi:10.1016/j.joca.2010.05.014
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  To identify determinants of different patterns of knee pain with a focus on risk factors for knee osteoarthritis (OA)..The Knee Pain Map is an interviewer-administered assessment that asks subjects to characterize their knee pain as localized, regional, or diffuse. A total of 2677 participants from the Osteoarthritis Initiative were studied. We used multinomial logistic regression to examine the relationship between risk factors for OA and knee pain patterns. We examined the bivariate and multivariate relationships of knee pain pattern with age, body mass index (BMI), sex, race, family history of total joint replacement, knee injury, knee surgery, and hand OA..We compared 2462 knees with pain to 1805 knees without pain. In the bivariate analysis, age, sex, BMI, injury, surgery, and hand OA were associated with at least one pain pattern. In the multivariate model, all of these variables remained significantly associated with at least one pattern. When compared to knees without pain, higher BMI, injury, and surgery were associated with all patterns. BMI had its strongest association with diffuse pain. Older age was less likely to be associated with localized pain while female sex was associated with regional pain..We have shown that specific OA risk factors are associated with different knee pain patterns. Better understanding of the relationship between OA risk factors and knee pain patterns may help to characterize the heterogeneous subsets of knee OA.
• Chang, A., Hochberg, M., Song, J., Dunlop, D., Chmiel, J. S., Nevitt, M., Hayes, K., Eaton, C., Bathon, J., Jackson, R., Kwoh, C. K., & Sharma, L. (2010). Frequency of varus and valgus thrust and factors associated with thrust presence in persons with or at higher risk of developing knee osteoarthritis. Arthritis and rheumatism, 62(5), 1403-11.
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  Varus thrust observed during gait has been shown to be associated with a 4-fold increase in the risk of medial knee osteoarthritis (OA) progression. Valgus thrust is believed to be less common than varus thrust; the prevalence of each is uncertain. Racial differences in risk factors may help explain variations in the natural history of knee OA. We undertook this study to determine the frequency of varus and valgus thrust in African Americans and Caucasians and to identify factors associated with thrust presence.
• Chu, C. R., Williams, A., Tolliver, D., Kwoh, C. K., Bruno, S., & Irrgang, J. J. (2010). Clinical optical coherence tomography of early articular cartilage degeneration in patients with degenerative meniscal tears. Arthritis and rheumatism, 62(5), 1412-20.
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  Quantitative and nondestructive methods for clinical diagnosis and staging of articular cartilage degeneration are important to the evaluation of potential disease-modifying treatments in osteoarthritis (OA). Optical coherence tomography (OCT) is a novel imaging technology that can generate microscopic-resolution cross-sectional images of articular cartilage in near real-time. This study tested the hypotheses that OCT can be used clinically to identify early cartilage degeneration and that OCT findings correlate with magnetic resonance imaging (MRI) T2 values and arthroscopy results.
• Eckstein, F., Wirth, W., Hunter, D. J., Guermazi, A., Kwoh, C. K., Nelson, D. R., Benichou, O., & , O. I. (2010). Magnitude and regional distribution of cartilage loss associated with grades of joint space narrowing in radiographic osteoarthritis--data from the Osteoarthritis Initiative (OAI). Osteoarthritis and cartilage, 18(6), 760-8.
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  Clinically, radiographic joint space narrowing (JSN) is regarded a surrogate of cartilage loss in osteoarthritis (OA). Using magnetic resonance imaging (MRI), we explored the magnitude and regional distribution of differences in cartilage thickness and subchondral bone area associated with specific Osteoarthritis Research Society International (OARSI) JSN grades.
• Hausmann, L. R., Mor, M., Hanusa, B. H., Zickmund, S., Cohen, P. Z., Grant, R., Kresevic, D. M., Gordon, H. S., Ling, B. S., Kwoh, C. K., & Ibrahim, S. A. (2010). The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting. Journal of general internal medicine, 25(9), 982-8.
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  The extent to which treatment recommendations in the orthopedic setting contribute to well-established racial disparities in the utilization of total joint replacement (TJR) in the treatment of advanced knee/hip osteoarthritis has not been explored.
• Hayashi, D., Roemer, F. W., Dhina, Z., Kwoh, C. K., Hannon, M. J., Moore, C., & Guermazi, A. (2010). Longitudinal assessment of cyst-like lesions of the knee and their relation to radiographic osteoarthritis and MRI-detected effusion and synovitis in patients with knee pain. Arthritis research & therapy, 12(5), R172.
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  The purpose of the present study was to determine the prevalence of cystic lesions and cyst-like bursitides in subjects with frequent knee pain and to assess their relation to radiographic osteoarthritis (OA) severity; to describe bilaterality and size fluctuation of the lesions over 6 months; and to assess relations between the prevalence of synovium-lined lesions communicating with the joint capsule and severity of magnetic resonance imaging (MRI)-detected effusion and synovitis.
• Hunter, D. J., Bowes, M. A., Eaton, C. B., Holmes, A. P., Mann, H., Kwoh, C. K., Maciewicz, R. A., Samuels, J., & Waterton, J. C. (2010). Can cartilage loss be detected in knee osteoarthritis (OA) patients with 3-6 months' observation using advanced image analysis of 3T MRI?. Osteoarthritis and cartilage, 18(5), 677-83.
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  Prior investigations of magnetic resonance imaging (MRI) biomarkers of cartilage loss in knee osteoarthritis (OA) suggest that trials of interventions which affect this biomarker with adequate statistical power would require large clinical studies of 1-2 years duration. We hypothesized that smaller, shorter duration, "Proof of Concept" (PoC) studies might be achievable by: (1) selecting a population at high risk of rapid medial tibio-femoral (TF) progression, in conjunction with; (2) high-field MRI (3T), and; (3) using advanced image analysis. The primary outcome was the cartilage thickness in the central medial femur.
• Hunter, D. J., Li, L., Zhang, Y. Q., Totterman, S., Tamez, J., Kwoh, C. K., Eaton, C. B., Le Graverand, M. P., Beals, C. R., & , O. I. (2010). Region of interest analysis: by selecting regions with denuded areas can we detect greater amounts of change?. Osteoarthritis and cartilage, 18(2), 175-83.
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  Based on recent analyses, the measures of short-term responsiveness of magnetic resonance imaging (MRI) derived cartilage morphometry may not be as large as earlier studies had suggested. We examined if by selecting regions of interest with denuded cartilage, the remaining cartilage within this region of interest was susceptible to greater rates of cartilage loss.
• Song, J., Semanik, P., Sharma, L., Chang, R. W., Hochberg, M. C., Mysiw, W. J., Bathon, J. M., Eaton, C. B., Jackson, R., Kwoh, C. K., Nevitt, M., & Dunlop, D. D. (2010). Assessing physical activity in persons with knee osteoarthritis using accelerometers: data from the osteoarthritis initiative. Arthritis care & research, 62(12), 1724-32.
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  Physical activity measured by accelerometers requires basic assumptions to translate the output into meaningful measures. We used accelerometer data from the Osteoarthritis Initiative to investigate in the context of knee osteoarthritis (OA) the following data processing assumptions derived from the general US adult population: nonwear (a period the monitor was removed), based on zero activity exceeding 60 minutes; and a valid day of monitoring, based on wear time evidence exceeding 10 hours.
• Suri, P., Morgenroth, D. C., Kwoh, C. K., Bean, J. F., Kalichman, L., & Hunter, D. J. (2010). Low back pain and other musculoskeletal pain comorbidities in individuals with symptomatic osteoarthritis of the knee: data from the osteoarthritis initiative. Arthritis care & research, 62(12), 1715-23.
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  To examine the association of concurrent low back pain (LBP), and other musculoskeletal pain comorbidity, with knee pain severity in symptomatic knee osteoarthritis (OA).
• Wirth, W., Benichou, O., Kwoh, C. K., Guermazi, A., Hunter, D., Putz, R., Eckstein, F., & , O. I. (2010). Spatial patterns of cartilage loss in the medial femoral condyle in osteoarthritic knees: data from the Osteoarthritis Initiative. Magnetic resonance in medicine, 63(3), 574-81.
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  The objective of this study was to develop a technique for analyzing spatial patterns of cartilage loss in the medial femoral condyle (MF), and to study MF cartilage loss in participants of the Osteoarthritis Initiative. Using a 0.7 mm sagittal double echo at steady state (DESS) sequence, 160 osteoarthritic knees from 80 participants with varying degrees of medial joint space narrowing were imaged at baseline and 1-year follow-up. MF cartilage was segmented and cartilage loss determined. Rate of change varied significantly (P = 0.0067) along the anterior-posterior extension of the MF, with the greatest changes (-45 microm, -2.7%) observed 30-60 degrees posterior to the trochlear notch. The rate was greater in the central MF after excluding peripheral aspects of the MF from analysis. Sensitivity to change was greatest at 45-75 degrees (standardized response mean = -0.32) but was minimally affected by medial-lateral trimming. In conclusion, the greatest sensitivity to change was achieved when analyzing the posterior aspect of the central, weight-bearing MF.
• Bae, K. T., Shim, H., Tao, C., Chang, S., Wang, J. H., Boudreau, R., & Kwoh, C. K. (2009). Intra- and inter-observer reproducibility of volume measurement of knee cartilage segmented from the OAI MR image set using a novel semi-automated segmentation method. Osteoarthritis and cartilage, 17(12), 1589-97.
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  We developed a semi-automated method based on a graph-cuts algorithm for segmentation and volumetric measurements of the cartilage from high-resolution knee magnetic resonance (MR) images from the Osteoarthritis Initiative (OAI) database and assessed the intra- and inter-observer reproducibility of measurements obtained via this method.
• Eckstein, F., Benichou, O., Wirth, W., Nelson, D. R., Maschek, S., Hudelmaier, M., Kwoh, C. K., Guermazi, A., Hunter, D., & , O. I. (2009). Magnetic resonance imaging-based cartilage loss in painful contralateral knees with and without radiographic joint space narrowing: Data from the Osteoarthritis Initiative. Arthritis and rheumatism, 61(9), 1218-25.
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  To determine by magnetic resonance imaging (MRI), whether knees with advanced radiographic disease (medial joint space narrowing [mJSN]) encounter greater longitudinal cartilage loss than contralateral knees with earlier disease (no or less mJSN).
• Malik, A., Dinnella, J. E., Kwoh, C. K., & Schumacher, H. R. (2009). Poor validation of medical record ICD-9 diagnoses of gout in a veterans affairs database. The Journal of rheumatology, 36(6), 1283-6.
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  Diagnostic codes based on medical records or claims data have been used to identify patient populations with gout for important epidemiologic and clinical studies. We evaluated whether we can document the accuracy of such diagnoses by review of medical records and then on direct interviews with a subset of patients.
• Rosen, P., Stenger, E., Bochkoris, M., Hannon, M. J., & Kwoh, C. K. (2009). Family-centered multidisciplinary rounds enhance the team approach in pediatrics. Pediatrics, 123(4), e603-8.
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  The objective of this study was to determine the impact of family-centered multidisciplinary rounds on an inpatient pediatric ward. We hoped to (1) gain a better understanding of the patient and family experience with family-centered multidisciplinary rounds, (2) measure hospital staff satisfaction with family-centered multidisciplinary rounds compared with conventional rounds, and (3) understand the time commitment for family-centered multidisciplinary rounds and conventional rounds.
• Shim, H., Chang, S., Tao, C., Wang, J. H., Kwoh, C. K., & Bae, K. T. (2009). Knee cartilage: efficient and reproducible segmentation on high-spatial-resolution MR images with the semiautomated graph-cut algorithm method. Radiology, 251(2), 548-56.
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  This HIPAA-compliant study was exempt from institutional review board approval because the 10 image data sets were deidentified in the Osteoarthritis Initiative database, and they were processed and analyzed without any clinical information being accessed. The purpose of this study was to prospectively evaluate the efficiency and reproducibility of the semiautomated graph-cut method (SA method) in the segmentation of knee cartilage and to compare its performance with that of the conventional manual delineation segmentation method (M method). Two radiologists independently performed segmentation with each method in two separate sessions: They performed the M method (M1 and M2 for the first and second sessions, respectively) for every third section and the SA method (SA1 and SA2 for the first and second sessions, respectively) for every section. The SA method was significantly more efficient (mean processing time, 53 minutes vs 156 minutes for SA1 vs M1 and 53 minutes vs 118 minutes for SA2 vs M2; P < .001) and reproducible (mean volume overlap, 94.3% vs 87.8% for the SA method vs the M method; P < .001) than the M method.
• Thompson, L. R., Boudreau, R., Hannon, M. J., Newman, A. B., Chu, C. R., Jansen, M., Nevitt, M. C., Kwoh, C. K., & , O. I. (2009). The knee pain map: reliability of a method to identify knee pain location and pattern. Arthritis and rheumatism, 61(6), 725-31.
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  To describe the location and pattern of knee pain in patients with chronic, frequent knee pain using the Knee Pain Map, and to evaluate the inter- and intrarater reliability of the map.
• Albert, S. M., Musa, D., Kwoh, C. K., Hanlon, J. T., & Silverman, M. (2008). Self-care and professionally guided care in osteoarthritis: racial differences in a population-based sample. Journal of aging and health, 20(2), 198-216.
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  The aim of this study was to examine the prevalence of self-management practices among older White and African American persons with osteoarthritis. Self-management was defined broadly to include all behaviors adopted to reduce morbidity, whether recommended by physicians or not.
• Cohen, P. Z., Henderson, W. G., Ibrahim, S. A., Khuri, S. F., Kwoh, C. K., & Stone, R. A. (2008).

  Race, ethnicity and length of hospital stay after knee or hip arthroplasty

  . Current Orthopaedic Practice, 19(5), 556-563. doi:10.1097/bco.0b013e328313a968
• Groeneveld, P. W., Kwoh, C. K., Mor, M. K., Appelt, C. J., Geng, M., Gutierrez, J. C., Wessel, D. S., & Ibrahim, S. A. (2008). Racial differences in expectations of joint replacement surgery outcomes. Arthritis and rheumatism, 59(5), 730-7.
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  Prior studies have indicated racial differences in patients' expectations for joint replacement surgery outcomes. The goal of this study was to measure these differences using a well-validated survey instrument and to determine if the differences could be explained by racial variation in disease severity, socioeconomic factors, literacy, or trust.
• Helmick, C. G., Felson, D. T., Lawrence, R. C., Gabriel, S., Hirsch, R., Kwoh, C. K., Liang, M. H., Kremers, H. M., Mayes, M. D., Merkel, P. A., Pillemer, S. R., Reveille, J. D., Stone, J. H., & , N. A. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis and rheumatism, 58(1), 15-25.
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  To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by arthritis overall, rheumatoid arthritis, juvenile arthritis, the spondylarthritides, systemic lupus erythematosus, systemic sclerosis, and Sjögren's syndrome. A companion article (part II) addresses additional conditions.
• Jones, A. C., Kwoh, C. K., Groeneveld, P. W., Mor, M., Geng, M., & Ibrahim, S. A. (2008). Investigating racial differences in coping with chronic osteoarthritis pain. Journal of cross-cultural gerontology, 23(4), 339-47.
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  Osteoarthritis is a prevalent disease in older patients of all racial groups, and it is known to cause significant pain and functional disability. Racial differences in how patients cope with the chronic pain of knee or hip osteoarthritis may have implications for utilization of treatment modalities such as joint replacement. Therefore, we examined the relationships between patient race and pain coping strategies (diverting attention, reinterpreting pain, catastrophizing, ignoring sensations, hoping and praying, coping self-statements, and increasing behavior activities) for hip and knee osteoarthritis. This is a cross-sectional survey of 939 veterans 50 to 79 years old with chronic hip or knee osteoarthritis pain recruited from VA primary care clinics in Philadelphia and Pittsburgh. Patients had to have moderate to severe hip or knee osteoarthritis symptoms as measured by the WOMAC index. Standard, validated instruments were used to obtain information on attitudes and use of prayer, pain coping strategies, and arthritis self-efficacy. Analysis included separate multivariable models adjusting for demographic and clinical characteristics. Attitudes on prayer differed, with African Americans being more likely to perceive prayer as helpful (adjusted OR = 3.38, 95% CI 2.35 to 4.86) and to have tried prayer (adjusted OR = 2.28, 95% 1.66 to 3.13) to manage their osteoarthritis pain. Upon evaluating the coping strategies, we found that, compared to whites, African Americans had greater use of the hoping and praying method (beta = 0.74, 95% CI 0.50 to 0.99). Race was not associated with arthritis pain self-efficacy, arthritis function self-efficacy, or any other coping strategies. This increased use of the hoping and praying coping strategy by African Americans may play a role in the decreased utilization of total joint arthroplasty among African Americans compared to whites. Further investigation of the role this coping strategy has on the decision making process for total joint arthroplasty should be explored.
• Krishnan, E., Lienesch, D., & Kwoh, C. K. (2008). Gout in ambulatory care settings in the United States. The Journal of rheumatology, 35(3), 498-501.
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  To describe the ambulatory care utilization by patients with gouty arthritis (gout) in the United States using a nationally representative sample.
• Spalding, S. J., Kwoh, C. K., Boudreau, R., Enama, J., Lunich, J., Huber, D., Denes, L., & Hirsch, R. (2008). Three-dimensional and thermal surface imaging produces reliable measures of joint shape and temperature: a potential tool for quantifying arthritis. Arthritis research & therapy, 10(1), R10.
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  The assessment of joints with active arthritis is a core component of widely used outcome measures. However, substantial variability exists within and across examiners in assessment of these active joint counts. Swelling and temperature changes, two qualities estimated during active joint counts, are amenable to quantification using noncontact digital imaging technologies. We sought to explore the ability of three dimensional (3D) and thermal imaging to reliably measure joint shape and temperature.
• Appelt, C. J., Burant, C. J., Siminoff, L. A., Kwoh, C. K., & Ibrahim, S. A. (2007). Arthritis-specific health beliefs related to aging among older male patients with knee and/or hip osteoarthritis. The journals of gerontology. Series A, Biological sciences and medical sciences, 62(2), 184-90.
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  Disease-specific beliefs may impact patients' perceptions of the efficacy of various treatment options, thus, it is important to understand these beliefs. We examined the relationship between patients' demographic characteristics and arthritis-specific beliefs related to aging.
• Bhanegaonkar, A., Crossett, L. S., Irrgang, J. J., Jones, D. L., Kriska, A. M., & Kwoh, C. K. (2007).

  Physical Activity Expectations Within Two Cohorts With Knee Osteoarthritis: 1513

  . Medicine and Science in Sports and Exercise, 39(5), S230. doi:10.1249/01.mss.0000273872.57084.3d
• Emejuaiwe, N., Jones, A. C., Ibrahim, S. A., & Kwoh, C. K. (2007). Disparities in joint replacement utilization: a quality of care issue. Clinical and experimental rheumatology, 25(6 Suppl 47), 44-9.
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  Although total joint replacement is an effective treatment option for end-stage lower extremity osteoarthritis, racial disparities in joint replacement utilization have been well documented. These disparities may be due in part to patient-level factors such as willingness to consider joint replacement and worse expectations of joint replacement outcomes. In addition, African-Americans may have worse outcomes after total joint replacement and are more likely to have surgery performed by surgeons with lower volumes or in hospitals with lower volumes. All of these issues may be considered concerns with the quality of care delivered to African-Americans with osteoarthritis.
• Ibrahim, S. A., Kwoh, C. K., & Krishnan, E. (2007). Factors associated with patients who leave acute-care hospitals against medical advice. American journal of public health, 97(12), 2204-8.
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  We examined hospital- and patient-related factors associated with discharge against medical advice (termed self-discharge) after emergency admission to acute-care hospitals.
• Krishnan, E., Fries, J. F., & Kwoh, C. K. (2007). Primary knee and hip arthroplasty among nonagenarians and centenarians in the United States. Arthritis and rheumatism, 57(6), 1038-42.
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  The number of individuals ages >or=100 years in the US is expected to increase considerably in the future along with the need for arthroplasties. This report focuses on the poorly studied epidemiology and mortality outcomes of arthroplasty among these individuals.
• Weiner, D. K., Rudy, T. E., Morone, N., Glick, R., & Kwoh, C. K. (2007). Efficacy of periosteal stimulation therapy for the treatment of osteoarthritis-associated chronic knee pain: an initial controlled clinical trial. Journal of the American Geriatrics Society, 55(10), 1541-7.
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  To examine the efficacy of periosteal stimulation therapy (PST, osteopuncture) for the treatment of chronic pain associated with advanced knee osteoarthritis.
• Borrero, S., Kwoh, C. K., Sartorius, J., & Ibrahim, S. A. (2006). Brief report: Gender and total knee/hip arthroplasty utilization rate in the VA system. Journal of general internal medicine, 21 Suppl 3, S54-7.
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  Osteoarthritis (OA) is a leading cause of disability and is more prevalent in women than men. Total joint arthroplasty is an effective treatment option for end-stage OA. We examined gender differences in utilization rates of total knee/hip arthroplasty in the Veterans Administration (VA) system.
• Jones, D. L., Kriska, A. M., Irrgang, J. J., Lian, Y., Pawar, V., Crossett, L. S., Kwoh, C. K., & Cauley, J. A. (2006).

  P232 PHYSICAL ACTIVITY AS A PREDICTOR OF LONG-TERM PHYSICAL HEALTH STATUS AFTER TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS

  . Osteoarthritis and Cartilage, 14, S127-S128. doi:10.1016/s1063-4584(07)60680-3
• Kwoh, C. K., Starz, T. W., & Vogt, M. T. (2006).

  Opioid usage among older adults with low back pain: comment on the article by Solomon et al.

  . Arthritis and rheumatism, 55(3), 513; author reply 513-4. doi:10.1002/art.21997
• Ansani, N. T., Vogt, M., Henderson, B. A., McKaveney, T. P., Weber, R. J., Smith, R. B., Burda, M., Kwoh, C. K., Osial, T. A., & Starz, T. (2005). Quality of arthritis information on the Internet. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 62(11), 1184-9.
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  The quality and reliability of Internet-based arthritis information were studied.
• Cope, D. K., Culyba, M., Kwoh, C. K., Osial, T. A., Starz, T. W., & Vogt, M. T. (2005).

  Analgesic usage for low back pain: impact on health care costs and service use.

  . Spine, 30(9), 1075-81. doi:10.1097/01.brs.0000160843.77091.07
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  Cross-sectional analysis of analgesic use by patients with low back pain (LBP)..To describe patterns of analgesic use and their cost implications for the use of other care services among individuals with LBP enrolled in a health insurance plan during 2001. It was hypothesized that the use of analgesics would be most frequent among patients with LBP with neurologic findings..National guidelines have recommended analgesics as the primary pharmacologic treatment of LBP. The choice of specific analgesics has major cost and service use implications..The University of Pittsburgh Health System includes 18 affiliated hospitals, more than 5000 physicians, and a commercial health plan with 255,958 members in 2001. This study uses the System Health Plan's insurance claims database to identify members who had services provided for one of 66 International Classification of Diseases, Version 9, Clinical Modification codes that identify mechanical LBP (n = 17,148)..In 2001, 7631 (43.5%) members with claims for LBP services had no analgesic pharmacy claims. The other 9517 (55.5%) had analgesics claims costing a total of $1.4 million; 68% of claimants were prescribed an opioid and 58% nonselective nonsteroidal antiinflammatory drugs (NSAID). The costs of opioids, NSAID, and cyclooxygenase-2 selective NSAID for patients with LBP represented 48%, 24%, and 28%, respectively, of total health plan expenditures for all uses of these drugs, including cancer. Opioid use was associated with the high volume usage of LBP care services. Patients with LBP with and without neurologic involvement and those with acquired lumbar spine structural disorders had similar patterns of analgesic use: those with congenital structural disorders were less likely to use analgesics; and those with psychogenic pain and LBP related to orthopedic devices were more likely to use opioids..With this health plan, a high proportion of patients with LBP had claims for opioids during 2001. The use of opioids by patients with LBP represents a major cost for the health plan, and is associated with specific patient characteristics and their use of other LBP services.
• Ibrahim, S. A., Stone, R. A., Han, X., Cohen, P., Fine, M. J., Henderson, W. G., Khuri, S. F., & Kwoh, C. K. (2005). Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty. Arthritis and rheumatism, 52(10), 3143-51.
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  The utilization of joint arthroplasty for knee or hip osteoarthritis varies markedly by patient race/ethnicity. Because of concerns about surgical risk, black patients are less willing to consider this treatment. There are few published race/ethnicity-specific data on joint arthroplasty outcomes. The present study was undertaken to examine racial/ethnic differences in mortality and morbidity following elective knee or hip arthroplasty.
• Ievers-Landis, C. E., Burant, C., Drotar, D., Morgan, L., Trapl, E. S., Colabianchi, N., & Kwoh, C. K. (2005). A randomized controlled trial for the primary prevention of osteoporosis among preadolescent girl scouts: 1-year outcomes of a behavioral program. Journal of pediatric psychology, 30(2), 155-65.
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  To provide 1-year outcomes for a randomized controlled trial of a behavioral-educational intervention for the primary prevention of osteoporosis among 247 preadolescent girls.
• Jones, A., Kwoh, C. K., Kelley, M. E., & Ibrahim, S. A. (2005). Racial disparity in knee arthroplasty utilization in the veterans health administration. Arthritis and rheumatism, 53(6), 979-81.
• Lopez, J. P., Burant, C. J., Siminoff, L. A., Kwoh, C. K., & Ibrahim, S. A. (2005). Patient perceptions of access to care and referrals to specialists: a comparison of African-American and white older patients with knee and hip osteoarthritis. Journal of the National Medical Association, 97(5), 667-73.
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  There is a marked racial difference in the use of knee and hip replacement for osteoarthritis (OA). The reasons for this disparity remain unclear. We examined how African-American and white patients with symptomatic OA of the knee and/or hip compare with respect to their perceptions of care for knee and hip OA.
• Dunbar-Jacob, J., Holmes, J. L., Sereika, S., Kwoh, C. K., Burke, L. E., Starz, T. W., McCall, M., & Foley, S. M. (2004). Factors associated with attrition of African Americans during the recruitment phase of a clinical trial examining adherence among individuals with rheumatoid arthritis. Arthritis and rheumatism, 51(3), 422-8.
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  To examine factors contributing to the loss of potential minority participants in a study of medication adherence among rheumatoid arthritis patients.
• Ibrahim, S. A., Zhang, A., Mercer, M. B., Baughman, M., & Kwoh, C. K. (2004). Inner city African-American elderly patients' perceptions and preferences for the care of chronic knee and hip pain: findings from focus groups. The journals of gerontology. Series A, Biological sciences and medical sciences, 59(12), 1318-22.
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  African Americans undergo joint replacement less often than do white persons. The authors studied African-American perceptions and preferences for the care of knee and hip pain.
• Jones, D. L., Cauley, J. A., Kriska, A. M., Wisniewski, S. R., Irrgang, J. J., Heck, D. A., Kwoh, C. K., & Crossett, L. S. (2004). Physical activity and risk of revision total knee arthroplasty in individuals with knee osteoarthritis: a matched case-control study. The Journal of rheumatology, 31(7), 1384-90.
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  To determine if physical activity was a risk factor for revision arthroplasty after primary total knee arthroplasty (TKA) due to osteoarthritis (OA) within the previous 15 years.
• Ang, D. C., Ibrahim, S. A., Burant, C. J., & Kwoh, C. K. (2003). Is there a difference in the perception of symptoms between african americans and whites with osteoarthritis?. The Journal of rheumatology, 30(6), 1305-10.
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  To determine if there is a difference in the perception of pain and functional disability between African Americans and Whites at any given radiographic severity of osteoarthritis (OA). Ethnic differences in utilization of joint replacement may reflect differences in the perception of symptoms of OA.
• Ibrahim, S. A., Burant, C. J., Mercer, M. B., Siminoff, L. A., & Kwoh, C. K. (2003). Older patients' perceptions of quality of chronic knee or hip pain: differences by ethnicity and relationship to clinical variables. The journals of gerontology. Series A, Biological sciences and medical sciences, 58(5), M472-7.
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  There is marked ethnic or racial disparity in the utilization of joint replacement for osteoarthritis. The reasons are not known. Pain is the reason most patients with osteoarthritis seek care. Cultural and psychosocial factors influence how patients experience and express pain. We examined whether patient descriptions of chronic pain vary by ethnicity and if they correlate with important clinical measures used in arthritis care.
• Ang, D. C., Ibrahim, S. A., Burant, C. J., Siminoff, L. A., & Kwoh, C. K. (2002). Ethnic differences in the perception of prayer and consideration of joint arthroplasty. Medical care, 40(6), 471-6.
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  Ethnic differences in utilization of arthroplasty may reflect differences in health-related attitudes and beliefs.
• Ibrahim, S. A., Burant, C. J., Siminoff, L. A., Stoller, E. P., & Kwoh, C. K. (2002). Self-assessed global quality of life: a comparison between African-American and white older patients with arthritis. Journal of clinical epidemiology, 55(5), 512-7.
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  Quality of life (QOL) perceptions influence patient decisions and preferences for care and, more importantly, physicians may render recommendations based on their impressions of the patient's QOL. QOL is perceived differently by different ethnic groups. This may have implications for understanding ethnic disparities in medical procedure utilization such as joint replacement for osteoarthritis. In a study of 596 elderly male patients with moderate to severe symptomatic knee/hip osteoarthritis, we examined how African-American and white patients rate their overall QOL. We adjusted their responses for important demographic, clinical, and psychosocial potential confounders. African-American (44%) and white (56%) patients in this study were comparable, except that African-Americans reported lower socioeconomic status compared with whites. After adjusting for all other study covariates, African-American ethnicity (B= -0.121, P = 0.004) was negatively correlated with overall QOL ratings. How ethnic variations in perceptions of QOL impact observed ethnic disparity in the utilization of joint replacement therapy needs further investigation.
• Ibrahim, S. A., Siminoff, L. A., Burant, C. J., & Kwoh, C. K. (2002). Differences in expectations of outcome mediate African American/white patient differences in "willingness" to consider joint replacement. Arthritis and rheumatism, 46(9), 2429-35.
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  Joint replacement therapy is an effective treatment option for end-stage osteoarthritis (OA) of the knee and/or hip. There are marked racial/ethnic disparities in the utilization of this procedure. The reasons for these disparities are not known. We sought to determine whether African American patients differ from white patients in their "willingness" to consider joint replacement and to determine the factors that influence this relationship.
• Ibrahim, S. A., Siminoff, L. A., Burant, C. J., & Kwoh, C. K. (2002). Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors. Medical care, 40(1 Suppl), I44-51.
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  There is a marked difference between black patients and white patients in the utilization of joint replacement therapy. The reasons behind this disparity remain unknown.
• Ibrahim, S. A., Siminoff, L. A., Burant, C. J., & Kwoh, C. K. (2001). Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients. Arthritis and rheumatism, 45(4), 340-5.
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  To compare elderly African American and white patients with osteoarthritis of the knee or hip with respect to their perceptions of the efficacy of traditional and complementary treatments and their self-care practices.
• Kwoh, C. K., & Ibrahim, S. A. (2001). Rheumatology patient and physician concordance with respect to important health and symptom status outcomes. Arthritis and rheumatism, 45(4), 372-7.
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  In chronic diseases such as arthritis, patients' priorities and values are of prime importance in the measurement of outcome. Relatively few indices take this into account. We sought to identify individual rheumatology patients' choices for important health and symptom status outcomes and assess physicians' ability to detect them.
• Fitzgerald, S. G., Kwoh, C. K., McCarty, D., Ramsey-Goldman, R., Medsger, T. A., & Manzi, S. (2000). The Lupus Foundation as an additional source for case ascertainment: developing a community-based lupus registry. Arthritis care and research : the official journal of the Arthritis Health Professions Association, 13(3), 137-40.
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  To determine whether the local Lupus Foundation of America (LFA) chapter would provide a unique source of additional lupus incident cases for a population-based incidence registry of SLE.
• Ibrahim, S. A., & Kwoh, C. K. (2000). Underutilization of oral anticoagulant therapy for stroke prevention in elderly patients with heart failure. American heart journal, 140(2), 219-20.
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  Oral anticoagulant therapy is the most effective prophylaxis against stroke in atrial fibrillation. Relatively few studies have examined the use of oral anticoagulant therapy for stroke prevention in a large cohort of elderly patients with heart failure. To examine the use of stroke prevention therapy, we studied elderly patients with heart failure admitted to 30 hospitals in northeast Ohio between 1992 and 1994.
• Ibrahim, S. A., Kwoh, C. K., Harper, D. L., & Baker, D. W. (2000). Racial differences in the utilization of oral anticoagulant therapy in heart failure: a study of elderly hospitalized patients. Journal of general internal medicine, 15(2), 134-7.
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  To assess racial differences in the use of oral anticoagulant therapy for patients with heart failure, we conducted a cohort study of 30 hospitals in northeast Ohio. For 12,911 Medicare enrollees consecutively admitted in 1992 through 1994 with heart failure, crude and adjusted odds of being on oral anticoagulation were determined. The crude and adjusted odds of being African Americans on oral anticoagulant therapy relative to whites were 0.57 (95% confidence interval 0.47-0.69) and 0.55 (95% confidence interval 0. 45-0.67), respectively. African-Americans with heart failure were much less likely than whites to receive oral anticoagulant therapy, even after adjusting for other variables associated with anticoagulant use.
• McCarty, D. J., Kwoh, C. K., Ramsey-Goldman, R., Manzi, S., & Medsger, T. A. (1999). We need simple guidelines for reporting rates of rheumatic diseases. Arthritis and rheumatism, 42(3), 585.
• Holm, M. B., Rogers, J. C., & Kwoh, C. K. (1998). Predictors of functional disability in patients with rheumatoid arthritis. Arthritis care and research : the official journal of the Arthritis Health Professions Association, 11(5), 346-55.
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  Using the World Health Organization's classification system of the consequences of disease, this study sought to examine the impact of physical and psychological impairment variables, beyond that contributed by social, demographic, and disease variables, on the functional disability of a rheumatoid arthritis (RA) sample. Data collected during an acute episode were used to predict concurrent and future disability status.
• Kwoh, C. K., Petrick, M. A., & Munin, M. C. (1997). Inter-rater reliability for function and strength measurements in the acute care hospital after elective hip and knee arthroplasty. Arthritis care and research : the official journal of the Arthritis Health Professions Association, 10(2), 128-34.
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  To determine the inter-rater reliability of function and strength measurements in patients undergoing elective hip and knee arthroplasty in an acute care setting.
• Scherping, S. C., Schmidt, C. C., Georgescu, H. I., Kwoh, C. K., Evans, C. H., & Woo, S. L. (1997). Effect of growth factors on the proliferation of ligament fibroblasts from skeletally mature rabbits. Connective tissue research, 36(1), 1-8.
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  Growth factors have been shown to stimulate fibroblast proliferation during wound and ligament healing. In this study, we analyzed individual effects of eight growth factors in vitro on the proliferation of fibroblasts from the medial collateral (MCL) and anterior cruciate (ACL) ligaments of skeletally mature rabbits. We compared the proliferative response of growth factor-treated and nontreated fibroblasts of both ligaments. The growth-factor treated fibroblasts of the MCL and ACL were also compared. We found that the fibroblasts exposed to epidermal growth factor, basic fibroblast growth factor and platelet-derived growth factor-BB proliferated significantly more than untreated fibroblasts. Acidic fibroblast growth factor at a dose of 1.0 ng/ml caused significant increases in fibroblast proliferation only in the MCL. Transforming growth factor-beta 1, insulin-like growth factor-1, platelet-derived growth factor-AA, and interleukin-1 alpha did not significantly stimulate fibroblast proliferation. MCL fibroblasts generally did not proliferate significantly more than ACL fibroblasts with the exception of MCL fibroblasts exposed to the highest doses of basic fibroblast growth factor, acidic fibroblast growth factor and platelet-derived growth factor-BB. The data were also compared with those obtained earlier using fibroblasts from skeletally immature rabbits (Schmidt et al., JOR 1995). The proliferative response of both the MCL and the ACL fibroblasts was found to decrease with skeletal maturation. Thus, our findings suggest that animal age and fibroblast origin are important factors in determining the proliferative response to growth factors.
• Kwoh, C. K., Venglish, C., Lynn, A. H., Whitley, D. M., Young, E., & Chakravarti, A. (1996). Age, sex, and the familial risk of rheumatoid arthritis. American journal of epidemiology, 144(1), 15-24.
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  The familial aggregation of rheumatoid arthritis was examined to determine factors modifying the risk of rheumatoid arthritis in first degree relatives of 165 cases ascertained from January 1, 1987, through March 31, 1987, using the Saint Margaret Memorial Hospital Rheumatoid Arthritis Registry, Pittsburgh, Pennsylvania, without regard to previous information concerning the occurrence of rheumatoid arthritis among their family members. The reported affection status of first degree relatives, verified through a structured clinical evaluation, revealed a false-positive reporting rate for family members of 61%. In contrast, there were no false-negative cases detected. There were no differences in average family size or total number of years at risk between 135 simplex and 30 multiplex families; however, aggregation analysis revealed that only 18 of 30 confirmed multiplex families had significant excess risk of rheumatoid arthritis. Significant differences were found when probands from multiplex families were compared with those from simplex families with regard to female to male ratio for probands (1:1 in multiplex families vs. 3:1 in simplex families) and average age of onset for probands (41 years in multiplex families vs. 48 years in simplex families). The familial risk for rheumatoid arthritis was similar in parents (4.2%) and siblings (4.6%) and lowest for children (0.7%) of probands. The authors assert that the affection status of first degree relatives of patients with rheumatoid arthritis is often falsely reported as positive. The familiality of rheumatoid arthritis may be more accurately related to the sex and age at onset of the affected family member.
• Pioro, M. H., & Kwoh, C. K. (1996). Update on measurement of relevant outcomes in rheumatology. Current opinion in rheumatology, 8(2), 101-5.
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  It is now recognized that disease has a multidimensional impact on patients' lives. This impact can be perceived as a spectrum encompassing on one end "hard" disease outcomes such as organ failure and mortality, and on the other end "soft" outcomes such as quality of life or patient satisfaction. This spectrum may be viewed as a framework in measuring both disease impact and response to treatment. In this paper, we review improvements in the methodology of measurement of relevant outcomes and highlight new findings and emerging trends in rheumatology.
• Tomlin, G. S., Holm, M. B., Rogers, J. C., & Kwoh, C. K. (1996). Comparison of standard and alternative health assessment questionnaire scoring procedures for documenting functional outcomes in patients with rheumatoid arthritis. The Journal of rheumatology, 23(9), 1524-30.
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  To compare statistical properties of data from the Health Assessment Questionnaire (HAQ) with those from an alternative version (AHAQ) that used a different scoring system for the item categories and disability index. Comparisons included descriptive statistics, correlations, and inferential statistics to determine whether the AHAQ would be a more sensitive measure of change in functional status.
• Kwoh, C. K., Laporte, R. E., Manzi, S., Mccarty, D. J., Medsger, T. A., & Ramsey-goldman, R. (1995).

  Incidence of systemic lupus erythematosus. Race and gender differences.

  . Arthritis and rheumatism, 38(9), 1260-70. doi:10.1002/art.1780380914
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  To examine racial differences in the incidence of systemic lupus erythematosus (SLE)..A population-based registry of SLE patients in Allegheny County, Pennsylvania, was used to identify incident cases of SLE diagnosed between January 1, 1985 and December 31, 1990, from 3 sources, by medical record review (University of Pittsburgh Lupus Databank, rheumatologists, and hospitals). Capture-recapture methods using log-linear models were used to estimate the level of case-finding and to calculate 95% confidence intervals (CI). Incidence rates were calculated per 100,000 population..A total of 191 definite and 78 probable incident cases of SLE were identified, and the overall annual incidence rates were 2.4 (95% CI 2.1-2.8) and 1.0 (95% CI 0.8-1.3), respectively. The crude incidence rates of definite SLE were 0.4 for white males, 3.5 for white females, 0.7 for African-American males, and 9.2 for African-American females. The annual incidence rates of definite SLE remained fairly constant over the study interval. African-American females with definite SLE had a younger mean age at diagnosis compared with white females (P < 0.05). Since the overall ascertainment rate was high (85%; 95% CI 78-92%), the ascertainment-corrected incidence rate for definite SLE, 2.8 (95% CI 2.6-3.2), was similar to the crude rate..Our rates clearly confirm previous reports of an excess incidence of SLE among females compared with males and among African-Americans compared with whites. We have used capture-recapture methods to improve the accuracy of SLE incidence rates, and we advocate their use to facilitate comparisons across studies.
• Lynn, A. H., Kwoh, C. K., Venglish, C. M., Aston, C. E., & Chakravarti, A. (1995). Genetic epidemiology of rheumatoid arthritis. American journal of human genetics, 57(1), 150-9.
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  We conducted family studies and segregation analyses of rheumatoid arthritis (RA) that were based on consecutive patients with RA ascertained without regard to family history or known risk factors. First-degree relatives from 135 simplex and 30 multiplex families were included in the analyses. A highly penetrant recessive major gene, with a mutant allele frequency of .005, was identified as the most parsimonious genetic risk factor. Significant evidence for heterogeneity in risk for RA was observed for proband gender but not for proband age at onset. Kaplan-Meier risk analysis demonstrated significant evidence for differences in the distribution of risk among first-degree relatives. These analyses demonstrated that both proband gender and age at onset are important risk factors but that proband gender appears to be the more important determinant of risk, with relatives of male probands having the greatest cumulative risk for RA. In addition, log-linear modeling identified proband gender, familiality (multiplex or simplex), and an interaction term between these two variables as being adequate to define the distribution of risk in families. The pattern of risk for RA among susceptible individuals and its inheritance is thus heterogeneous. For future genetic analyses, families with an excess of affected males having a young age at onset may be the most informative in identifying the putative recessive gene and its modifiers.
• Munin, M. C., Kwoh, C. K., Glynn, N., Crossett, L., & Rubash, H. E. (1995). Predicting discharge outcome after elective hip and knee arthroplasty. American journal of physical medicine & rehabilitation, 74(4), 294-301.
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  The objective of this prospective study was to determine if differences exist between individuals who require an inpatient rehabilitation program after elective hip and knee arthroplasty from those patients who can be discharged directly home. Multiple variables consisting of baseline demographics, social status, insurance status, medical history, pain level, quantitative strength, range of motion, and functional ability were examined. The primary outcome measure was the discharge destination from the orthopedic service and consisted of either a discharge to home or a discharge to an inpatient rehabilitation unit. Of the 162 patients followed, 65 (40%) were discharged to an inpatient rehabilitation unit, whereas 97 were discharged to home. The patients discharged to inpatient rehabilitation tended to live alone, were significantly older (mean difference = 6.3 yr), and had increased comorbid conditions (p < 0.001 for all variables). Patients discharged to a rehabilitation unit reported significantly greater pain levels than those discharged to home (P < 0.001). The attainment of a supervision level of function demonstrated greater differences between groups than the attainment of independent function for all functional measures. A logistic regression model was developed that predicted 76% of the discharges to rehabilitation by the third physical therapy session postsurgery. In conclusion, predictive markers do exist that differentiate individuals who require further inpatient therapy services after joint replacement surgery.
• Radis, C. D., Kahl, L. E., Baker, G. L., Wasko, M. C., Cash, J. M., Gallatin, A., Stolzer, B. L., Agarwal, A. K., Medsger, T. A., & Kwoh, C. K. (1995). Effects of cyclophosphamide on the development of malignancy and on long-term survival of patients with rheumatoid arthritis. A 20-year followup study. Arthritis and rheumatism, 38(8), 1120-7.
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  To examine the effects of cyclophosphamide (CYC) on the development of malignancies and on the long-term survival of patients with rheumatoid arthritis (RA).
• Schmidt, C. C., Georgescu, H. I., Kwoh, C. K., Blomstrom, G. L., Engle, C. P., Larkin, L. A., Evans, C. H., & Woo, S. L. (1995). Effect of growth factors on the proliferation of fibroblasts from the medial collateral and anterior cruciate ligaments. Journal of orthopaedic research : official publication of the Orthopaedic Research Society, 13(2), 184-90.
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  Growth factors have been shown to stimulate fibroblast division and thus may influence ligament healing. We analyzed the effects of individual growth factors on the proliferation of fibroblasts from the medial collateral and anterior cruciate ligaments of the rabbit in vitro in order to identify growth factors that might enhance proliferation of fibroblasts and to compare the responses of the fibroblasts from the two ligaments to these growth factors. Through measurement of the uptake of [3H]-thymidine into DNA, fibroblasts from these ligaments that had been treated with epidermal growth factor and basic fibroblast growth factor were found to proliferate nearly eight times more than control fibroblasts. Additionally, the fibroblasts of both ligaments proliferated at similar rates when exposed to platelet-derived growth factor-AA, platelet-derived growth factor-BB, basic fibroblast growth factor, insulin-like growth factor-1, and interleukin-1-alpha. However, epidermal growth factor and transforming growth factor-beta caused the fibroblasts from the medial collateral ligament to proliferate at a rate 1.3-1.4 times greater than that of fibroblasts from the anterior cruciate ligament. The reverse was true with acidic fibroblast growth factor, which stimulated the fibroblasts from the anterior cruciate ligament to proliferate at a rate 1.3-1.6 times greater than that of fibroblasts from the medial collateral ligament. This study demonstrated that growth factors can stimulate cell division in ligaments and may be effective in enhancing ligament healing but that these differences were not great enough to explain fully the clinical differences observed between healing of the medial collateral and anterior cruciate ligaments.
• Zavadak, K. H., Gibson, K. R., Whitley, D. M., Britz, P., & Kwoh, C. K. (1995). Variability in the attainment of functional milestones during the acute care admission after total joint replacement. The Journal of rheumatology, 22(3), 482-7.
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  To quantify patients' functional improvement in the immediate postoperative period after total hip arthroplasty (THA) or total knee arthroplasty (TKA).
• Cauley, J. A., Kwoh, C. K., Egeland, G., Nevitt, M. C., Cooperstein, L., Rohay, J., Towers, A., & Gutai, J. P. (1993). Serum sex hormones and severity of osteoarthritis of the hand. The Journal of rheumatology, 20(7), 1170-5.
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  To examine the relationship of endogenous sex hormones to the severity of radiographic hand osteoarthritis (ROA) in 229 white women, mean age 74 years.
• Kwoh, C. K., Laporte, R. E., Mccarty, D. J., Moy, C. S., & Tull, E. S. (1993).

  Ascertainment corrected rates: applications of capture-recapture methods.

  . International journal of epidemiology, 22(3), 559-65. doi:10.1093/ije/22.3.559
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  Accurate rates, though fundamental to epidemiology, are often very difficult to obtain. Incidence, prevalence, and mortality rates have traditionally been established through either passive reporting surveillance systems, through active surveillance systems, or by a combination of the two methods. Typically, when researchers employ these approaches they do not formally evaluate or correct for the degree of underascertainment. Undercount of cases is a potent determinant of rates which we cannot continue to ignore. We believe all rates should be adjusted for underascertainment in order to achieve a truer picture of the risk and risk factors of disease. Here, we present a procedure to ascertainment correct rates based upon well established capture-recapture methods.
• Kwoh, C. K. (1992). Epidemiology of the rheumatic diseases. Current opinion in rheumatology, 4(2), 138-44.
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  Replication of similar findings in diverse study populations using different study designs provides important evidence for causal inferences regarding risk factors reported in epidemiologic studies. Risk factors for knee osteoarthritis have been substantiated in a number of cross-sectional and longitudinal cohort studies. Longitudinal cohort studies have also added to our understanding of risk factors associated with hip osteoarthritis and hand osteoarthritis. In contrast, studies of hormonal and reproductive factors and the risk of developing rheumatoid arthritis continue to report conflicting results, and the importance of these risk factors remains unresolved. Recent studies suggest that the protective effect is limited only to the development of definite rheumatoid arthritis with a more severe clinical course. Cross-sectional studies of diverse populations show consistent age- and gender-specific differences in the rates of hip fracture among persons of Japanese ancestry and rates among several different groups of whites in the United States. The results of a population-based longitudinal cohort study suggest that women who live in communities where the drinking water has a high content of fluoride have a greater risk of osteoporosis and subsequent fractures than those living in communities with low fluoride in the drinking water. Finally, several recent reports provide additional evidence of the increasing incidence of acute rheumatic fever in the United States and other parts of the world.
• Kwoh, C. K., O'Connor, G. T., Regan-Smith, M. G., Olmstead, E. M., Brown, L. A., Burnett, J. B., Hochman, R. F., King, K., & Morgan, G. J. (1992). Concordance between clinician and patient assessment of physical and mental health status. The Journal of rheumatology, 19(7), 1031-7.
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  The degree of concordance between clinicians' and patients' assessment of the patient's physical and mental functioning was examined in 166 consecutive eligible outpatients with rheumatoid arthritis (RA) using 4-category ordinal scales. The weighted kappa statistic was 0.39 for physical functioning and 0.30 for mental functioning, both indicating a fair degree of concordance. This disagreement differed in magnitude and direction depending on the level of disability present. We conclude that clinicians and their patients with RA often disagree in their assessment of the degree of physical and mental impairment that the patient experiences. These disagreements demonstrate the need for formal assessments of outcome and should be recognized and resolved when managing individual patients.
• McCarty, D. J., Kwoh, C. K., & LaPorte, R. E. (1992). The importance of incidence registries for connective tissue diseases. The Journal of rheumatology, 19(1), 1-7.
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  There have been numerous studies conducted to determine the frequencies of CTD. These investigations, however, were usually not population based, relied on data sources set up primarily for administrative purposes, lacked unified methodologies for case definitions and verification, and failed to estimate the level of case ascertainment. Population based registries offer an alternative to past approaches and should not be overlooked for CTD. We propose that a standardized approach, as outlined above, will facilitate the development of registries and will permit the evaluation of the incidence of CTD across race, geographic area, and time. The establishment of standardized population based registries would form the foundation of a coordinated national and global effort to identify the etiology, and perhaps preventative measures, for these serious conditions.
• McKnight, P. T., & Kwoh, C. K. (1992). Randomized, controlled trial of compression gloves in rheumatoid arthritis. Arthritis care and research : the official journal of the Arthritis Health Professions Association, 5(4), 223-7.
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  A randomized, controlled trial was conducted to determine efficacy of the Isotoner and the Futuro compression gloves in 39 patients with hand synovitis secondary to rheumatoid arthritis. After 7 days of nighttime treatment, both brands of gloves were found to decrease subjective symptoms of pain and stiffness (p < 0.05). In addition, swelling of the proximal interphalangeal joints decreased, while range of motion, rate of finger motion, and grip strength all increased (p < 0.05). Compression gloves should be used with caution in patients with bilateral carpal tunnel syndrome, because 12 of 13 such patients experienced worsening of their symptoms following one nighttime wearing of compression gloves. While both gloves were found to be efficacious in improving the signs and symptoms of hand synovitis, neither glove was found to be superior to the other. Patient preferences related to glove composition and fit may ultimately determine which glove to prescribe.
• Regan-Smith, M. G., O'Connor, G. T., Kwoh, C. K., Brown, L. A., Olmstead, E. M., & Burnett, J. B. (1989). Lack of correlation between the Steinbrocker staging of hand radiographs and the functional health status of individuals with rheumatoid arthritis. Arthritis and rheumatism, 32(2), 128-33.
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  We evaluated the correlation between destructive changes seen on hand radiographs and disability in 54 patients with definite or classic rheumatoid arthritis. No statistically significant correlation was found between radiographic findings and patient disability as determined by patient and physician assessment or by the patient's score on the Arthritis Impact Measurement Scales questionnaire. These findings call into question the appropriateness of using hand radiographs as a determinant of disability or as a criterion for disability insurance benefits.

Proceedings Publications

• Bae, K. T., Chang, S., Kim, B., Kwoh, K., Kwoh, C. K., Lee, S., Lee, S., Lee, S. U., Shim, H., Tao, C., & Yun, I. D. (2008).

  3-D segmentation of articular cartilages by graph cuts using knee MR images from osteoarthritis initiative

  . In SPIE Proceedings, 6914.
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  Knee osteoarthritis is the most common debilitating health condition affecting elderly population. MR imaging of the knee is highly sensitive for diagnosis and evaluation of the extent of knee osteoarthritis. Quantitative analysis of the progression of osteoarthritis is commonly based on segmentation and measurement of articular cartilage from knee MR images. Segmentation of the knee articular cartilage, however, is extremely laborious and technically demanding, because the cartilage is of complex geometry and thin and small in size. To improve precision and efficiency of the segmentation of the cartilage, we have applied a semi-automated segmentation method that is based on an s/t graph cut algorithm. The cost function was defined integrating regional and boundary cues. While regional cues can encode any intensity distributions of two regions, "object" (cartilage) and "background" (the rest), boundary cues are based on the intensity differences between neighboring pixels. For three-dimensional (3-D) segmentation, hard constraints are also specified in 3-D way facilitating user interaction. When our proposed semi-automated method was tested on clinical patients' MR images (160 slices, 0.7 mm slice thickness), a considerable amount of segmentation time was saved with improved efficiency, compared to a manual segmentation approach.

Presentations

• Kwoh, C. K. (2020, March). NIH Health Initiative. NIH Health InitiativeNational Institute of Health.
• Kwoh, C. K. (2020, March). OAI Early OA Principal Investigators Meeting. OAI. UCSF Video Conference.
• Kwoh, C. K. (2018, April). Accelerated Approvals According to Subpart H- What Does That Mean for the OA Field: A Scientific and Regulatory Perspective and Discussion. OARSI.
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  Invited talk
• Kwoh, C. K. (2018, April). Utility of QMRI and SQMRI as Surrogate Measures in OA Clinical Trials. OARSI.
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  Invited talk
• Kwoh, C. K. (2018, July). Where Are We on the Road to Qualification of MRI for Drug Approval?. IWOAI.
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  Invited talk
• Kwoh, C. K., Hunter, D. J., Guermazi, A., Roemer, F., Vina, E. R., Ashbeck, E., Zhou, L., Kaur, M., Kwoh, C. K., Hunter, D. J., Guermazi, A., Roemer, F., Vina, E. R., Ashbeck, E., Zhou, L., & Kaur, M. (2018, October). Evaluating MRI-Detected Knee Inflammation Prior to Total Knee Replacement As a Predictive Biomarker of Clinically Important Pain Reduction Two Years Later. American College of Rheumatology Annual Meeting. Chicago, IL.
• Kwoh, C. K., Ibrahim, S. A., Weiner, D., Youk, A., Obrsosky, D. S., Hausmann, L., & Vina, E. R. (2018, June). Examining Modifiable Psychological & Social Health Factors Associated with Use of Osteoarthritis Oral Analgesic Treatment.. European League Against Rheumatism Annual Meeting. Amsterdam, Netherlands.
• Kwoh, C. K., Lee, J. K., Bhattacharjee, S., Malone, D. C., Lindermann, J., Hines, L., Roubal, A., Donohue, J., Zhou, L., Gellad, W. F., & Lo Ciganic, W. H. (2018, May). Geographic Variation of High-Risk Opioid Use and Risk of Overdose among Disabled Medicare Beneficiaries in the US from 2011 to 2015. ISPOR 23rd Annual International Meeting. Baltimore, MD, USA: ISPOR.
• Vina, E. R., Ran, D., Ashbeck, E., & Kwoh, C. K. (2017, November). Widespread Pain Prior to Total Knee Replacement (TKR) Is Associated with Increased Risk of No Clinical Improvement in Pain Among Women. American College of Rheumatology Annual Meeting. San Diego, CA.
• Zhou, L., Kwoh, C. K., Gellad, W. F., Donohue, J. M., Roubal, A., Hines, L., Malone, D. C., Bhattacharjee, S., Lee, J. K., Lindermann, J., Bell, M. L., Westra, J., Lo Ciganic, W. H., Zhou, L., Kwoh, C. K., Gellad, W. F., Donohue, J. M., Roubal, A., Hines, L., , Malone, D. C., et al. (2017, May). Geographic Variation of Inappropriate Prescription Opioid Use Among Disabled Medicare Beneficiaries. PODIUM presentation at the ISPOR 22nd Annual International Meeting. Boston, MA, USA.
• Vina, E. R., Hannon, M., & Kwoh, C. K. (2014, November). Improvement following total knee replacement (TKR) surgery: exploring preoperative symptoms and change in preoperative symptoms. American College of Rheumatology Annual Meeting. Boston, MA.

Poster Presentations

• Kwoh, C. K., Dagnino, J., Hannon, M. J., & Vina, E. R. (2019, June). Understanding ethnic differences in the utilization of nonsteroidal anti-inflammatory drugs for osteoarthritis. European League Against Rheumatism Annual Meeting. Madrid, Spain.
• Vina, E. R., Dagnino, J., & Kwoh, C. K. (2019, November). Attitudes and Beliefs About Opioid Medications: Determining Treatment Use in Osteoarthritis. American College of Rheumatology Annual Meeting. Atlanta, GA.
• Kwoh, C. K., Ashbeck, E., Ran, D., & Vina, E. R. (2018, January). Widespread Pain Prior to Total Knee Replacement (TKR) Is Associated with Increased Risk of No Clinical Improvement in Pain Among Women. University of Arizona Principal Investigator Poster Session. Tucson, AZ.
• Kwoh, C. K., Hannon, M. J., Ran, D., & Vina, E. R. (2018, June). Understanding ethnic differences in the utilization of exercise for osteoarthritis. American College of Rheumatology Research Workshop. San Francisco, CA.
• Kwoh, C. K., Hannon, M. J., Ran, D., Vina, E. R., Kwoh, C. K., Hannon, M. J., Ran, D., & Vina, E. R. (2018, June). Understanding ethnic differences in the utilization of exercise for osteoarthritis. European League Against Rheumatism Annual Meeting. Amsterdam, Netherlands.
• Tighe, C., Ibrahim, S. A., Youk, A., Vina, E. R., Parks, A., Weiner, D., Kwoh, C. K., & Hausmann, L. (2018, June). Examining pain catastrophizing and self-efficacy as cross-sectional mediators of sleep disturbance and pain in a sample of Veterans with arthritis. Annual Meeting of the Associated Professional Sleep Societies, LLC. Baltimore, MD.
• Vina, E. R., Dagnino, J., Kwoh, C. K., Hannon, M. J., Masood, H., Vina, E. R., Dagnino, J., Kwoh, C. K., Hannon, M. J., & Masood, H. (2018, October). Examining Ethnic Differences in Osteoarthritis (OA) Patients’ Knowledge and Attitudes Regarding Prescription Nonsteroidal Anti-Inflammatory Drugs. American College of Rheumatology Annual Meeting. Chicago, IL.
• Vina, E. R., Ran, D., Ashbeck, E., & Kwoh, C. K. (2016, November). Racial Differences in Self-Reported Pain and Disability: A Longitudinal Study of Knee Osteoarthritis. American College of Rheumatology Annual Meeting. Washington, DC.
• Vina, E. R., Ran, D., Ashbeck, E., Kaur, M., & Kwoh, C. K. (2016, November). Relationship Between Knee Pain and Patient Preferences for Joint Replacement: Health Care Access Matters. American College of Rheumatology Annual Meeting. Washington, DC.
• Masood, H., Hannon, M., Dagnino, J., Kwoh, C. K., & Vina, E. R. (2019, January). Examining Ethnic Differences in Osteoarthritis (OA) Patients’ Knowledge and Attitudes Regarding Prescription Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). University of Arizona Principal Investigator Poster Session. Tucson, AZ.
• Vina, E. R., Ran, D., Ashbeck, E., Ibrahim, S., Hannon, M., Zhou, J., & Kwoh, C. K. (2015, November). Patient preferences for total knee replacement surgery: two year follow-up.. American College of Rheumatology Annual Meeting. San Francisco, CA.
• Vina, E. R., Ran, D., Ashbeck, E., Kwoh, C. K., Vina, E. R., Ran, D., Ashbeck, E., & Kwoh, C. K. (2017, January). Racial Differences in Self-Reported Pain and Disability: A Longitudinal Study of Knee Osteoarthritis. Department of Medicine Principal Investigator Poster Session. Tucson, Arizona.
• Vina, E. R., Utset, T., Hannon, M., Masi, C., & Kwoh, C. K. (2013, October). Racial differences in lupus patients’ treatment preferences: a two-site study. American College of Rheumatology Annual Meeting. San Diego, CA.
• Vina, E. R., Cloonan, Y., Ibrahim, S., Hannon, M., Boudreau, R., & Kwoh, C. K. (2012, November). Race, gender and total knee replacement consideration: the role of social support. American College of Rheumatology Annual Meeting. Washington, DC.
• Vina, E. R., Cloonan, Y., Ibrahim, S., Hannon, M., Boudreau, R., & Kwoh, C. K. (2012, October). Race and total joint replacement consideration: the role of social support. Society for Medical Decision-Making Annual Meeting. Phoenix, AZ.

Reviews

• Kwoh, C. K. (2020. Investigators Meeting DSMB.
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  Reviewer for the DSMB MATCH Study.
• Demehri, S., Guermazi, A., & Kwoh, C. K. (2016. Diagnosis and Longitudinal Assessment of Osteoarthritis: Review of Available Imaging Techniques(pp 607-620).
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  Osteoarthritis (OA) is a major chronic and global health care problem. Recent technological advances in imaging and postprocessing techniques have enhanced the understanding and characterization of the pathophysiology of this chronic and prevalent disease. Although plain radiograph remains the modality of choice for initial assessment of OA, recent studies have shown that advanced cross-sectional imaging can improve the early detection, grading, structural damage quantification, and risk stratification of OA. This article discusses the currently available evidence regarding both the conventional and novel imaging modalities that can be used for evaluation of patients with OA and its longitudinal assessment.

Others

• Kwoh, C. K., Cauley, J. A., Strayhorn, M. T., Hannon, M. J., White, D., & Green, S. (2017, November). Feasibility of a Novel Approach to Studying Early Knee Osteoarthritis: An Offspring Study. ACR.
• Kwoh, C. K., Roemer, F., Ashbeck, E. L., Ratzlaff, C., Duryea, J., & Guermazi, A. (2016, November). MRI-Detected Cartilage Damage, Meniscal Damage, and Meniscal Extrusion Prior to Incident Radiographic Osteoarthritis and the Subsequent Trajectory of Joint Space Loss. ACR.
• Berlinberg, A., Bilal, J., Alhifany, A., Faridi, W., & Kwoh, C. K. (2018, October). The Risk of Serious and Opportunistic Infections in Rheumatologic Patients on Interleukin Inhibitors: A Systematic Review and Meta-Analysis. ACR.
• Dunlap, D., Song, J., Hootman, J., Lee, J., Nevitt, M., Sharma, L., Semanik, P., Eaton, C., Kwoh, C. K., Hochberg, M., Jackson, R., & Chang, R. (2018, October). Some Is Better Than None: Minimum Physical Activity Threshold to Prevent Disability in Older Adults with Lower Extremity Joint Symptoms. ACR.
• Eaton, C., Roberts, M., Driban, J., Haugen, I. K., Schaefer, L. F., Lu, B., Jackson, R., Hochberg, M., Kwoh, C. K., Blanco, F., & McAlindon, T. (2018, October). Association of Mitochondrial DNA Haplotypes with Symptomatic Hand and Thumb Based Osteoarthritis and Hand OA Progression. ACR.
• Eckstein, F., Mascheck, S., Sharma, L., Kwoh, C. K., & Wirth, W. (2018, April). Quantitative cartilage thickness change in radiographically normal knees with and without OA risk factors - Data from the OAI. OARSI.
• Kaur, M., Kwoh, C. K., Zhou, L., Ashbeck, E., Ashbeck, E., Bedrick, E., Vina, E., Eckstein, F., Roemer, F., Guerzmazi, A., Hunter, D., & Kwoh, C. K. (2018, October). Predictive Probabilities Are Superior in Communicating the Clinical Relevance of Cartilage Thickness As an Imaging Biomarker of Knee Osteoarthritis Progression. ACR.
• Kollampare, S., Kwoh, C. K., Lo-Ciganic, W., Zhou, L., Ashbeck, E., & Sudano, D. (2018, October). Serologic Screening for Coccidioidomycosis Among Medicare Beneficiaries with Rheumatic Diseases on Biologic Response Modifiers, Corticosteroids, and Dmards. ACR.
• Kumar, N., Lo-Ciganic, W., Zhou, L., Ashbeck, E., & Kwoh, C. K. (2018, October). Lipid Screening in Medicare Beneficiaries with Rheumatoid Arthritis. ACR.
• Kwoh, C. K., Ashbeck, E. L., Aydemir, A., Hannon, M. H., & Guehring, H. (2018, April). Pain medication reporting and patient-reported outcomes in the years prior to knee replacement: Challenges to assessing symptomatic experiences. OARSI.
• Kwoh, C. K., Ashbeck, E. L., Aydemir, A., Hannon, M. J., & Guehring, H. (2018, April). Two year tibiofemoral joint cartilage loss is weakly correlated with increased pain among knees with lower baseline cartilage thickness. OARSI.
• Kwoh, C. K., Ashbeck, E. L., Hannon, M. J., Wax, S., & Kraines, J. (2018, June). On the way to knee replacement: trajectory and correlation of knee oa mri cartilage thickness, radiographic joint space width, and womac knee pain in the oai. EULAR.
• Kwoh, C. K., Ashbeck, E., Bedrick, E., & Eckstein, F. (2018, July). Communicating Clinical Relevance of an Imaging Biomarker with Probability: Predicting Knee Replacement with Total Cartilage Thickness. IWOAI.
• Lee, J., Chang, A., Almagor, O., Chmiel, J., Hayes, K., Kwoh, C. K., & Sharma, L. (2018, October). Trajectories of Extensive Sitting and Associated Predictors in Persons at High Risk for Knee Osteoarthritis. ACR.
• Lo, G., Driban, J. B., Kriska, A. M., Price, L. L., Rockette-Wagner, B. J., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & McAlindon, T. E. (2018, April). Gardening associates with less knee pain: Data from the Osteoarthritis Initiative. OARSI.
• Lo, G., McAlindon, T., Kriska, A., Price, L. L., Rockette-Wagner, B., Mandl, L., Eaton, C., Hochberg, M., Jackson, R., Kwoh, C. K., Nevitt, M., & Driban, J. (2018, October). Participation in American Football Is Associated with Increased Risk for Knee Pain and Osteoarthritis: Data from the Osteoarthritis Initiative. ACR.
• Lo, G., Song, J., McAlindon, T. E., Hawker, G. A., Driban, J. B., Price, L. L., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., & Dunlop, D. D. (2018, April). Change in radiographic knee OA severity correlates better with change in composite pain and activity knee score compared with pain alone score. OARSI.
• Masood, H., Hannon, M., Kwoh, C. K., Dagnino, J., & Vina, E. (2018, October). Examining Ethnic Differences in Osteoarthritis (OA) Patients’ Knowledge and Attitudes Regarding Prescription Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). ACR.
• Peck, A., Pender, A., & Kwoh, C. K. (2018, October). Benefits Accrued through the Implementation of Telerheumatology Services. ACR.
• Roth, M., Emmanuel, K., Wirth, W., Kwoh, C. K., Hunter, D. J., Hannon, M. J., & Eckstein, F. (2018, April). 3D meniscal position predicts knee replacement in fast progressing knee osteoarthritis. OARSI.
• Sharma, L., Almagor, O., Chang, A., Kwoh, C. K., Nevitt, M., Hochberg, M., Jackson, R., Eaton, C., Cauley, J., Szymaszek, J., & Chmiel, J. (2018, October). Prediction Models for Poor Function Outcomes over 10 Years in Persons at High Risk for Knee Osteoarthritis. ACR.
• Vina, E. R., Hausmann, L., Obrosky, D. S., Youk, A., Weiner, D., Ibrahim, S., & Kwoh, C. K. (2018, June). Examining modifiable psychological & social health factors associated with use of osteoarthritis oral analgesic treatment. EULAR.
• Vina, E. R., Ran, D., Hannon, M. J., & Kwoh, C. K. (2018, June). Understanding ethnic differences in the utilisation of exercise for osteoarthritis. EULAR.
• Wirth, W., Nevitt, M. C., Hunter, D. J., Sharma, L., Kwoh, C. K., Mascheck, S., & Eckstein, F. (2018, April). Sensitivity to structural change in osteoarthritis is greatest in knees with low minimum JSW (<2mm) - Data from the OAI. OARSI.
• Martinez, J. A., Chalasani, P., Witte, R. S., Kwoh, C. K., Hadden, A., & Taljanovic, M. (2016, April). Imaging Biomarkers of Aromatase-Inhibitor Induced Joint Pain. University of Arizona, Cancer Center Retreat.
• Vina, E. R., Ashbeck, E. L., Ran, D., & Kwoh, C. K. (2016, June). Race and sex differences in radiographic progression of knee osteoarthritis. European League Against Rheumatism Annual Meeting.
• Collins, J. E., Collins, J. E., Losina, E., Losina, E., Nevitt, M. C., Nevitt, M. C., Roemer, F. W., Roemer, F. W., Guermazi, A., Guermazi, A., Lynch, J. A., Lynch, J. A., Katz, J. N., Katz, J. N., Kwoh, C. K., Kwoh, C. K., Jordan, J. M., Jordan, J. M., Kraus, V., , Kraus, V., et al. (2015, Unsure). Change in Semi-Quantitative Imaging Biomarkers Predicts Knee Osteoarthritis Progression: Data from the Fnih OA Biomarkers Consortium. Arthritis Rheumatol.
• Fujii, T., Boudreau, R. M., Guermazi, A., Strotmeyer, E. S., Brach, J., Miljkovic, I., Carbone, L., Harris, T. B., Nevitt, M., Shiroma, E. J., Newman, A. B., & Kwoh, C. K. (2015, Unsure). Physical activity and MRI assessed structural changes in knees of community-dwelling older adults. Osteoarthritis and Cartilage.
• Fujii, T., Miljkovic, I., Boudreau, R. M., Guermazi, A., Piva, S. R., Strotmeyer, E. S., Carbone, L., Harris, T. B., Marques, E. A., Shea, M. K., Nevitt, M. C., Newman, A. B., & Kwoh, C. K. (2015, Unsure). Are General and Central Adiposity Associated with MRI-Assessed Structural Changes in the Knees of Older Adults?. Arthritis Rheumatol.
• Johnson, V. L., Kwoh, C. K., Guermazi, A., Roemer, F., Boudreau, R. M., Fujii, T., Hannon, M. J., & Hunter, D. J. (2015, Unsure). Loss of anterior cruciate ligament integrity and the development of radiographic knee osteoarthritis: a sub-study of the osteoarthritis initiative. Osteoarthritis and Cartilage.
• Kwoh, C. K., Hannon, M. J., Fujii, T., Roemer, F. W., Guermazi, A., Hunter, D., Eckstein, F., & Boudreau, R. M. (2015, Unsure). Incident Frequent Knee Pain Is Associated with Changes in Semi-Quantitative Imaging Biomarkers of Inflammation. Arthritis Rheumatol.
• Kwoh, C. K., Sury, M., Russell, R., Maetani, T., Ratzlaff, C., Guermazi, A., Jarraya, M., & Duryea, J. (2015, Unsure). Software method to measure effusion-synovitis volume on MRI for knee OA. Osteoarthritis and Cartilage.
• Lo, G. H., Driban, J. B., Kriska, A. M., Storti, K. L., McAlindon, T. E., Souza, R. B., Eaton, C. B., Hochberg, M. C., Jackson, R. D., Kwoh, C. K., Nevitt, M. C., Petersen, N. J., & Suarez-Almazor, M. E. (2015, Unsure). Habitual running does not increase risk for symptom or structure progression in those with pre-existing knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis and Cartilage.
• McAlindon, T. E., Bannuru, R. R., Sullivan, M. C., Arden, N. K., Berenbaum, F., Bierma-Zeinstra, S. M., Hawker, G. A., Henrotin, Y., Hunter, D. J., Kawaguchi, H., Kwoh, C. K., Lohmander, S., Rannou, F., Roos, E. M., & Underwood, M. (2015, Unsure). Corrigendum to ‘2014 OARSI Guidelines for the Non-Surgical Management of Knee Osteoarthritis’ [Osteoarthritis and Cartilage 22 (2014) 363–388]. Osteoarthritis and Cartilage.
• Nicolella, D. P., Bredbenner, T. L., Havill, L. M., Tamez-Pena, J. G., Gonzalez, P., Schreyer, E., Totterman, S., & Kwoh, C. K. (2015, Unsure). Variation in knee shape predicts the future onset of radiographic knee osteoarthritis (RKOA) and this variation is different in males compared to females. Osteoarthritis and Cartilage.
• Razjouyan, J., Najafi, B., Ashbeck, E., Dunlop, D. D., Lee, J., Hamilton, L., & Kwoh, C. K. (2015, Unsure). Knee Pain Burden Is Associated with Decreased Motor Performance: Data from the Osteoarthritis Initiative. Arthritis Rheumatol.
• Razjouyan, J., Najafi, N., Ashbeck, E., Dunlop, D. D., Lee, J., Hamilton, L., & Kwoh, C. K. (2015, Unsure). Knee Pain Burden Is Associated with Decreased Moderate to Vigorous Physical Activity: Data from the Osteoarthritis Initiative. Arthritis Rheumatol.
• Roemer, F. W., Guermazi, A., Hannon, M. J., Hunter, D. J., Fujii, T., Eckstein, F., Boudreau, R. M., & Kwoh, C. K. (2015, Unsure). Incident MRI features during 4 years prior increase risk for radiographic osteoarthritis development. Osteoarthritis and Cartilage.
• Roemer, F. W., Guermazi, A., Hannon, M., Fujii, T., Boudreau, R. M., Hunter, D. J., Eckstein, F., & Kwoh, C. K. (2015, Unsure). Presence of MRI markers of inflammation especially in overweight persons increases risk of incident OA: The Poma Study. Osteoarthritis and Cartilage.
• Roemer, F. W., Hunter, D. J., Crema, M. D., Kwoh, C. K., Ochoa-Albiztegui, E., & Guermazi, A. (2015, Unsure). An illustrative overview of semi-quantitative MRI scoring of knee osteoarthritis: lessons learned from longitudinal observational studies. Osteoarthritis and Cartilage.
• Roemer, F. W., Kwoh, C. K., Hannon, M. J., Hunter, D. J., Eckstein, F., Fujii, T., Boudreau, R. M., & Guermazi, A. (2015, Unsure). Lesion load increases risk for osteoarthritis development: A 4 year longitudinal MRI-based multi-tissue analysis in the osteoarthritis initiative. Osteoarthritis and Cartilage.
• Sharma, L., Jackson, R., Almagor, O., Roemer, F., Guermazi, A., Crema, M., Nevitt, M. C., Hochberg, M., Kwoh, C. K., Eaton, C. B., Bathon, J., & Chmiel, J. S. (2015, Unsure). Significance of changing vs. stable pre-radiographic MRI lesions in persons at higher risk for knee osteoarthritis. Osteoarthritis and Cartilage.
• Shea, M. K., Kritchevsky, S. B., Hsu, F. C., Nevitt, M., Booth, S. L., Kwoh, C. K., McAlindon, T. E., Vermeer, C., Drummen, N., Harris, T. B., Womack, C., & Loeser, R. F. (2015, Unsure). The association between vitamin K status and knee osteoarthritis features in older adults: The Health, Aging and Body Composition Study. Osteoarthritis and Cartilage.
• Song, J., Gilbert, A., Chang, R. W., Pellegrini, C., Ehrlich-Jones, L. S., Lee, J., Pinto, D., Semanik, P., Sharma, L., Kwoh, C. K., Jackson, R. D., & Dunlop, D. D. (2015, Unsure). Influence of Increasing Physical Activity on Longitudinal Changes in Disability Status Among Inactive Older Adults. Arthritis Rheumatol.
• Vina, E. R., Ran, D., Ashbeck, E., Ibrahim, S., Hannon, M. J., Zhou, J., & Kwoh, C. K. (2015, Unsure). Patient Preferences for Total Knee Replacement Surgery: Two Year Follow-up. Arthritis Rheumatol.