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LAURE GOSSEC, GILLIAN HAWKER, AILEEN M. DAVIS, JEAN FRANCIS MAILLEFERT, L. STEFAN LOHMANDER, ROY ALTMAN, JOLANDA CIBERE, PHILIP G. CONAGHAN, MARC C. HOCHBERG, JOANNE M. JORDAN, JEFFREY N. KATZ, LYN MARCH, NIZAR MAHOMED, KAREL PAVELKA, EWA M. ROOS, MARIA E. SUAREZ-ALMAZOR, GUSTAVO ZANOLI, and MAXIME DOUGADOS

ABSTRACT.

Objective. Time to theoretical indication of joint replacement surgery has been proposed as a primary outcome for potential structure-modifying interventions for osteoarthritis (OA). The objectives of this OMERACT/OARSI Working Group were to identify pain, physical function, and structure states that represent the progression from early to late disease for individuals with OA of the hip and knee, and to create a composite measure of these 3 domains to define states of OA severity and a surrogate measure of "need for joint replacement surgery."

Methods. For pain, focus groups and one-on-one interviews were used. For function, Rasch analysis was performed on existing indices — the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS), each of which subsumes the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questions. For structure, a comparison of existing indices (Kellgren-Lawrence, OARSI stages, and joint space width) was performed for the hip and the knee.

Results. For pain, key features of pain that are most distressing to people with OA from early to late disease were identified. For function, the reduction of the number of items based on the existing indices continues. For structure, the analysis is also ongoing.

Conclusion. Preliminary results were presented at OMERACT 8; the final objective will be to combine the 3 domains (pain, function, and structure) and to create a composite index that could define states of severity and "need for total joint replacement," which could be used to evaluate treatment response to disease-modifying drugs in OA clinical trials. (J Rheumatol 2007;34:1432-5)

Key Indexing Terms:

OSTEOARTHRITIS
SEVERITY
PAIN
FUNCTION
STRUCTURE
OUTCOME MEASURE

From the Medicine Faculty, Paris 5 René Descartes University; AP-HP, Cochin Hospital, Department of Rheumatology B, Paris, France; Division of Rheumatology, Department of Medicine, Women's College Hospital; Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada; Outcomes and Population Health, Toronto Western Research Institute; Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada; Dijon University Hospital, and INSERM ERM 0207, University of Burgundy, Dijon, France; Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Division of Rheumatology and Immunology, University of California at Los Angeles, Los Angeles, California, USA; Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Centre of Canada, Vancouver, Canada; Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK; Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA; Departments of Medicine and Orthopaedics, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, and Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; University of Sydney, Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St. Leonards, NSW, Australia; Musculoskeletal Health and Arthritis Program, University of Toronto, Toronto Western Hospital, Toronto, Canada; Institute of Rheumatology and Clinic of Rheumatology, Charles University, Prague, Czech Republic; University of Texas, M.D. Anderson Cancer Center, Houston, Texas, USA; and Department of Orthopaedics, Ferrara University, Ferrara, Italy.

Supported by grants from OMERACT and Association de Recherche Clinique, Paris, and by a New Emerging Team Grant jointly funded by the Canadian Arthritis National Centres of Excellence and the Canadian Institutes of Health Research, and Arthritis Australia. Industrial support was obtained from Pfizer, Astra Zeneca, Novartis, and Negma Lerads Laboratories.

L. Gossec, MD, Medicine Faculty, Paris 5 René Descartes University; AP-HP, Cochin Hospital, Department of Rheumatology B; G. Hawker, MD, MSc, Division of Rheumatology, Department of Medicine, Women's College Hospital; Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, Professor of Medicine, Faculty of Medicine, University of Toronto; A. Davis, PhD, Clinical Epidemiology and Health Care Research Program, Department of Health Policy, Management and Evaluation, Associate Professor, Faculty of Medicine, University of Toronto; J.F. Maillefert, MD, PhD, Dijon University Hospital, and INSERM ERM 0207, Associate Professor of Rheumatology, University of Burgundy; L.S. Lohmander, MD, PhD, Professor and Senior Consultant, Department of Orthopaedics, Clinical Sciences Lund, Lund University; R. Altman, MD, Professor of Medicine, Division of Rheumatology and Immunology, University of California at Los Angeles; J. Cibere, MD, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia, Arthritis Research Centre of Canada; P.G. Conaghan, MBBS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Academic Unit of Musculoskeletal Disease, University of Leeds; M.C. Hochberg, MD, MPH, Professor of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine; J.M. Jordan, MD, MPH, Departments of Medicine and Orthopaedics, Thurston Arthritis Research Center, University of North Carolina; J.N. Katz, MD, MS, Associate Professor of Medicine and Orthopaedic Surgery, Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, and Department of Orthopaedic Surgery, Brigham and Women's Hospital; L. March, MD, PhD, Associate Professor of Medicine and Public Health, University of Sydney, Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital; N.N. Mahomed, MD, ScD, Smith & Nephew Chair in Orthopaedic Surgery, Associate Professor, Department of Surgery, Director, Musculoskeletal Health and Arthritis Program, University of Toronto, Toronto Western Hospital; K. Pavelka, MD, PhD, Professor, Institute of Rheumatology and Clinic of Rheumatology, Charles University; E.M. Roos, PT, PhD, Associate Professor, Department of Orthopaedics, Clinical Sciences Lund, Lund University; M.E. Suarez-Almazor, MD, PhD, Professor of Medicine, University of Texas, M.D. Anderson Cancer Center; G. Zanoli, MD, PhD, Department of Orthopaedics, Ferrara University; M. Dougados, MD, Professor of Rheumatology, Medicine Faculty, Paris 5 René Descartes University; AP-HP, Cochin Hospital, Department of Rheumatology B.

Address reprint requests to Prof. M. Dougados, Department of Rheumatology B, Cochin Hospital, 27 rue du Fbg St. Jacques, 75014 Paris, France.