Ultrasound Phenotype-Based Approach to Treatment Choice in Osteoarthritis

Area of Science:

• Rheumatology
• Medical Imaging
• Orthopedics

Background:

• Osteoarthritis (OA) is a prevalent chronic disease impacting joint structures, leading to reduced quality of life and increased healthcare costs.
• Current OA classification and patient stratification methods are often inconclusive, hindering the development of effective disease-modifying therapies.
• Musculoskeletal ultrasonography (MSK US) offers dynamic visualization of joint tissues, providing insights into inflammatory and structural changes.

Purpose of the Study:

• To evaluate the potential of MSK US in determining OA clinical phenotypes.
• To emphasize the role of MSK US in guiding therapeutic strategies for OA.
• To identify predominant ultrasound phenotypes across different OA joint localizations.

Main Methods:

• A prospective, single-center study enrolled 259 patients with confirmed OA.
• Data were analyzed using Minitab statistical software (version 22.2.1).
• Predominant and secondary ultrasound phenotypes were tabulated and compared using paired z-tests with Bonferroni correction.

Main Results:

• For knee OA, intra-articular effusion was the most frequent phenotype (37.90%).
• Altered subchondral bone was the leading phenotype in hip (47.1%) and hand (55.40%) OA.
• Extra-articular soft tissue changes (46.20%) and post-traumatic changes (30.70%) were most frequent in shoulder OA.

Conclusions:

• MSK US is a valuable tool for the clinical phenotyping of OA.
• Identifying specific ultrasound phenotypes can inform and rationalize OA treatment selection.
• The choice of therapy can be guided by the predominant affected tissue and pathogenetic mechanism visualized by MSK US.