Protocol - Arthritis/Osteoarthritis

Description

This protocol is divided into two parts. The first part contains detailed instructions for obtaining knee, hand, and pelvic radiographs using the Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative: A Knee Health Study. The second part of the protocol is the Kellgren-Lawrence Grading Scale©. This scale is a tool used by radiologists to determine the extent of osteo-arthritic findings seen via radiographs. Radiologists look at the amount of spacing between joints, bone formation, and bone contour when determining the Kellgren-Lawrence Grade©.

Specific Instructions

The Skin, Bone, Muscle and Joint Working Group (WG) recommends the knee, hand, and hip as the most critical areas to examine for osteoarthritis in genome wide association studies (GWAS) and other large population-based studies. Study investigators will need to tailor the area of examination according to their specific study hypotheses.

The Working Group recommends using the Osteoarthritis Initiative radiographic procedure manual for obtaining radiographs. This manual provides guidance for obtaining radiographs of the knee, hand, and pelvis of adults. However, please note that not all sites must be done.

Additionally, the Working Group recommends using the Kellgren-Lawrence Grading Scale© once a radiograph is obtained. The Kellgren-Lawrence Grading Scale© grades are for each joint and are not combined or averaged. Each grade provides information on the level of osteoarthritis at each joint location.

Availability

Available

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Protocol

Part I: Summary of the Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative: A Knee Health Study

The Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs is designed for obtaining radiographs by use of conventional radiographic equipment with exposure of radiographic film. The manual also contains information for applying its procedures with the use of digital radiographic equipment.

The manual contains information for preparing X-ray participants, proper participant positioning, and information for assisting participants in maintaining proper positioning.

In addition, the manual contains instructions for obtaining unilateral posteroanterior (PA) fixed flexion knee radiographs with fluoroscopy, PA semiflexed knee radiographs with fluoroscopy, lateral knee radiographs for controls, and unilateral and bilateral hand radiographs (including pictures of proper and improper positioning), positioning of the X-ray tube, documentation, and quality control.

Instructions for obtaining the Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs can be found in the Source section. Sections 3.3 and 3.6–3.8 of this manual are for obtaining knee radiographs. The first part of section 3.4 (pages 24–36) is for obtaining hand radiographs, whereas the second part of section 3.4 (pages 37–42) is for obtaining pelvic radiographs, which include the hip joints.

Part II: Kellgren-Lawrence Grading Scale^©

Once the radiograph(s) is obtained, the PhenX Skin, Bone, Muscle and Joint Working Group recommends that a radiologist use the Kellgren-Lawrence Grading Scale^© for interpretation.

Kellgren-Lawrence Grading Scale^©

[ ] Grade 1: doubtful narrowing of joint space and possible osteophytic lipping

[ ] Grade 2: definite osteophytes, definite narrowing of joint space

[ ] Grade 3: moderate multiple osteophytes, definite narrowing of joints space, some sclerosis and possible deformity of bone contour

[ ] Grade 4: large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone contour

Personnel and Training Required

A trained X-ray technician is required to administer the radiograph, and radiographs (X-rays) must be interpreted (“read”) by a trained radiologist.

Equipment Needs

Conventional or digital X-ray machine and the related standard implementation equipment, such as lead vests for patients. Standard equipment used by radiologists to view radiographs is also required.

Requirements

Requirement Category	Required
Major equipment	Yes
Specialized training	Yes
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	Yes

Mode of Administration

Noninvasive radiologic assessment

Lifestage

Adult, Senior

Participants

For the Osteoarthritis Initiative manual: Adults, age 45 to 79

For the Kellgren-Lawrence Grading Scale®: Adults, Older Adults

Selection Rationale

The Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative was chosen because it was a large-scale study of 5,000 male and female participants with well established standards and quality control procedures.

The Kellgren-Lawrence Grading Scale® was chosen because it has been vetted against other radiographic grading scales and is considered the gold standard in radiographic interpretation for the presence of osteoarthritis. This scale has been widely and routinely used in both clinical and research settings for several years.

Language

Chinese, English

Standards

Standard	Name	ID	Source
Logical Observation Identifiers Names and Codes (LOINC)	Arthritis osteoarthritis proto	62900-6	LOINC
Human Phenotype Ontology	Osteoaerthritis	HP:0002758	HPO
caDSR Form	PhenX PX170201 - Arthritis Osteoarthritis	6185913	caDSR Form

Derived Variables

None

Process and Review

Not applicable.

Protocol Name from Source

A Knee Health Study, The Kellgren-Lawrence Grading Scale, version 2.1, August 2006

Source

The Radiographic Procedure Manual for Examinations of the Knee, Hand, Pelvis and Lower Limbs from the Osteoarthritis Initiative: A Knee Health Study (version 2.1 August 2006).

Information regarding this manual can also be obtained through:

San Francisco Coordinating Center
185 Berry St.
Lobby 4, Suite 5700
San Francisco, CA 94107
(415) 514-8000
OAIOnlineFeedback@psg.ucsf.edu

The Kellgren-Lawrence Grading Scale^©can be found on the American College of Radiology Imaging Network (ACRIN) website.

General References

Kellgren, J. H., & Lawrence, J. S. (1957). Radiological assessment of osteo-arthrosis. Annals of the Rheumatic Diseases,16, 494–502.

Protocol ID

170201

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX170201_Hand_Image_ID
	PX170201010000	Hand scan image name (ID)	N/A
PX170201_Hand_Score
	PX170201030000	Kellgren-Lawrence score for hand	N/A
PX170201_Hip_Image_ID
	PX170201070000	Hip scan image name (ID)	N/A
PX170201_Hip_Score
	PX170201090000	Kellgren-Lawrence score for hip	N/A
PX170201_Knee_Image_ID
	PX170201040000	Knee scan image name (ID)	N/A
PX170201_Knee_Score
	PX170201060000	Kellgren-Lawrence score for knee	N/A
PX170201_Left_Right_Hand
	PX170201020000	Left or right hand scanned	Variable Mapping
PX170201_Left_Right_Hip
	PX170201080000	Left or right hip scanned	Variable Mapping
PX170201_Left_Right_Knee
	PX170201050000	Left or right knee scanned	N/A

Bone and Joint

Measure Name

Arthritis/Osteoarthritis

Release Date

November 12, 2010

Definition

This is a measure to obtain unilateral or bilateral knee, hand, and pelvic (for hip joint) radiographs (X-rays) and to interpret the radiographs to determine the level of osteoarthritis.

Purpose

This measure can be used to determine the level of osteoarthritis, one of the most common joint conditions affecting adults and older adults.

Keywords

arthritis, knee osteoarthritis, hand osteoarthritis, hip osteoarthritis, pelvis, radiographs, X-rays, joint narrowing, joint spacing, The Osteoarthritis Initiative (OAI), Kellgren-Lawrence Grading Scale, K-L Grade, gerontology, aging, geriatrics, bone, joint

Measure Protocols

Protocol ID	Protocol Name
170201	Arthritis/Osteoarthritis

Publications

There are no publications listed for this protocol.

Mapping for PX170201_Left_Right_Hand

dbGAP Study	dbGAP Variable	dbGAP Variable Description
Atherosclerosis Risk in Communities (ARIC) Cohort	phv00207154	[Handedness]. Are you right-handed or left-handed? Q73 [Health/Medical History, exam 2]
CIDR: Genome Wide Association Study in Familial Parkinson Disease (PD)	phv00045296	The subject has a hand preference (left, right), or uses both hands equally well (ambidextrous) (see phs000004: NINDS Repository Neurologically Normal Control Collection)
Coenzyme Q10 (CoQ) in Huntington's Disease (HD) (2CARE)	phv00261299	16 Handedness
GWAS on Cataract and HDL in the PMRP	phv00181826	Handedness Classification 1=Right 2=Left 3=Mixed
Ischemic Stroke Genetics Study (ISGS)	phv00024322	The subject has a hand preference (left, right), or uses both hands equally well (ambidextrous).
NIH Exome Sequencing of Familial Amyotrophic Lateral Sclerosis Project	phv00024145	The hand preference of the subject; the subject's dominant hand.
NIH Exome Sequencing of Familial Amyotrophic Lateral Sclerosis Project	phv00024219	The subject has a hand preference (left, right), or uses both hands equally well (ambidextrous).
NINDS Parkinson's Disease	phv00023996	The subject has a hand preference (left, right), or uses both hands equally well (ambidextrous).
NINDS Parkinson's Disease	phv00024015	The hand preference of the subject; the subject's dominant hand
NINDS Parkinsonism Study	phv00000190	The hand preference of the subject; the subject's dominant hand
NINDS Repository Cerebrovascular Disease/Stroke Study	phv00000297	The subject has a hand preference (left, right) or uses both hands equally well (ambidextrous).
NINDS Repository Motor Neuron Disease/ALS Study	phv00000405	The hand preference of the subject; the subject's dominant hand.
NINDS Repository Neurologically Normal Control Collection	phv00000272	The subject has a hand preference (left, right), or uses both hands equally well (ambidextrous).
Whole Exome Sequencing in Familial Parkinson Disease	phv00161346	Subject's report of handedness

Mapping for PX170201_Left_Right_Hip

dbGAP Study	dbGAP Variable	dbGAP Variable Description
Framingham Cohort	phv00036221	HIP SIDE (RIGHT VS. LEFT) THAT WAS SCANNED
Framingham Cohort	phv00036252	HIP SIDE (RIGHT VS. LEFT) THAT WAS SCANNED
Framingham Cohort	phv00156712	Hip side that was scanned