BACKGROUND: Early stage of osteoarthritis (OA) is characterized by joint stiffness and pain as well as by subclinical structural changes that may affect cartilage, synovium, and bone. At the moment, the lack of a validated definition of early osteoarthritis (EOA) does not allow to make an early diagnosis and adopt a therapeutic strategy to slow disease progression. Also, no questionnaires are available to evaluate the early stage, and therefore this remains an unmet need. OBJECTIVE: Therefore, the purpose of the technical experts panel (TEP) of 'International Symposium of intra-articular treatment' (ISIAT) was to create a specific questionnaire to evaluate and monitor the follow-up and clinical progress of patients affected by early knee OA. DESIGN: The items for the Early Osteoarthritis Questionnaire (EOAQ) were identified according to the following steps: items generation, items reduction, and pre-test submission. METHODS: During the first step, literature has been reviewed and a comprehensive list of items about pain and function in knee EOA was drafted. Then, during the ISIAT (5th edition 2019), the draft has been discussed by the board, which reformulated, deleted, or subdivided some of the items. After the ISIAT symposium, the draft was submitted to 24 subjects affected by knee OA. A score based on the importance and the frequency was created and the items with a score ⩾0.75 were selected. After intermediate evaluation made by a sample of patients, the second and final version of the questionnaire EOAQ was submitted to the whole board for final analysis and acceptance in a second meeting (29 January 2021). RESULTS: After an exhaustive elaboration, the final version of the questionnaire contains two domains (Clinical Features and Patients Reported Outcome) with respectively 2 and 9 questions, for a total of 11 questions. Questions mainly explored the fields of early symptoms and patients reported outcomes. Marginally, the need of the symptoms treatment and the use of painkillers were investigated. CONCLUSIONS: Adoption of diagnostic criteria of early OA is strongly encouraged and a specific questionnaire for the whole management of the clinical features and patients' outcome might really improve the evolution of OA in the early stages of the disease, when the treatment is expected to be more effective.

Academic Department of Orthopaedics Hull and East Yorkshire NHS Trust Castle Hill Hospital Cottingham UK

Centre for Treatment Comparison and Integrative Analysis Division of Rheumatology Tufts Medical Centre Boston MA USA

Chirurgia Ortopedica Mininvasiva e Nuove Tecnologie Humanitas Research Hospital Castellanza Italy

Department of Emergency Medicine Dr Ram Manohar Lohia Hospital Lucknow India

Department of Experimental and Clinical Medicine University of Florence Florence Italy

Department of Family Medicine School of Kinesiology University Western Ontario Ontario ON Canada

Department of Internal Medicine and Rheumatology Sf Maria Hospital University of Medicine and Pharmacy 'Carol Davila' Bucharest Romania

Department of Medical and Surgical Specialties and Dentistry University of Campania 'L Vanvitelli' Caserta Italy

Department of Metabolic Diseases of Bone and Joints VA Nasonova Research Institute of Rheumatology Moscow Russian Federation

Department of Orthopaedics and Traumatology 'Policlinico Tor Vergata' Foundation Rome Italy

Department of Orthopaedics and Traumatology University of Campinas São Paulo Brazil

Department of Physical Medicine and Rehabilitation Division of Pain Medicine Istanbul University Istanbul Turkey

Department of Rheumatology Belorussian State Medical University Minsk Belarus

EUPATI Graduate and Patient Advocate Brussels Belgium

Institute of Rheumatology Prague Czech Republic

Joint and Bone Research Unit IIS Fundacion Jimenez Diaz UAM Madrid Spain

Orthopaedic Department Johanna Etienne Hospital Neuss Germany

Physical Rehabilitation Medicine Department Rovisco Pais Medical and Rehabilitation Centre Tocha Portugal

Rheumatology Department AP HP Saint Antoine Hospital Paris France

Rheumatology Unit San Pietro Fatebenefratelli Hospital Rome Italy

Rheumatology Unit San Pietro Fatebenefratelli Hospital Via Cassia 600 00189 Rome Italy

Service de Rhumatologie Hôpital Nord Franche Belfort France

Unit of Rheumatology Henri Mondor Hospital Créteil France

See more in PubMed

Abramoff B, Caldera FE. Osteoarthritis: pathology, diagnosis, and treatment options. Med Clin North Am 2020; 104: 293–311. PubMed

Hunter DJ, Schofield D, Callander E. The individual and socioeconomic impact of osteoarthritis. Nat Rev Rheumatol 2014; 10: 437–441. PubMed

Centers for Disease Control Prevention (CDC). Prevalence and impact of arthritis among women – United States, 1989-1991 [published correction appears in MMWR Morb Mortal Wkly Rep 1995 Jul 14;44(27):517–518]. MMWR Morb Mortal Wkly Rep 1995; 44: 329–334. PubMed

Glyn-Jones S, Palmer AJ, Agricola R, et al.. Osteoarthritis. Lancet 2015; 386: 376–387. PubMed

Grazina R, Andrade R, Bastos R, et al.. Clinical management in early OA. Adv Exp Med Biol 2018; 1059: 111–135. PubMed

Zheng L, Zhang Z, Sheng P, et al.. The role of metabolism in chondrocyte dysfunction and the progression of osteoarthritis. Ageing Res Rev 2020; 66: 101249. PubMed

Rajandran SN, Ann Ma C, Tan JR, et al.. Exploring the association of innate immunity biomarkers with MRI features in both early and late stages osteoarthritis. Front Med (Lausanne) 2020; 7: 554669. PubMed PMC

Greif DN, Kouroupis D, Murdock CJ, et al.. Infrapatellar fat pad/synovium complex in early-stage knee osteoarthritis: potential new target and source of therapeutic mesenchymal stem/stromal cells. Front Bioeng Biotechnol 2020; 8: 860. PubMed PMC

Migliore A, Picarelli G. Is osteoarthritis a gender-specific disease? Ital J Gender-Specific Med 2018; 4: 13–20.

Luyten FP, Denti M, Filardo G, et al.. Definition and classification of early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2012; 20: 401–406. PubMed

Madry H, Kon E, Condello V, et al.. Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24: 1753–1762. PubMed

Iolascon G, Gimigliano F, Moretti A, et al.. Early osteoarthritis: how to define, diagnose, and manage. A systematic review. Eur Geriatr Med 2017; 8: 383–396.

Migliore A, Scirè CA, Carmona L, et al.. The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology. Rheumatol Int 2017; 37: 1227–36. PubMed

Mobasheri A, Saarakkala S, Finnilä M, et al.. Recent advances in understanding the phenotypes of osteoarthritis. F1000RES 2019; 8: F1000. PubMed PMC

Castaneda S, Roman-Blas JA, Largo R, et al.. Osteoarthritis: a progressive disease with changing phenotypes. Rheumatology (Oxford) 2014; 53: 1–3. PubMed

Deveza LA, Melo L, Yamato TP, et al.. Knee osteoarthritis phenotypes and their relevance for outcomes: a systematic review. Osteoarthritis Cartilage 2017; 25: 1926–1941. PubMed

Beaudart C, Biver E, Reginster JY, et al.. Development of a self-administrated quality of life questionnaire for sarcopenia in elderly subjects: the SarQoL. Age Ageing 2015; 44: 960–966. PubMed PMC

Collins GS, Reitsma JB, Altman DG, et al.. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med 2015; 162: W1–W73. PubMed

Eijkenboom JFA, Timmer ER, van der Heijden RA, et al.. Association between self-reported measures, physical examination, and early magnetic resonance imaging signs of osteoarthritis in patients with patellofemoral pain. J Orthop Sports Phys Ther 2019; 49: 634–639. PubMed

Emery CA, Whittaker JL, Mahmoudian A, et al.. Establishing outcome measures in early knee osteoarthritis. Nat Rev Rheumatol 2019; 15: 438–448. PubMed

Luyten FP, Bierma-Zeinstra S, Dell’Accio F, et al.. Toward classification criteria for early osteoarthritis of the knee. Semin Arthritis Rheum 2018; 47: 457–463. PubMed

Sancheti P, Shetty VD, Dhillon MS, et al.. India-Based Knee Osteoarthritis Evaluation (iKare): a multi-centre cross-sectional study on the management of knee pain and early osteoarthritis in India. Clin Orthop Surg 2017; 9: 286–294. PubMed PMC

Migliore A, Scirè CA, Carmona L, et al.. The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology [published correction appears in Rheumatol Int. 2017 Aug;37(8):1237–1238]. Rheumatol Int 2017; 37: 1227–1236. PubMed

Suzuki Y, Iijima H, Shimoura K, et al.. Patients with early-stage knee osteoarthritis and knee pain have decreased hip abductor muscle strength while descending stairs. Clin Rheumatol 2019; 38: 2249–2254. PubMed

Bieleman HJ, Stewart R, Reneman MF, et al.. Trajectories of physical work capacity in early symptomatic osteoarthritis of hip and knee: results from the Cohort Hip and Cohort Knee (CHECK) Study. J Occup Rehabil 2019; 29: 483–492. PubMed

Mahmoudian A, van Dieen JH, Baert IA, et al.. Changes in proprioceptive weighting during quiet standing in women with early and established knee osteoarthritis compared to healthy controls. Gait Posture 2016; 44: 184–188. PubMed

Fukutani N, Iijima H, Aoyama T, et al.. Knee pain during activities of daily living and its relationship with physical activity in patients with early and severe knee osteoarthritis. Clin Rheumatol 2016; 35: 2307–2316. PubMed

Meireles S, De Groote F, Reeves ND, et al.. Knee contact forces are not altered in early knee osteoarthritis. Gait Posture 2016; 45: 115–120. PubMed

Hensor EM, Dube B, Kingsbury SR, et al.. Toward a clinical definition of early osteoarthritis: onset of patient-reported knee pain begins on stairs. Arthritis Care Res (Hoboken) 2015; 67: 40–47. PubMed PMC

van der Esch M, Holla JF, van der Leeden M, et al.. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil 2014; 95: 1962–1968. PubMed

Arliani GG, Astur DC, Yamada RK, et al.. Early osteoarthritis and reduced quality of life after retirement in former professional soccer players. Clinics (Sao Paulo) 2014; 69: 589–594. PubMed PMC

Duffell LD, Gulati V, Southgate DF, et al.. Measuring body weight distribution during sit-to-stand in patients with early knee osteoarthritis. Gait Posture 2013; 38: 745–750. PubMed

Holla JF, van der Leeden M, Knol DL, et al.. Avoidance of activities in early symptomatic knee osteoarthritis: results from the CHECK cohort. Ann Behav Med 2012; 44: 33–42. PubMed

Holla JF, Steultjens MP, van der Leeden M, et al.. Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the CHECK cohort. Osteoarthritis Cartilage 2011; 19: 411–419. PubMed

Bieleman HJ, van Ittersum MW, Groothoff JW, et al.. Functional capacity of people with early osteoarthritis: a comparison between subjects from the cohort hip and cohort knee (CHECK) and healthy ageing workers. Int Arch Occup Environ Health 2010; 83: 913–921. PubMed PMC

Holla JF, Steultjens MP, Roorda LD, et al.. Prognostic factors for the two-year course of activity limitations in early osteoarthritis of the hip and/or knee. Arthritis Care Res (Hoboken) 2010; 62: 1415–1425. PubMed

Bennell KL, Messier SP. Osteoarthritis: strength training, self-management or both for early knee OA. Nat Rev Rheumatol 2010; 6: 313–314. PubMed

Bieleman HJ, Oosterveld FG, Oostveen JC, et al.. Work participation and health status in early osteoarthritis of the hip and/or knee: a comparison between the Cohort Hip and Cohort Knee and the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2010; 62: 683–689. PubMed PMC

Farr JN, Going SB, McKnight PE, et al.. Progressive resistance training improves overall physical activity levels in patients with early osteoarthritis of the knee: a randomized controlled trial. Phys Ther 2010; 90: 356–366. PubMed PMC

Diraçoglu D, Baskent A, Yagci I, et al.. Isokinetic strength measurements in early knee osteoarthritis. Acta Reumatol Port 2009; 34: 72–77. PubMed

Petrella M, Gramani-Say K, Serrão PR, et al.. Measuring postural control during mini-squat posture in men with early knee osteoarthritis. Hum Mov Sci 2017; 52: 108–116. PubMed

Schiphof D, Runhaar J, Waarsing JH, et al.. The clinical and radiographic course of early knee and hip osteoarthritis over 10 years in CHECK (Cohort Hip and Cohort Knee). Osteoarthritis Cartilage 2019; 27: 1491–1500. PubMed

Berlinberg A, Ashbeck EL, Roemer FW, et al.. 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 Cartilage 2019; 27: 80–89. PubMed

Wesseling J, Bastick AN, ten Wolde S, et al.. Identifying trajectories of pain severity in early symptomatic knee osteoarthritis: a 5-year followup of the Cohort Hip and Cohort Knee (CHECK) Study. J Rheumatol 2015; 42: 1470–1477. PubMed

Holla JF, van der Leeden M, Knol DL, et al.. Predictors and outcome of pain-related avoidance of activities in persons with early symptomatic knee osteoarthritis: a five-year followup study. Arthritis Care Res (Hoboken) 2015; 67: 48–57. PubMed

Leyland KM, Gates LS, Sanchez-Santos MT, et al.. Knee osteoarthritis and time-to all-cause mortality in six community-based cohorts: an international meta-analysis of individual participant-level data. Aging Clin Exp Res 2021; 33: 529–545. PubMed PMC

Favero M, Ramonda R, Goldring MB, et al.. Early knee osteoarthritis. RMD Open 2015; 1(Suppl. 1): E000062. PubMed PMC

Chu CR, Williams AA, Coyle CH, et al.. Early diagnosis to enable early treatment of pre-osteoarthritis. Arthritis Res Ther 2012; 14: 212. PubMed PMC

Martel-Pelletier J, Maheu E, Pelletier JP, et al.. A new decision tree for diagnosis of osteoarthritis in primary care: international consensus of experts. Aging Clin Exp Res 2019; 31: 19–30. PubMed PMC

Migliore A, Gigliucci G, Alekseeva L, et al.. Treat-to-target strategy for knee osteoarthritis. International technical expert panel consensus and good clinical practice statements. Ther Adv Musculoskelet Dis 2019; 11: 1759720X19893800. PubMed PMC