Observational studyAnnals of the rheumatic diseases2020
Does cartilage loss cause pain in osteoarthritis and if so, how much?
Observational study in Annals of the rheumatic diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07402291 (Comparative Effects of Mulligan's Pain Release Phenomenon and Kaltenborn Mobilizations on Pain, Range of Motion And Disability in Patients With Knee Osteoarthritis.), which is not on this map. Cited by 67 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Comparative Effects of Mulligan's Pain Release Phenomenon and Kaltenborn Mobilizations on Pain, Range of Motion And Disability in Patients With Knee Osteoarthritis.
Who cites it
67 citing papers in PubMed, 1 synthesis or guideline pooled it, 125 citations in OpenAlex.
- Intra-articular therapy with methotrexate or tumor necrosis factor inhibitors in rheumatoid arthritis: a systematic review.BMC musculoskeletal disorders · 2021Pooled it
- Single-DoseToxins · 2025Trial
- Efficacy and safety of fasinumab in an NSAID-controlled study in patients with pain due to osteoarthritis of the knee or hip.BMC musculoskeletal disorders · 2025Trial
- Effects of unloader bracing on clinical outcomes and articular cartilage regeneration following microfracture of isolated chondral defects: a randomized trial.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2021Trial
- Beyond the algorithms: Challenges in predicting knee osteoarthritis pain from a machine learning point of view.Osteoarthritis imaging · 2026Article
- Localizing Knee Pain via Explainable Bayesian Generative Models and Counterfactual MRI: Data from the Osteoarthritis Initiative.Journal of imaging informatics in medicine · 2026Article
- Electroacupuncture for knee osteoarthritis: a multicentre randomised controlled trial assessing symptomatic and structural efficacy.EClinicalMedicine · 2026Article
- Disruption of proteoglycan 4 (PRG4)-CD44 signaling modulates chronic synovitis in conditionally inactivated mice.Arthritis research & therapy · 2026Article
- Examples of Treatments That May Be Highly Effective for Osteoarthritis: Do They Provide Insights Into Future Treatment Directions?Arthritis & rheumatology (Hoboken, N.J.) · 2026Article
- Multi-Omics Reveal the Dysregulated Gut-Joint Axis in Knee Synovitis: Data from Two Osteoarthritis Studies in China.Advanced science (Weinheim, Baden-Wurttemberg, Germany) · 2026Article
- Ultrasound-Based Knee Osteoarthritis Severity Assessment and Its Association With Kellgren-Lawrence Grading.TheScientificWorldJournal · 2026Observational
- Synovial Parasitosis and Inflammatory Biomarker Profiles in Osteoarthritis: Associations with Host and Therapeutic Factors.Acta parasitologica · 2025Article
- The relationship between circulating and tissue biomarkers and OA-related pain: A systematic literature review.Osteoarthritis and cartilage open · 2025Review
- Superb microvascular imaging in the assessment of persistent synovitis after anterior cruciate ligament reconstruction.Osteoarthritis imaging · 2025Article
- Novel approaches to the stratified management of knee osteoarthritis.Nature reviews. Rheumatology · 2025Review
- Disruption of Proteoglycan 4 (PRG4)-CD44 Signaling Modulates Chronic Synovitis in Conditionally Inactivated Mice.Research square · 2025Article
- Roles of TGF-β in the therapeutic potential of hypoxic mesenchymal stem cells for treating osteoarthritis in a Rabbit model.Journal of orthopaedic surgery and research · 2025Article
- Understanding pain heterogeneity in osteoarthritis patients: a narrative review.Frontiers of medicine · 2025Review
- Bone marrow lesion coexisted with subchondral bone attrition and/or subchondral bone cyst is associated with knee pain in knee osteoarthritis regardless of cartilage lesion: the Bunkyo health study.Arthritis research & therapy · 2025Article
- Comorbid hypertension and osteoarthritis exacerbates joint remodeling and gait compensations in female rats with milder effects observed in males.Osteoarthritis and cartilage open · 2025Article
7 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors at 1 institution in 2 countries.
Funding
Abstract
objectivesAlthough treatment development in osteoarthritis (OA) focuses on chondroprotection, it is unclear how much preventing cartilage loss reduces joint pain. It is also unclear how nociceptive tissues may be involved.
methodsUsing data from the Osteoarthritis Initiative, we quantified the relation between cartilage loss and worsening knee pain after adjusting for bone marrow lesions (BMLs) and synovitis, and examined how much these factors mediated this association. 600 knee MRIs were scored at baseline, 12 months and 24 months for quantitative and semiquantitative measures of OA structural features. We focused on change in medial cartilage thickness using an amount similar to that seen in recent trials. Linear models calculated mean change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score with cartilage loss, adjusted for baseline BMLs, synovitis and covariates. Mediation analysis tested whether change in synovitis or BMLs mediated the cartilage loss-pain association. We carried out a subanalysis for knees with non-zero baseline WOMAC pain scores and another for non-valgus knees.
resultsCartilage thickness loss was significantly associated with a small degree of worsening in pain over 24 months. For example, a loss of 0.1 mm of cartilage thickness over 2 years was associated with a 0.32 increase in WOMAC pain (scale 0-20). The association of cartilage thickness loss with pain was mediated by synovitis change but not by BML change. Subanalysis results were similar.
conclusionsCartilage thickness loss is associated with only a small amount of worsening knee pain, an association mediated in part by worsening synovitis. Demonstrating that chondroprotection reduces knee pain will be extremely challenging and is perhaps unachievable.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.