

The diagnosis of osteoarthritis has often been based on the radiographic appearance of the joint space according to the criteria of Kellgren and Lawrence rather than clinical features. However, recent research has shown that radiographic imaging and the amount of pain and limitation a patient experiences does not have as strong of a correlation as once believed. More so, central sensitization and psychosocial factors might play an important role in explaining which patients with radiographic osteoarthritis experience pain and which don’t.
The cluster by Altman et al. from the year 1986 has a sensitivity of 95% and a specificity of 69% for three out of six signs and symptoms. With four out of six positive findings, sensitivity decreased to 84%, but specificity increased to 89%.
For this reason, this cluster has a high clinical value to rule out or confirm osteoarthritis of the knee.
The cluster contains the presence of knee pain plus the following six items:
As mentioned earlier, radiographs alone do not define the clinical syndrome of osteoarthritis, as 40% of the patients included in the study by Altman were asymptomatic. This is a good message as it opens up possibilities for an effective treatment, including load management, strengthening, mobility exercises, and maybe more importantly, proper patient education and explanation of how psychosocial factors might contribute to the patient’s individual pain experience.
Check out the signs & symptoms for hip osteoarthritis as well.