Knee osteoarthritis is currently diagnosed too late, when cartilage is already severely damaged and treatments are unlikely to work. The PIOKNEER study aims to catch the disease much earlier by tracking people aged 35–70 who have knee pain but no visible changes on x-ray. This matters because there are no drugs that can slow osteoarthritis damage. The problem is that clinical trials enrol patients whose cartilage loss is already visible on x-ray, meaning large changes have already occurred. Without a way to detect early-stage disease or measure whether a new treatment is working, developing effective therapies has stalled. The project will use a new imaging technology called Field-Cycling Imaging (FCI), which uses lower magnetic fields than standard MRI and can be rapidly changed during a scan to provide more detailed information about cartilage. Over four years, participants will receive annual knee scans, x-rays, and provide blood and urine samples. Those whose disease worsens rapidly or not at all in the first two years will undergo knee biopsies to study how the synovium—the membrane surrounding the knee—drives joint damage. If successful, this research could establish reliable markers for early diagnosis and precise monitoring, enabling clinical trials to test treatments at the stage when they might actually work. It will also produce guidance for timely care pathways, based on patients’ own priorities and experiences.
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Osteoarthritis (OA) is a common condition resulting from joint damage, with knees most affected. It is a leading cause of disability, poorer well-being, and reduced work capacity. Current treatments involve lifestyle changes, painkillers, and ultimately joint replacement. There are no drugs that can slow down the damage, partly because we are not able to detect changes in the knee at an early stage of disease. Studies typically include patients who have knee abnormalities that can be seen on x-ray, meaning large changes including cartilage loss have already occurred, at which point treatments are less likely to work. Furthermore, there is no accurate way to measure if a new treatment is working. Finding ways to detect changes in the knee at an early stage and monitor them over time is crucial and has been highlighted by our patient partners as a key evidence gap. The PIOKNEER study seeks to establish ways for early detection and monitoring of knee OA (KOA) using innovative techniques. We will use a population survey to recruit people aged 35-70 years with knee pain who have not had knee injury or surgery, and no other condition causing their pain. We will select people who do not yet have changes that can be seen on x-ray, and we will monitor them over 4 years to see how their disease progresses. Once a year, we will take a knee x-ray and ask questions to understand their symptoms. To measure cartilage changes, we will take annual knee scans using a new imaging technology developed in Aberdeen, called Field-Cycling Imaging (FCI). FCI uses much lower magnetic fields than standard MRI that can be rapidly changed while the person is being scanned, providing more detailed information. Serum and urine samples will also be collected to measure indicators of joint damage. People with rapid worsening or no worsening of their disease in the first 2 years will be invited to undergo knee biopsies to collect tiny pieces of synovium, a membrane that surrounds the knee. These will be taken to the laboratory to understand how changes in synovium can drive knee damage. We will also examine the experiences of people living with early-stage KOA, their priorities for care and current resources and support. We will then identify care gaps and work with patients to produce guidance to support timely care pathways. The PIOKNEER study builds upon our recently completed FRESKO pilot study, which established the feasibility and acceptability of FCI and knee biopsies for people with early-stage KOA. We will work with our patient partners to ensure all elements of the project are relevant and accessible to people living with OA. Our study will be part of a global initiative, promoted by OARSI (Osteoarthritis Research Society International), and the results will be compared with other studies around the world to ensure the most benefit. Early diagnosis of knee OA and its precise monitoring will help determine which treatments are most effective at what stage of disease and for which patients to improve care.
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