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Objective: As part of the first phase of the OARSI Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) initiative, we explored the first symptoms and experiences recalled by individuals with knee osteoarthritis (OA)., Design: This qualitative study, informed by qualitative description, was a secondary analysis of focus groups (n ​= ​17 groups) and one-on-one interviews (n ​= ​3) conducted in 91 individuals living with knee OA as part of an international study to better understand the OA pain experience. In each focus group or interview, participants were asked to describe their first symptoms of knee OA. We inductively coded these transcripts and conducted thematic analysis., Results: Mean age of participants was 70 years (range 47-92) and 68 ​% were female. We developed four overarching themes: Insidious and Episodic Onset , Diverse Early Symptoms, Must be Something Else , and Adjustments . Participants described the gradual and intermittent way in which symptoms of knee OA developed over many years; many could not identify a specific starting point. Participants described diverse initial knee symptoms, including activity-exacerbated joint pain, stiffness and crepitus. Most participants dismissed early symptoms or rationalized their presence, employing various strategies to enable continued participation in recreational and daily activities. Few sought medical attention until physical functioning was demonstrably impacted., Conclusions: The earliest symptoms of knee OA are frequently insidious in onset, episodic and present long before individuals present to health professionals. These results highlight challenges to identifying people with knee OA early and support the development of specific classification criteria for EsSKOA to capture individuals at an early stage., Competing Interests: LKK reports support from Canadian Institutes of Health Research Doctoral Award, and grant funding from Physician Services Incorporated (PSI) Resident Grant; JWL reports a Pfizer research grant completed in 2021, unrelated to this work; QW reports support from Osteoarthritis and Cartilage as an Associate Editor for statistics; AT reports support from Osteoarthritis and Cartilage as an Associate Editor for statistics, IKH reports consulting fees from AbbVie, GSK and Grünenthal, and leadership role as the OARSI Board of Directors Secretary; CTA reports grant funding and consulting/honoraria from AbbVie, Novartis, Pfizer, and Servier; LSL reports consulting/honoraria from Arthro Therapeutics AB, Sweden, and participation on a DSMB board for AstraZeneca; ME reports grant funding from Swedish Research Council, ERC, ALF, Kock Foundations, Gustav V 80 ​Year ​B-day foundation, NORDFORSK, FOREUM, Foundation for support to people with movement disability in Skåne, Österlund Foundation, SUS donations, consulting from Cellcolabs AB, and leadership role as the OARSI President-elect; JR reports a leadership role on the OARSI Ethics & Governance Committee, Nominating Committee; and TN reports grant funding and consulting/honoraria from Pfizer/Lilly, Regeneron and Novartis. All other authors report no competing interests., (© 2023 The Author(s).)

Objective: Fluorescence Optical Imaging (FOI) demonstrates indocyanine green (ICG)-enhanced microcirculation in wrist and finger joints, as a sign of inflammation. We wanted to assess the reliability of three FOI scoring methods from Berlin, Stockholm, and Copenhagen, to assess the validity of FOI with MRI as reference and to compare enhancement in hand joints in erosive hand osteoarthritis (OA) vs. rheumatoid arthritis (RA)., Design: Five readers scored all finger and wrist joints of 26 patients with erosive hand OA and RA on semi-quantitative 0-3 scales using three different FOI scoring methods. To evaluate inter-reader reliability, we calculated the intraclass correlation coefficients (ICC) for sum scores and prevalence and bias adjusted kappa values for ordinal scales (Pabak-OS) on joint level. Enhancement in joint groups in erosive hand OA vs. RA was compared using Mann-Whitney test. Sensitivities and specificities of FOI was calculated with MRI as reference for hand OA patients only., Results: We found moderate to good inter-reader reliability for all FOI scoring methods (Pabak-OS: 0.50-0.78, ICC: 0.43-0.85) and different patterns of enhancement in erosive hand OA vs. RA with significantly more FOI enhancement in DIP joints in erosive hand OA across all methods. With MRI as reference the different FOI scoring methods reached similar sensitivities (63-65%) and specificities (76-91%)., Conclusion: FOI enhancement can be measured reliably in erosive hand OA and RA using three different scoring methods. More DIP enhancement in erosive hand OA patients and good agreement with MRI support the diagnostic performance of FOI., (© 2019 The Authors.)