For many people with knee pain, osteoarthritis (OA) is diagnosed once complaints have become chronic and structural joint damage is already irreversible. At that stage, there is no cure, and treatment mainly focuses on symptom control.

Often, individuals diagnosed with OA are suffering from symptoms for many years. During the time prior to the diagnosis, there is much uncertainty and concerns among those suffering from joint pain and functional limitations. What is causing the pain? What can still be done? And what does it mean for the future?

The CREDO project aims to support earlier recognition of knee OA. There is growing belief and some emerging evidence that early diagnosis of OA provides a ‘window of opportunity’: a phase in which affected joints may still be more responsive to conservative interventions. Moreover, early diagnosis could serve an unmet need for those individuals affected and would allow for early patient education and more feasible self-management.

A practical tool for early-stage knee OA

Using data from the national CHECK cohort, researchers developed diagnostic criteria for early-stage knee OA: the CREDO criteria. After extensive internal and external validation, and application in clinical cohort to assess their clinical relevance, an easy-to-use diagnostic tool was developed.

This decision-support tool uses seven easy obtainable items (sex, BMI, three questions on joint symptoms, and two items from physical examination). Together these items provide a score for the likelihood of early-stage knee OA. What makes the approach practical is that it translates validated research criteria into a tool based on information that can be collected in routine clinical practice, without advanced imaging or specialist diagnostics.

The tool is designed to support clinicians, especially primary care physicians, in recognising early-stage knee OA among people presenting with knee pain.

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Why this matters

Earlier recognition can give patients something they often miss: clarity. A diagnosis can help explain symptoms, reduce uncertainty and create space for education, feasible self-management and early conservative treatment.

For Healthy Joints, CREDO is a concrete step towards the broader goal of preventing or delaying OA where possible, and treating it earlier and more personally when it does occur. Objective and validated criteria may also make future clinical trials more targeted, by helping researchers test whether early diagnosis and early treatment are clinically effective, cost-effective and able to reduce the burden of knee OA for patients and society.

From criteria to implementation

The next step is implementation. Together with the external stakeholders, we are currently exploring the options for clinical implementation of the criteria towards general practitioners and an accompanying (implementation) trial to study the effects of these criteria in clinical practice.

In future clinical trials, the team hopes to prove that using these criteria in clinical practice will be clinically and cost-effective and reduce the burden of knee OA on patients and society.

Key take away: Feasible and validated criteria for the early diagnosis of knee OA in clinical practice are now ready to be implemented and tested, to unlock the potential of early treatment.

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Which disciplines and institutions are involved?

The CREDO project was led by a project group of OA experts (dr. Jos Runhaar and prof.dr. S. Bierma-Zeinstra of Erasmus MC, prof.dr. G. Kloppenburg of LUMC, prof.dr. M. Boers of Amsterdam UMC, and prof.dr. J. Bijlsma of UMC Utrecht), with collaboration of a diverse group of clinical experts from general practice, orthopedics, sports medicine, rheumatology, and rehabilitation medicine. The project was funded by the Dutch Arthritis Society.

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