Harkey MS, Davis JE, Price LL, et al. - Utilizing data from a nested case-control analysis of participants from the Osteoarthritis Initiative without radiographic knee osteoarthritis (KOA) at baseline, researchers investigated whether the radiographic onset of accelerated knee osteoarthritis can be predicted by composite structural measures of KOA progression on magnetic resonance (MR) imaging. On the basis of radiographic disease progression over 4 years, the participants were split into three groups: accelerated (Kellgren-Lawrence grades [KL] 0/1 to 3/4), typical (increase in KL, eliminating accelerated osteoarthritis), or no KOA (no change in KL). Two MR-based composite scores were computed. Experts found greater odds of developing accelerated KOA in individuals with worsening disease activity or cumulative damage, as noted during a pre-radiographic disease period. Based on these findings, experts suggested the likely utility of MR-based disease activity and cumulative damage metrics as prognostic markers to aid the detection of persons carrying risk for accelerated onset and progression of knee osteoarthritis.