Synovitis in Knee Osteoarthritis: a Precursor of Disease?

Overview

Journal Ann Rheum Dis

Specialty Rheumatology

Date 2014 Dec 10

PMID 25488799

Citations 145

Authors

I Atukorala

C K Kwoh

A Guermazi

F W Roemer

R M Boudreau

M J Hannon

D J Hunter

Affiliations

Soon will be listed here.

Abstract

Objectives: It is unknown whether joint inflammation precedes other articular tissue damage in osteoarthritis. Therefore, this study aims to determine if synovitis precedes the development of radiographic knee osteoarthritis (ROA).

Methods: The participants in this nested case-control study were selected from persons in the Osteoarthritis Initiative with knees that had a Kellgren Lawrence grading (KLG)=0 at baseline (BL). These knees were evaluated annually with radiography and non-contrast-enhanced MRI over 4 years. MRIs were assessed for effusion-synovitis and Hoffa-synovitis. Case knees were defined by ROA (KLG≥2) on the postero-anterior knee radiographs at any assessment after BL. Radiographs were assessed at P0 (time of onset of ROA), 1 year prior to P0 (P-1) and at BL. Controls were participants who did not develop incident ROA (iROA) from BL to 48 months).

Results: 133 knees of 120 persons with ROA (83 women) were matched to 133 control knees (83 women). ORs for occurrence of iROA associated with the presence of effusion-synovitis at BL, P-1 and P0 were 1.56 (95% CI 0.86 to 2.81), 3.23 (1.72 to 6.06) and 4.7 (1.10 to 2.95), respectively. The ORs for the occurrence of iROA associated with the presence of Hoffa-synovitis at BL, P-1 and P0 were 1.80 (1.1 to 2.95), 2.47 (1.45 to 4.23) and 2.40 (1.43 to 4.04), respectively.

Conclusions: Effusion-synovitis and Hoffa-synovitis strongly predicted the development of iROA.

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References

Kellgren J, Lawrence J . Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957; 16(4):494-502. PMC: 1006995. DOI: 10.1136/ard.16.4.494. View

Hayashi D, Roemer F, Katur A, Felson D, Yang S, Alomran F . Imaging of synovitis in osteoarthritis: current status and outlook. Semin Arthritis Rheum. 2011; 41(2):116-30. DOI: 10.1016/j.semarthrit.2010.12.003. View

Blom A, van der Kraan P, van den Berg W . Cytokine targeting in osteoarthritis. Curr Drug Targets. 2007; 8(2):283-92. DOI: 10.2174/138945007779940179. View

Ledingham J, Regan M, Jones A, Doherty M . Factors affecting radiographic progression of knee osteoarthritis. Ann Rheum Dis. 1995; 54(1):53-8. PMC: 1005513. DOI: 10.1136/ard.54.1.53. View

Baker K, Grainger A, Niu J, Clancy M, Guermazi A, Crema M . Relation of synovitis to knee pain using contrast-enhanced MRIs. Ann Rheum Dis. 2010; 69(10):1779-83. PMC: 3885343. DOI: 10.1136/ard.2009.121426. View

Kornaat P, Ceulemans R, Kroon H, Riyazi N, Kloppenburg M, Carter W . MRI assessment of knee osteoarthritis: Knee Osteoarthritis Scoring System (KOSS)--inter-observer and intra-observer reproducibility of a compartment-based scoring system. Skeletal Radiol. 2004; 34(2):95-102. DOI: 10.1007/s00256-004-0828-0. View

Fernandez-Madrid F, Karvonen R, Teitge R, Miller P, An T, Negendank W . Synovial thickening detected by MR imaging in osteoarthritis of the knee confirmed by biopsy as synovitis. Magn Reson Imaging. 1995; 13(2):177-83. DOI: 10.1016/0730-725x(94)00119-n. View

Attur M, Samuels J, Krasnokutsky S, Abramson S . Targeting the synovial tissue for treating osteoarthritis (OA): where is the evidence?. Best Pract Res Clin Rheumatol. 2010; 24(1):71-9. DOI: 10.1016/j.berh.2009.08.011. View

Roemer F, Guermazi A, Zhang Y, Yang M, Hunter D, Crema M . Hoffa's Fat Pad: Evaluation on Unenhanced MR Images as a Measure of Patellofemoral Synovitis in Osteoarthritis. AJR Am J Roentgenol. 2009; 192(6):1696-700. DOI: 10.2214/AJR.08.2038. View

10.

Peterfy C, Guermazi A, Zaim S, Tirman P, Miaux Y, White D . Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage. 2004; 12(3):177-90. DOI: 10.1016/j.joca.2003.11.003. View

11.

Roemer F, Javaid M, Guermazi A, Thomas M, Kiran A, Keen R . Anatomical distribution of synovitis in knee osteoarthritis and its association with joint effusion assessed on non-enhanced and contrast-enhanced MRI. Osteoarthritis Cartilage. 2010; 18(10):1269-74. DOI: 10.1016/j.joca.2010.07.008. View

12.

Benito M, Veale D, FitzGerald O, van den Berg W, Bresnihan B . Synovial tissue inflammation in early and late osteoarthritis. Ann Rheum Dis. 2005; 64(9):1263-7. PMC: 1755629. DOI: 10.1136/ard.2004.025270. View

13.

Hunter D . Advanced imaging in osteoarthritis. Bull NYU Hosp Jt Dis. 2008; 66(3):251-60. View

14.

Markou P, Chatzopoulos D . Yttrium-90 silicate radiosynovectomy treatment of painful synovitis in knee osteoarthritis. Results after 6 months. Hell J Nucl Med. 2009; 12(1):33-6. View

15.

Loeuille D, Chary-Valckenaere I, Champigneulle J, Rat A, Toussaint F, Pinzano-Watrin A . Macroscopic and microscopic features of synovial membrane inflammation in the osteoarthritic knee: correlating magnetic resonance imaging findings with disease severity. Arthritis Rheum. 2005; 52(11):3492-501. DOI: 10.1002/art.21373. View

16.

Menkes C . Radiographic criteria for classification of osteoarthritis. J Rheumatol Suppl. 1991; 27:13-5. View

17.

Englund M . The role of the meniscus in osteoarthritis genesis. Rheum Dis Clin North Am. 2008; 34(3):573-9. DOI: 10.1016/j.rdc.2008.05.009. View

18.

Braun H, Gold G . Diagnosis of osteoarthritis: imaging. Bone. 2011; 51(2):278-88. PMC: 3306456. DOI: 10.1016/j.bone.2011.11.019. View

19.

Myers S, Brandt K, Ehlich J, Braunstein E, Shelbourne K, Heck D . Synovial inflammation in patients with early osteoarthritis of the knee. J Rheumatol. 1990; 17(12):1662-9. View

20.

Fuerst M, Lammers L, Schafer F, Niggemeyer O, Steinhagen J, Lohmann C . Investigation of calcium crystals in OA knees. Rheumatol Int. 2009; 30(5):623-31. DOI: 10.1007/s00296-009-1032-2. View