Wallace Gemma, Cro Suzie, Doré Caroline, King Leonard, Kluzek Stefan, Price Andrew, Roemer Frank, Guermazi Ali, Keen Richard, Arden Nigel
University of Oxford, Oxford, UK.
University College London, London, UK.
Arthritis Care Res (Hoboken). 2017 Sep;69(9):1340-1348. doi: 10.1002/acr.23162. Epub 2017 Aug 14.
Painful knee osteoarthritis (KOA) has been associated with joint inflammation. There is, however, little literature correlating signs of localized inflammation with contrast-enhanced (CE) magnetic resonance imaging (MRI) of synovium. This study examined the relationship between clinical and functional markers of localized knee inflammation and CE MRI-based synovial scores.
Patients with symptomatic KOA were enrolled into the randomized, double-blind, Vitamin D Evaluation in Osteoarthritis (VIDEO) trial. In this cross-sectional substudy, associations between validated MRI-based semiquantitative synovial scores of the knee and the following markers of inflammation were investigated: self-reported pain and stiffness, effusion, warmth, joint line tenderness, erythrocyte sedimentation rate, radiographic severity, and functional ability tests.
A total of 107 patients satisfied the inclusion criteria of complete data and were included in the analysis. Significant associations were found between the number of regions affected by synovitis and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, effusion, and joint line tenderness. Each additional region affected by synovitis was associated with an increase in WOMAC pain (1.82 [95% confidence interval (95% CI) 0.05, 3.58], P = 0.04), and the association with extent of medial synovitis was particularly strong (3.21 [95% CI 0.43, 5.99], P = 0.02). Extent of synovitis was positively associated with effusion (odds ratio 1.69 [95% CI 1.37, 2.08], P < 0.01) and negatively associated with joint line tenderness (relative risk 0.87 [95% CI 0.84, 0.90], P < 0.01).
There is a strong positive association between synovitis and self-reported patient pain and clinically detectable effusion. Nonoperative treatments directed at management of inflammation and future trials targeting the synovial tissue for treating KOA should consider these 2 factors as potential inclusion criteria.
疼痛性膝关节骨关节炎（KOA）与关节炎症相关。然而，将局部炎症体征与滑膜对比增强（CE）磁共振成像（MRI）相关联的文献很少。本研究探讨了膝关节局部炎症的临床和功能指标与基于CE MRI的滑膜评分之间的关系。
有症状的KOA患者被纳入随机、双盲的骨关节炎维生素D评估（VIDEO）试验。在这项横断面子研究中，研究了基于MRI的膝关节半定量滑膜评分与以下炎症指标之间的关联：自我报告的疼痛和僵硬、积液、发热、关节线压痛、红细胞沉降率、放射学严重程度和功能能力测试。
共有107例患者满足完整数据的纳入标准并被纳入分析。发现滑膜炎受累区域数量与西安大略和麦克马斯特大学骨关节炎指数（WOMAC）疼痛、积液和关节线压痛之间存在显著关联。滑膜炎每增加一个受累区域，WOMAC疼痛就会增加（1.82[95%置信区间（95%CI）0.05，3.58]，P = 0.04），与内侧滑膜炎程度的关联尤为强烈（3.21[95%CI 0.43，5.99]，P = 0.02）。滑膜炎程度与积液呈正相关（优势比1.69[95%CI 1.37，2.08]，P < 0.01），与关节线压痛呈负相关（相对风险0.87[95%CI 0.84，0.90]，P < 0.01）。
滑膜炎与患者自我报告的疼痛和临床上可检测到的积液之间存在强烈的正相关。针对炎症管理的非手术治疗以及未来针对滑膜组织治疗KOA的试验应将这两个因素作为潜在的纳入标准。
