Swaminathan Vikram, Parkes Matthew J, Callaghan Michael J, O'Neill Terence W, Hodgson Richard, Gait Andrew D, Felson David T
Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
BMC Musculoskelet Disord. 2017 Aug 10;18(1):347. doi: 10.1186/s12891-017-1691-1.
Braces are used to treat pain in patellofemoral joint osteoarthritis (PFJOA). In a trial, we previously reported pain improvement after 6-weeks brace use. The pain reduction did not correlate with changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. Studies show that changes in the synovium on dynamic contrast enhanced (DCE) MRI are more closely associated with symptom change than static synovial volume changes. We hypothesised change in synovitis assessed using dynamic imaging could explain the reduction in pain.
One hundred twenty-six men and women aged 40-70 years with painful radiographically confirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. Pain assessment and DCE-MRI were performed at baseline and 6 weeks. DCE data was analysed using Tofts's equation. Pain measures included a VAS of pain on nominated aggravating activity (VAS), and the KOOS pain subscale. Paired t-tests were used to determine within person change in outcome measures and Spearman's correlation coefficients were used to determine the correlation between change in pain and change in the DCE parameters.
Mean age of subjects was 55.5 years (SD = 7.5) and 57% were female. There was clear pain improvement in the brace users compared to controls (VAS - 16.87 mm, p = <0.001). There was no significant change to the dynamic synovitis parameters among brace users nor was pain change correlated with change in dynamic synovitis parameters.
The reduction in knee pain following brace wearing in patients with PFJOA is not explained by changes in synovitis.
Trial registration number UK. ISRCTN50380458 /Registered 21.5.2010.
支具用于治疗髌股关节骨关节炎（PFJOA）的疼痛。在一项试验中，我们之前报告了使用支具6周后疼痛有所改善。疼痛减轻与磁共振成像（MRI）评估的骨髓病变体积或静态滑膜体积的变化无关。研究表明，动态对比增强（DCE）MRI上滑膜的变化比静态滑膜体积变化与症状变化的相关性更强。我们假设使用动态成像评估的滑膜炎变化可以解释疼痛的减轻。
126名年龄在40 - 70岁、经影像学证实患有疼痛性PFJOA的男性和女性被随机分为佩戴支具组或不佩戴支具组，为期6周。在基线和6周时进行疼痛评估和DCE - MRI检查。使用Tofts方程分析DCE数据。疼痛测量包括指定加重活动时的疼痛视觉模拟评分（VAS）和膝关节损伤与骨关节炎疗效评分（KOOS）疼痛子量表。采用配对t检验确定个体内结局指标的变化，采用Spearman相关系数确定疼痛变化与DCE参数变化之间的相关性。
受试者的平均年龄为55.5岁（标准差 = 7.5），57%为女性。与对照组相比，佩戴支具的患者疼痛明显改善（VAS降低16.87 mm，p = <0.001）。佩戴支具的患者动态滑膜炎参数无显著变化，疼痛变化与动态滑膜炎参数变化也无相关性。
PFJOA患者佩戴支具后膝关节疼痛减轻不能用滑膜炎的变化来解释。
试验注册号英国。ISRCTN50380458 /于2010年5月21日注册。
