From the Menzies Institute for Medical Research, and Faculty of Health, University of Tasmania, Hobart; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Translational Research Centre, Academy of Orthopedics; School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
X. Wang, PhD, Menzies Institute for Medical Research, University of Tasmania; X. Jin, PhD, Menzies Institute for Medical Research, University of Tasmania; L. Blizzard, PhD, Menzies Institute for Medical Research, University of Tasmania; B. Antony, PhD, Menzies Institute for Medical Research, University of Tasmania; W. Han, MD, PhD, Menzies Institute for Medical Research, University of Tasmania; Z. Zhu, MD, PhD, Menzies Institute for Medical Research, University of Tasmania; F. Cicuttini, MD, PhD, Department of Epidemiology and Preventive Medicine, Monash University; A.E. Wluka, MD, PhD, Department of Epidemiology and Preventive Medicine, Monash University; T. Winzenberg, MD, PhD, Menzies Institute for Medical Research, University of Tasmania, and Faculty of Health, University of Tasmania; G. Jones, MD, PhD, Menzies Institute for Medical Research, University of Tasmania; C. Ding, MD, PhD, Menzies Institute for Medical Research, University of Tasmania, and Department of Epidemiology and Preventive Medicine, Monash University, and Translational Research Centre, Academy of Orthopedics, and School of Basic Medical Sciences, Southern Medical University.
J Rheumatol. 2017 Nov;44(11):1644-1651. doi: 10.3899/jrheum.161596. Epub 2017 Sep 1.
To describe the associations between effusion-synovitis and joint structural abnormalities in patients with knee osteoarthritis (OA) over 24 months.
A posthoc analysis using data from a randomized controlled trial in 413 patients with symptomatic OA (aged 63 ± 7 yrs, 208 women). Knee effusion-synovitis volume and score, cartilage defects, cartilage volume, and bone marrow lesions (BML) were assessed using magnetic resonance imaging. Joint space narrowing (JSN) and osteophytes were assessed using radiograph. Least significant change criterion was used to define change in effusion-synovitis volume. Knee symptoms were assessed by Western Ontario and McMaster University OA Index. Multivariable linear/logistic regression and multilevel generalized mixed-effects models were used in longitudinal analyses.
Total effusion-synovitis volume increased modestly from baseline (8.0 ± 8.5 ml) to followup (9.0 ± 10.5 ml). Baseline BML, cartilage defect, JSN, and osteophyte scores were positively associated with change in effusion-synovitis volume (p < 0.05). Baseline cartilage defects and JSN were also associated with change in effusion-synovitis score (p < 0.05). However, neither baseline effusion-synovitis score nor volume consistently predicted change in the above structures except cartilage volume. In the mixed-effects models, knee effusion-synovitis was positively associated with BML (volume: β = 1.19 ml/grade; score: OR = 1.75/grade) and cartilage defects (volume: β = 1.87 ml/grade; score: OR = 2.22/grade), while negatively associated with cartilage volume loss. Change in effusion-synovitis volume was positively correlated with changes in knee pain and stiffness scores (p < 0.05).
Knee cartilage and subchondral bone abnormalities predicted change in effusion-synovitis, but effusion-synovitis did not predict knee structural changes. These findings suggest that synovial inflammation is likely the result of joint structural abnormalities in established OA. ClinicalTrials.gov identifier: NCT01176344. Australian New Zealand Clinical Trials Registry: ACTRN12610000495022.
描述膝关节骨关节炎（OA）患者 24 个月内滑液滑膜炎与关节结构异常之间的关系。
对 413 例症状性 OA 患者（年龄 63 ± 7 岁，208 例女性）随机对照试验的数据进行了一项事后分析。采用磁共振成像评估膝关节滑液滑膜炎体积和评分、软骨缺损、软骨体积和骨髓病变（BML）；采用 X 线评估关节间隙狭窄（JSN）和骨赘。使用最小有意义变化标准定义滑液滑膜炎体积的变化。采用 Western Ontario 和 McMaster 大学骨关节炎指数评估膝关节症状。采用多变量线性/逻辑回归和多级广义混合效应模型进行纵向分析。
滑液滑膜炎总体积从基线（8.0 ± 8.5 ml）增加到随访时（9.0 ± 10.5 ml），略有增加。基线 BML、软骨缺损、JSN 和骨赘评分与滑液滑膜炎体积的变化呈正相关（p < 0.05）。基线软骨缺损和 JSN 也与滑液滑膜炎评分的变化相关（p < 0.05）。然而，除了软骨体积外，基线滑液滑膜炎评分或体积均不能预测上述结构的变化。在混合效应模型中，膝关节滑液滑膜炎与 BML 呈正相关（体积：β = 1.19 ml/级；评分：OR = 1.75/级）和软骨缺损（体积：β = 1.87 ml/级；评分：OR = 2.22/级），而与软骨体积丢失呈负相关。滑液滑膜炎体积的变化与膝关节疼痛和僵硬评分的变化呈正相关（p < 0.05）。
膝关节软骨和软骨下骨异常预测了滑液滑膜炎的变化，但滑液滑膜炎并未预测膝关节结构的变化。这些发现表明，滑膜炎症可能是已建立的 OA 关节结构异常的结果。临床试验注册编号：NCT01176344。澳大利亚新西兰临床试验注册中心：ACTRN12610000495022。
