Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien.
Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei.
Rheumatology (Oxford). 2021 Oct 2;60(10):4486-4494. doi: 10.1093/rheumatology/keab020.
To determine whether ultrasound (US)-detected synovitis affects the therapeutic efficacy of hyaluronic acid (HA) injection for treating knee OA.
Patients with symptomatic knee OA were recruited. All the patients received HA injection two times at 2-week intervals. Clinical assessments were performed using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities OA Index (WOMAC) at baseline and 1 and 6 months after treatment. Imaging evaluation was based on complete knee US examination and the Kellgren-Lawrence grading. Suprapatellar synovial fluid (SF) depth, synovial hypertrophy (SH) and vascularity were measured through US.
In total, 137 patients who fulfilled the inclusion criteria were included in the analysis. All patients demonstrated improvement in VAS and WOMAC scores at 1 and 6 months after treatment (P < 0.001). Moreover, regression model-based analysis revealed significant associations of SF depth with the VAS and WOMAC scores in all patients. Each centimetre increase in the effusion diameter was associated with a decrease in the 1-month post-treatment VAS improvement percentage (15.26; 95% CI: 0.05, 29.5; P = 0.042) and 6-month post-treatment WOMAC improvement (37.43; 95% CI: 37.68, 50.69; P < 0.01). However, SH and vascularity were not significantly associated with VAS or WOMAC scores.
Ultrasound detected suprapatellar effusion predicts reduced efficacy of HA injection in knee OA.
确定超声（US）检测到的滑膜炎是否会影响透明质酸（HA）注射治疗膝骨关节炎的疗效。
招募有症状的膝骨关节炎患者。所有患者均接受 HA 注射，每 2 周一次，共两次。治疗前、治疗后 1 个月和 6 个月分别采用视觉模拟评分（VAS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）进行临床评估。影像学评估基于膝关节全超声检查和 Kellgren-Lawrence 分级。通过 US 测量髌上滑液（SF）深度、滑膜肥厚（SH）和血管。
共纳入符合纳入标准的 137 例患者进行分析。所有患者在治疗后 1 个月和 6 个月时 VAS 和 WOMAC 评分均有改善（P<0.001）。此外，基于回归模型的分析显示，SF 深度与所有患者的 VAS 和 WOMAC 评分均有显著关联。积液直径每增加 1 厘米，治疗后 1 个月的 VAS 改善百分比（15.26%；95%CI：0.05，29.5%；P=0.042）和 6 个月的 WOMAC 改善（37.43%；95%CI：37.68，50.69%；P<0.01）均会降低。然而，SH 和血管与 VAS 或 WOMAC 评分无显著相关性。
超声检测到的髌上积液可预测 HA 注射治疗膝骨关节炎的疗效降低。
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