Gottreich Julia R, Katz Jeffrey N, Jones Morgan H
Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Orthop J Sports Med. 2024 Dec 12;12(12):23259671241272667. doi: 10.1177/23259671241272667. eCollection 2024 Dec.
Knee osteoarthritis (OA) is a debilitating condition, and synovitis is a structural marker of disease progression that can be identified on magnetic resonance imaging (MRI). Nonsurgical therapies have been developed with the goal of targeting this inflammation to reduce pain and slow disease progression.
To review current randomized controlled trials (RCTs) that measured changes in pain outcomes and synovitis on MRI scans after nonsurgical treatment for persons with knee OA.
Systematic review; Level of evidence, 1.
The PubMed database was searched using the terms "knee osteoarthritis AND (synovitis OR inflammation)" for RCTs published between 2012 and 2022. Included were studies that collected both pain outcomes and quantitative measurements of synovitis on MRI scan before and after treatment; studies that investigated surgical treatments were excluded. We calculated standardized response means (SRMs) to analyze the effect sizes of treatment on pain and synovitis outcomes; SRMs were classified as having low responsiveness to treatment if <0.5, moderate responsiveness to treatment if between 0.5 and 0.8, and large responsiveness to treatment if >0.8.
Included in the review were 9 RCTs. Vitamin D and exercise therapy were the only 2 treatments that improved both pain and synovitis outcomes in comparison with their respective control groups. Statistically significant group differences in favor of treatment were seen in changes in pain after lutikizumab (anti-interleukin-1α/β dual variable domain immunoglobulin; SRM, 0.22; = .050), allogenic human chondrocytes transduced with retroviral vector encoding transforming growth factor-β1 ( = .0119 at 12 weeks, = .120 at 52 weeks, and = .0074 at 72 weeks), and (turmeric; SRM, 0.35; = .039 on the visual analog scale for pain and SRM, 0.47; = .006 on the Western Ontario and McMaster Universities Osteoarthritis Index pain subscore). One study reported a statistically significant group difference in synovitis only after treatment with intra-articular methylprednisolone ( = .01 at 14 weeks and = .0006 at 26 weeks).
Only vitamin D and exercise therapy were found to improve pain and synovitis after treatment in this review. Further research is needed to validate these findings and investigate alternative treatments for reducing pain and synovitis in persons with knee OA.
膝关节骨关节炎（OA）是一种使人衰弱的疾病，滑膜炎是疾病进展的结构标志物，可通过磁共振成像（MRI）识别。已开发出非手术疗法，目标是针对这种炎症以减轻疼痛并减缓疾病进展。
回顾当前的随机对照试验（RCT），这些试验测量了膝关节OA患者非手术治疗后疼痛结局和MRI扫描上滑膜炎的变化。
系统评价；证据级别，1级。
在PubMed数据库中使用“膝关节骨关节炎AND（滑膜炎或炎症）”搜索2012年至2022年发表的RCT。纳入的研究需在治疗前后收集疼痛结局以及MRI扫描上滑膜炎的定量测量数据；排除研究手术治疗的试验。我们计算标准化反应均值（SRM）以分析治疗对疼痛和滑膜炎结局的效应大小；如果SRM<0.5，则分类为对治疗反应低，如果SRM在0.5至0.8之间，则分类为对治疗反应中等，如果SRM>0.8，则分类为对治疗反应大。
该综述纳入9项RCT。与各自的对照组相比，维生素D和运动疗法是仅有的两种能同时改善疼痛和滑膜炎结局的治疗方法。在使用鲁奇单抗（抗白细胞介素-1α/β双可变域免疫球蛋白；SRM，0.22；P = 0.050）、用编码转化生长因子-β1的逆转录病毒载体转导的同种异体人软骨细胞（12周时P = 0.0119，52周时P = 0.120，72周时P = 0.0074）以及姜黄（视觉模拟疼痛量表上的SRM，0.35；P = 0.039，西安大略和麦克马斯特大学骨关节炎指数疼痛子评分上的SRM，0.47；P = 0.006）治疗后，在疼痛变化方面观察到治疗组有统计学意义的显著差异。一项研究报告仅在关节内注射甲基强的松龙治疗后滑膜炎有统计学意义的组间差异（14周时P = 0.01，26周时P = 0.0006）。
在本综述中，仅发现维生素D和运动疗法在治疗后可改善疼痛和滑膜炎。需要进一步研究来验证这些发现，并研究减轻膝关节OA患者疼痛和滑膜炎的替代治疗方法。
