SYNOVIAL HYPERTROPHY DETECTED USING ULTRASONOGRAM IN PRIMARY OSTEOARTHRITIC KNEES: PREVALENCE AND CORRELATIONWITH RADIOGRAPHIC STAGING
DOI:
https://doi.org/10.55374/jseamed.v4i1.55Keywords:
Ultrasonogram, Radiographic staging, Osteoarthritic knee, Synovitis, Synovial hypertrophyAbstract
Background: Treatment of primary osteoarthritic (OA) knee has changed in recent decades with a greater focus on synovitis as one cause of cartilage destruction and degeneration. Ultrasonography (US), a noninvasive, low cost and convenient procedure may be used for early detection and monitoring synovitis in primary OA knee. Somehow, the lack of data on the prevalence of synovial hypertrophy (SH) and its correlation to disease progression has precluded the use of US in clinical practice.
Objective: The study aimed to determine the prevalence of SH at each stage of the disease and its correlation to structural damage.
Methods: In all, 214 knees among 127 cases diagnosed as having primary OA knee were examined using US. The midline scanning technique of US was performed and synovial thickness at the suprapatellar pouch was observed. All knees were categorized according to the Kellgren-Lawrence radiographic staging (KL). The prevalence of SH in each KL with 2, 2.5 and 3 mm cutoff level were calculated. The correlation between synovial thickness and KL was also analyzed.
Results: The prevalence of SH with 2 mm cutoff level in KL I-IV was 38.8, 70.8, 66.6 and 91.1%, respectively. The prevalence of SH with 2.5 mm cutoff level in KL I-IV was 5.5, 37.5, 35.4 and 74.2%, respectively. The prevalence of SH with 3 mm cutoff level in KL I-IV was 0, 29.1, 20.8 and 56.4%, respectively. The overall prevalence with 2, 2.5 and 3 mm cut-off level was 72.2, 50.9 and 37.1%, respectively. Synovial thickness, measured in millimeters, correlated well with KL (p<0.01). The correlation of synovial thickness between each KL was also statistically significant (p<0.05) except those between KL II and KL III (p=0.98).
Conclusion: Synovial thickness at the suprapatellar pouch detected with midline scanning US reflected the degree of synovitis which correlated well with structural damage and could be used to monitor disease progression in primary OA knee.
Metrics
References
Wang Y, Teichtahl AJ, Abram F, Hussain SM, Pelletier JP, Cicuttini FM, Martel-Pelletier J. Knee pain as a predictor of structural progression over 4 years: data from the Osteoarthritis Initiative, a prospective cohort study. Arthritis Res Ther 2018; 20: 250. DOI: https://doi.org/10.1186/s13075-018-1751-4
Mathiessen A, Conaghan PG, Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther 2017; 19: 18. DOI: https://doi.org/10.1186/s13075-017-1229-9
Felson DT, Niu J, Neogi T, Goggins J, Nevitt MC, Roemer F et al. Synovitis and the risk of knee osteoarthritis: the most study. Osteoarthritis Cartilage 2016; 24: 458-64. DOI: https://doi.org/10.1016/j.joca.2015.09.013
Chu CR, Millis MB, Olson SA. Osteoarthritis: From palliation to prevention: AOA critical issues. J Bone Joint Surg Am 2014; 96:e130. DOI: https://doi.org/10.2106/JBJS.M.01209
Heidari B. Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I. Caspian J Intern Med 2011; 2:205-12.
Roos EM, Arden NK. Strategies for the prevention of knee osteoarthritis. Nat Rev Rheumatol 2016; 12: 92-101. DOI: https://doi.org/10.1038/nrrheum.2015.135
Berenbaum F. Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!). Osteoarthr Cartil 2013; 21:16-21. DOI: https://doi.org/10.1016/j.joca.2012.11.012
Daghestani HN, Kraus VB. Inflammatory biomarkers in osteoarthritis. Osteoarthritis Cartil 2015; 23: 1890-6. DOI: https://doi.org/10.1016/j.joca.2015.02.009
Malfait AM. Osteoarthritis year in review 2015: Biology. Osteoarthr Cartil 2016 ; 24: 21-6. DOI: https://doi.org/10.1016/j.joca.2015.09.010
Orlowsky EW, Kraus VB. The role of innate immunity in osteoarthritis: When our first line of defense goes on the offensive. J Rheumatol 2015; 42: 363-71. DOI: https://doi.org/10.3899/jrheum.140382
Scanzello CR, Goldring SR. The role of synovitis in osteoarthritis pathogenesis. Bone 2012; 51: 249- 57. DOI: https://doi.org/10.1016/j.bone.2012.02.012
Sellam J, Berenbaum F. Is osteoarthritis a metabolic disease? Jt Bone Spine 2013; 80: 568-73. DOI: https://doi.org/10.1016/j.jbspin.2013.09.007
Varady NH, Grodzinsky AJ. Osteoarthritis year in review 2015: Mechanics. Osteoarthr Cartil 2016; 24: 27-35. DOI: https://doi.org/10.1016/j.joca.2015.08.018
Iagnocco A. Imaging the joint in osteoarthritis: a place for ultrasound? Best Pract Res Clin Rheumatol 2010; 24: 27-38. DOI: https://doi.org/10.1016/j.berh.2009.08.012
Sarmanova A, Hall M, Moses J, Doherty M, Zhang W. Synovial changes detected by ultrasound in people with knee osteoarthritis - a meta-analysis of observational studies. Osteoarthr Cartil 2016; 24: 1376-83. DOI: https://doi.org/10.1016/j.joca.2016.03.004
D’Agostino MA, Conaghan P, Le Bars M, Baron G, Grassi W, Martin-Mola E, et al. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: prevalence of inflammation in osteoarthritis. Ann Rheum Dis 2005; 64: 1703-9. DOI: https://doi.org/10.1136/ard.2005.037994
Mermerci BB, Garip Y, Uysal RS, Dogruel H, Karabulut E, Ozoran K, et al. Clinic and ultrasound findings related to pain in patients with knee osteoarthritis. Clin Rheumatol 2011; 30: 1055-62. DOI: https://doi.org/10.1007/s10067-011-1701-x
Iagnocco A, Meenagh G, Riente L, Filippucci E, Delle Sedie A, Scire CA, et al. Ultrasound imaging for the rheumatologist XXIX. Sonographic assessment of the knee in patients with osteoarthritis. Clin Exp Rheumatol 2010; 28: 643-6.
Hall M, Doherty S, Courtney P, Latief K, Zhang W, Doherty M. Synovial pathology detected on ultrasound correlates with the severity of radiographic knee osteoarthritis more than with symptoms. Osteoarthr Cartil 2014; 22: 1627e33 DOI: https://doi.org/10.1016/j.joca.2014.05.025
Karim Z, Wakefield RJ, Quinn M, Conaghan PG, Brown AK, Veale DJ, et al. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum 2004; 50: 387-94. DOI: https://doi.org/10.1002/art.20054
Iagnocco A, Perricone C, Scirocco C, Ceccarelli F, Mariagrazia M, Gattamelata A, et al. The interobserver reliability of ultrasound in knee osteoarthritis. Rheumatology (Oxford). 2012; 51: 2013-9. DOI: https://doi.org/10.1093/rheumatology/kes161
Altman R, Asch E, Bloch D. Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum 1986; 29: 1039-49. DOI: https://doi.org/10.1002/art.1780290816
Alves TI, Girish G, Kalume Brigido M, Jacobson JA, US of the Knee: Scanning Techniques, Pitfalls, and Pathologic Conditions. Radiographics. 2016 ;36: 1759-1775. DOI: https://doi.org/10.1148/rg.2016160019
Gandikota G, Tun M. Ultrasound of the hip in rheumatology. Indian J Rheumatol 2018; 13: 29-35.
Kohn MD, Sassoon AA, Fernando ND. Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res 2016 ; 474: 1886-93. DOI: https://doi.org/10.1007/s11999-016-4732-4
Downloads
Published
How to Cite
Issue
Section
License
The Journal of Southeast Asian Medical Research will hold the copyright to all published articles. The publisher's production department handles copyright forms once a manuscript is accepted and scheduled for publication.
