Objective To evaluate the relationships of quantitative and semi-quantitative (SQ) assessments of synovium with knee OA severity by radiographic and 3T MRI findings. Methods 58 knee OA patients underwent non-fluoroscopic fixed-flexion knee radiographs. Dynamic contrast-enhanced (CE) 3T MRI was performed pre-/post-gadolinium administration to quantify synovial volume (qSV). SQ synovial outcomes were assessed on CE and unenhanced images. Two radiologists scored X-rays using the OARSI atlas; inter-reader agreement was assessed using Kappas and concordance correlation coefficients. Multiple linear and logistic regression analysis was used to assess associations among variables while controlling the effects of age, BMI, gender and meniscal extrusion. Results KL grade, diseased compartment joint space width (dcJSW) and diseased compartment joint space narrowing (dcJSN) were significantly associated with synovial proliferation, measured as CE qSV (β = 0.78, p = 0.0001; β = -0.22, p = 0.0003; β = 0.53, p = 0.0001, respectively). Furthermore, qSV strongly correlated with total subchondral BML volume (β = 0.22, p = 0.0003). KL grade, dcJSW, and dcJSN were significantly associated with BLOKS SQ infrapatellar synovitis (OR [95%CI]: 9.05, [1.94,42.3]; 0.75 [0.54,1.03]; 2.22 [1.15,4.31], respectively) and effusion (OR [95%CI]: 5.75, [1.23,26.8]; 0.70, [0.50,0.98]; 1.96, [1.02,3.74], respectively). CE SQ synovitis also significantly associated with KL and dcJSN (β = 0.036, p = 0.0040; β = 0.015, p=0.0266, respectively), and BLOKS synovitis. Conclusion Synovitis is a characteristic feature of advancing knee OA stages, and is significantly associated with KL, JSW, JSN, and BMLs. BLOKS synovitis scoring on unenhanced MRI is associated with CE synovitis measures.

Objective Inflammatory mediators, such as PGE2 and IL-1β, are produced by osteoarthritic joint tissues, where they may contribute to disease pathogenesis. We examined whether inflammation, reflected in plasma and peripheral blood leukocytes (PBLs) reflected presence of osteoarthritis (OA), progression or symptoms in patients with symptomatic knee osteoarthritis (SKOA). Methods SKOA patients were enrolled in a 24-month prospective study of radiographic progression. Standardized knee radiographs were obtained at baseline and 24 months. Biomarkers assessed at baseline included plasma lipids PGE2 and 15-HETE, and transcriptome analysis of PBLs by microarray and qPCR. Results Baseline PGE synthases (PGES) by PBL microarray gene expression, and plasma PGE2 distinguished SKOA patients from non-OA controls (AUCs 0.87 and 0.89 respectively, p<0.0001). Baseline plasma 15-HETE was significantly elevated in SKOA versus non-OA controls (p<0.019). In the 146 patients who completed the 24-month study, elevated baseline expression of IL-1β, TNFα and COX-2 mRNA in PBLs predicted higher risk for radiographic progression by joint space narrowing (JSN). In a multivariate model, AUC point estimates of models containing COX-2 in combination with demographic traits overlap the confidence interval of the base model in two out of the three JSN outcome measures (JSN >0.0mm, >0.2mm and >0.5mm, AUC=0.62–0.67). Conclusion Inflammatory plasma lipid biomarkers PGE2 and 15-HETE identify patients with SKOA. PBL inflammatory transcriptome identifies a subset of SKOA patients at higher risk for radiographic progression. These findings may reflect low-grade inflammation in OA and may be useful as diagnostic and prognostic biomarkers in clinical development of disease-modifying OA drugs.

No abstract

Percutaneous RF ablation is an alternative to surgery for treatment of selected chondroblastomas. Larger lesions beneath weight-bearing surfaces should be approached with caution due to an increased risk of articular collapse and recurrence.

No abstract