Is treated HIV infection associated with knee cartilage degeneration and structural changes? A longitudinal study using data from the osteoarthritis initiative

Abstract

Background Metabolic disorders presenting in HIV-infected patients on antiretroviral therapy (ART) may increase the risk of osteoarthritis. However, structural changes of the knee in HIV infected subjects are understudied. The aim of this study is to investigate knee cartilage degeneration and knee structural changes over 8 years in subjects with and without HIV infection determined based on the use of ART. Methods We studied 10 participants from the Osteoarthritis Initiative who received ART at baseline and 20 controls without ART, frequency matched for age, sex, race, baseline body mass index (BMI) and Kellgren & Lawrence grade. Knee abnormalities were assessed using the whole-organ magnetic resonance imaging score (WORMS) and cartilage T2 including laminar and texture analyses were analyzed using a multislice-multiecho spin-echo sequence. Signal abnormalities of the infrapatellar fat pad (IPFP) and suprapatellar fat pad (SPFP) were assessed separately using a semi-quantitative scoring system. Linear regression models were used in the cross-sectional analysis to compare the differences between ART/HIV subjects and controls in T2 (regular and laminar T2 values, texture parameters) and morphologic parameters (subscores of WORMS, scores for signal alterations of IPFP and SPFP). Mixed effects models were used in the longitudinal analysis to compare the rate of change in T2 and morphological parameters between groups over 8 years. Results At baseline, individuals on ART had significantly greater size of IPFP signal abnormalities ( P = 0.008), higher signal intensities of SPFP ( P = 0.015), higher effusion scores ( P = 0.009), and lower subchondral cysts sum scores ( P = 0.003) compared to the controls. No significant differences were found between the groups in T2-based cartilage parameters and WORMS scores for cartilage, meniscus, bone marrow edema patterns and ligaments ( P > 0.05). Longitudinally, the HIV cohort had significantly higher global knee T2 entropy values ( P = 0.047), more severe effusion ( P = 0.001) but less severe subchondral cysts ( P = 0.002) on average over 8 years. Conclusions Knees of individuals with HIV on ART had a more heterogeneous cartilage matrix, more severe synovitis and abnormalities of the IPFP and SPFP, which may increase the risk of incident knee osteoarthritis. Electronic supplementary material The online version of this article (10.1186/s12891-019-2573-5) contains supplementary material, which is available to authorized users.

Obese and overweight individuals have greater knee synovial inflammation and associated structural and cartilage compositional degeneration: data from the osteoarthritis initiative

“…Our study has several limitations. We graded size and highest signal of IPFP signal alterations as previously reported [17], but most previous studies focused only on size of signal alterations by using the MOAKS grading system [16], a subjective score differentiating mild to severe grades, and another study used a more detailed grading with 0 = normal; 1 = < 10% signal abnormality of the region; grade 2 = 10-20% of the region; and grade 3 > 20% of the region [41]. However, we demonstrated that both size and degree of signal intensity of IPFP abnormalities potentially contributed to a good surrogate marker for synovial inflammation.…”

“…Specifically, six sub-features were graded per knee as described in previous publications (Table 1) [15][16][17][18]. As it is not always possible to differentiate synovial thickening from intra-articular joint fluid on NCE-MRI, we used the term effusion-synovitis as previously described [16,18].…”

“…1 Patient selection from the OAI database detail, effusion-synovitis was graded by using a 4-point scale (0 = physiologic amount of fluid; 1 = small amount of fluid continuously extending into the retropatellar space; 2 = medium-with slight convexity of the suprapatellar bursa; 3 = large-evidence of capsular distention). Third and fourth, we assessed the size and highest signal intensity on the sagittal IW fat-suppressed images of Hoffa or the infrapatellar fat pad (IPFP) abnormality as previously published [17]. The size of the IPFP signal abnormalities was graded as follows: grade 0 = no signal abnormality; grade 1 ≤ 33% of the region showing signal abnormality; grade 2 = 34-66% of the region; and grade 3 ≥ 66% of the region.…”

Meniscal anterior and posterior horn heights are associated with MRI-defined knee structural abnormalities in middle-aged and elderly patients with symptomatic knee osteoarthritis

“…The University of California San Francisco (UCSF)modified whole-organ MRI score (WORMS) system was used to semi-quantitatively assess OA-related knee morphological abnormalities [19][20][21]. Meniscal lesions were graded from 0 to 4 in each of 6 regions (anterior/body/ posterior regions of the medial and lateral menisci) using the following 4-point scale: 0 = normal, 1 = intrasubstance signal, 2 = nondisplaced tear, 3 = displaced or complex tear, and 4 = complete destruction/maceration.…”

Current issues in the management of patients with HIV infection and rheumatic diseases

“…У ВИЧ-инфицированных пациентов, как правило, отмечается более тяжелое течение ОА с быстрым эрозированием суставных поверхностей. Было установлено, что пациенты с гонартрозом, получавшие АРВТ по поводу ВИЧ, имели более неоднородное состояние хрящевого матрикса, более тяжелый синовит и аномалии над-и поднадколенниковых жировых тел по сравнению с больными ОА без ВИЧ [15]. Сходные данные были получены A.L.…”