Presence of MRI-detected joint effusion and synovitis increases the risk of cartilage loss in knees without osteoarthritis at 30-month follow-up: the MOST study

Abstract

Objective To evaluate if two different measures of synovial activation, baseline Hoffa-synovitis and effusion-synovitis, assessed by MRI, predict cartilage loss in the tibiofemoral joint at 30 months follow-up in subjects with neither cartilage damage nor tibiofemoral radiographic osteoarthritis (OA) of the knee. Methods Non-contrast enhanced MRI was performed using proton density-weighted fat-suppressed sequences in the axial and sagittal planes and a STIR sequence in the coronal plane. Hoffa-synovitis, effusion-synovitis and cartilage status were assessed semiquantitatively according to the WORMS scoring system. Included were knees that had neither radiographic OA nor MRI-detected tibio-femoral cartilage damage at the baseline visit. Presence of Hoffa-synovitis was defined as any grade ≥2 (range from 0–3) and effusion-synovitis as any grade ≥2 (range from 0–3). We performed logistic regression to examine the relation of presence of either measure to the risk of cartilage loss at 30 months adjusting for other potential confounders of cartilage loss. Results Of 514 knees included in the analysis, prevalence of Hoffa-synovitis and effusion-synovitis at the baseline visit was 8.4% and 10.3%, respectively. In the multivariable analysis, baseline effusion-synovitis was associated with an increased risk for cartilage loss (odds ratio (OR) = 2.7, 95% confidence intervals 1.4–5.1, p=0.002); however, no such an association was observed for baseline Hoffa-synovitis (OR =1.0, 95% confidence intervals 0.5–2.0). Conclusions Baseline effusion-synovitis, but not Hoffa-synovitis, predicted cartilage loss. Our findings suggest that effusion-synovitis, a reflection of inflammatory activity including joint effusion and synovitic thickening, may play a role in future development of cartilage lesions in knees without OA.

Evolution of synovitis in osteoarthritic knees and its association with clinical features

“…In the present study cartilage deterioration was seen in 43.6% of patients in the TFJ and in 43.6% of patients in the PFJ over 2 years, which is higher than described in a previous study investigating cartilage progression on MRI (27% in the TFJ, 24% PFJ) 14 . The difference in progression could be explained by the difference in study population: symptomatic patients in secondary care in present study vs a general study population in the other study.…”

Inhibited osteoclastic bone resorption through alendronate treatment in rats reduces severe osteoarthritis progression

“…Recently, bisphosphonates have been reported to significantly reduce pain in patients with clinical and radiographic knee osteoarthritis [45]. Synovitis and activation of synovial macrophages are related to patient complaints, like joint dysfunction and pain [46], and has been related to the progression of cartilage erosion [47,48]. Possibly, a loss of macrophage activation in ALN treated animals reflected the reduced amount of articular cartilage degradation.…”

Use of imaging techniques to predict progression in osteoarthritis

“…Joint effusion was associated with increased progression of patellofemoral cartilage defects in individuals with chronic knee pain over 6 months [32 && ], and baseline joint effusion and synovitis assessed on nonenhanced MRI in knees without tibiofemoral ROA, but at risk of developing osteoarthritis predicted increased progression of tibiofemoral cartilage defects over 24 months [37].…”