Relation of synovitis to knee pain using contrast-enhanced MRIs

Abstract

Background It has been suggested that synovitis causes joint pain. On non-contrast-enhanced MRIs synovial thickening cannot be assessed and on these images synovitis has been inconsistently associated with pain. Objective To assess synovial thickening in relation to knee pain severity among subjects in the Multicenter Osteoarthritis Study (MOST) using contrast-enhanced (CE) MRI. Methods MOST is a cohort study of people who have, or are at high risk of, knee osteoarthritis (OA). An unselected subset of 535 participants who volunteered underwent CE 1.5 T MRI of one knee. Synovitis was scored in six compartments and a summary score was created. Knee pain severity was assessed using the maximum item score on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain scale. The association between synovitis and pain severity was examined using a logistic regression model adjusting for age, sex, body mass index (BMI), MRI bone marrow lesions and effusions in the whole sample and in a subgroup without radiographic OA. Results 454 of the 535 subjects undergoing CE MRI had complete data on synovitis and WOMAC pain. Mean age was 59 years, mean BMI 30 and 48% were women. In knees with moderate pain, 80% had synovitis. For knee pain, synovitis conferred a 9.2-fold increased odds compared with those without synovitis. In knees without radiographic OA (n=329), there was also an association of synovitis with an increased prevalence of pain. Conclusion Synovitis has a strong relation with knee pain severity, an association detected more clearly with CE MRI than suggested by previous studies using non-CE MRI measures of synovitis.

Serum and synovial fluid C-reactive protein level variations in dogs with degenerative joint disease and their relationships with physiological parameters

“…Additionally, the study considered the facility with which individuals expressed their painful condition, verifying that SCRP mean was higher in patients who had easier-to-elicit pain (5.21 ± 1.46 mg/l), than in patients in which elicit pain was difficult (3.46 ± 3.25 mg/l), however, this difference was not statistically significant. The results are in line with several studies carried out in humans, where it was possible to demonstrated the relationship between the DJD grade and it tissues changes such as, effusions, popliteal cysts, and synovial thickening, and the pain level exibit by the patients (Hill et al 2001;Conaghan et al 2006;Hill et al 2007;Baker et al 2010). Imaging is an important component for DJD stage characterization.…”

The evolving role of biomarkers for osteoarthritis

“…Since cartilage loss on MRI may also reflect the influence of local inflammation, which may in turn be related to systemic inflammation [Baker et al 2010], authors also examined the relationships between cartilage loss and the n-6 and n-3 PUFA levels. Among the 472 subjects (average 60 years of age, mean BMI 30, 50% women), half of the subjects exhibited radiographic knee OA and one-third demonstrated synovitis on MRI.…”

The impact of MRI on the clinical management of inflammatory arthritides

“…Studies using nonenhanced MRI showed inconsistent results regarding an association between synovitis and knee pain. A recent report showed that synovitis detected by contrast-enhanced MRI had a strong association (adjusted odds ratio 9.2) with at least moderate severity of knee pain as assessed by the Western Ontario and McMaster Osteoarthritis Index pain scale [169]. A comprehensive whole-knee joint synovitis scoring system has been proposed recently, which showed a high reliability based on contrast-enhanced MRI [170].…”