The value of different involvement patterns of the knee “synovio-entheseal complex” in the differential diagnosis of spondyloarthritis, rheumatoid arthritis, and osteoarthritis: an MRI-based study

Li, Boya; Guo, Zikang; Qu, Jin Ping; Zhan, Yanhui; Shen, Zhiwei; Lei, Xinwei

doi:10.1007/s00330-023-09485-4

Cited by 2 publications

(1 citation statement)

References 45 publications

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“…MRI is increasingly being used for diagnosis in patients with knee symptoms; however, similar imaging findings such as cartilage defect, effusion, and synovitis have resulted in make an accurate differential diagnosis [ 3 ]. Many patients with a preliminary diagnosis of OA are discharged from the hospital for a routine follow-up with their primary care physician.…”

Section: Introductionmentioning

confidence: 99%

Broken-fat pad sign: a characteristic radiographic finding to distinguish between knee rheumatoid arthritis and osteoarthritis

Wang,

Zhao,

et al. 2024

Insights Imaging

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Objectives Diagnostic imaging plays an important role in the pre-treatment workup of knee osteoarthritis (OA) and rheumatoid arthritis (RA). Herein, we identified a useful MRI sign of infrapatellar fat pad (IPFP) to improve diagnosis. Methods Eighty-one age- and sex-matched RA and OA patients each, with pathological diagnosis and pre-treatment MRI were retrospectively evaluated. All randomized MR images were blinded and independently reviewed by two radiologists. The assessment process included initial diagnosis, sign evaluation, and final diagnosis, with a 3-week interval between each assessment. Broken-fat pad (BFP) sign was assessed on sagittal T2-weighted-imaging in routine MRI. The area under the curve and Cohen’s kappa (κ) were used to assess the classification performance. Two shape features were extracted from IPFP for quantitative interpretation. Results The median age of the study population was 57.6 years (range: 31.0–78.0 years). The BFP sign was detected more frequently in patients with RA (72.8%) than those with OA (21.0%). Both radiologists achieved better performance by referring to the BFP sign, with accuracies increasing from 58.0 to 75.9% and 72.8 to 79.6%, respectively. The inter-reader correlation coefficient showed an increase from fair (κ = 0.30) to substantial (κ = 0.75) upon the consideration of the BFP sign. For quantitative analysis, the IPFP of RA had significantly lower sphericity (0.54 ± 0.04 vs. 0.59 ± 0.03, p < 0.01). Despite larger surface-volume-ratio of RA (0.38 ± 0.05 vs. 0.37 ± 0.04, p = 0.25) than that of OA, there was no statistical difference. Conclusions The BFP sign is a potentially important diagnostic clue for differentiating RA from OA with routine MRI and reducing misdiagnosis. Critical relevance statement With the simple and feasible broken-fat pad sign, clinicians can help more patients with early accurate diagnosis and proper treatment, which may be a valuable addition to the diagnostic workup of knee MRI assessment. Key points • Detailed identification of infrapatellar fat pad alterations of patients may be currently ignored in routine evaluation. • Broken-fat pad sign is helpful for differentiating rheumatoid arthritis and osteoarthritis. • The quantitative shape features of the infrapatellar fat pad may provide a possible explanation of the signs. • This sign has good inter-reader agreements and is feasible for clinical application. Graphical Abstract

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Section: Introductionmentioning

confidence: 99%

Broken-fat pad sign: a characteristic radiographic finding to distinguish between knee rheumatoid arthritis and osteoarthritis

Wang,

Zhao,

et al. 2024

Insights Imaging

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Hydraulic theory of pathogenesis of posttraumatic osteoarthritis of knee joints and perspectives of therapeutic measures

Noskov,

Shepelyaeva,

Bashkina

et al. 2024

Vrach

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An original hydraulic theory of the pathogenesis of osteoarthritis of the knee joints is proposed. The hydraulic theory suggests the presence of an initial traumatic or domestic injury to the menisci, cruciate ligaments, and synovial membrane, followed by a post-traumatic increase in the volume of synovial fluid and, accordingly, hydrostatic pressure inside the synovial cavity. Damage to the cell layer of synovial macrophages, which form the basis of the intima and synovial barrier, leads to the leakage of synovial fluid into the subintima with the development of cellular alteration and the subsequent growth of fibrosis and the growth of uncontrolled hyperplasia, cellular hypertrophy and neoplasm of vessels and nerve endings. Later damage to the thick bone and cartilage barrier leads to intrusion of synovial fluid into the bone tissue with the formation of bone cysts and osteoarthritic damage/edema of the bone marrow. Restoration of barriers through the use of repair, including cellular, technologies in the near future is impossible due to the lack of regenerative potential in synovial macrophages and chondrocytes. Damage to the synovial and osteocartilage barrier suggests different medical tactics for the management of patients with osteoarthritis of the knee joints. The authors substantiate the undesirability of any type of analgesic therapy in case of damage to the synovial barrier and preservation of the integrity of the bone-cartilage barrier. The only effective and safe method of treatment at all stages of the disease is therapeutic exercise with an emphasis on exercises that accelerate lymphatic and venous outflow in order to achieve antifibrotic and antihypoxic effects.

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The value of different involvement patterns of the knee “synovio-entheseal complex” in the differential diagnosis of spondyloarthritis, rheumatoid arthritis, and osteoarthritis: an MRI-based study

Cited by 2 publications

References 45 publications

Broken-fat pad sign: a characteristic radiographic finding to distinguish between knee rheumatoid arthritis and osteoarthritis

Broken-fat pad sign: a characteristic radiographic finding to distinguish between knee rheumatoid arthritis and osteoarthritis

Hydraulic theory of pathogenesis of posttraumatic osteoarthritis of knee joints and perspectives of therapeutic measures

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