- Increasing synovitis and bone marrow lesions are associated with incident joint tenderness in hand osteoarthritisIda K Haugen 1, Barbara Slatkowsky Christensen 1, Pernille Bøyesen 1, Sølve Sesseng 2,3, Désirée van der Heijde 1,4, Tore K Kvien 1
1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway 2Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway 3Department of Radiology, Kongsvinger Hospital, Kongsvinger, Norway 4Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
Objectives To explore whether changes of MRI defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort.
Methods We included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0–3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA.
Results Among joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant.
Conclusions The Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs.
- Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 yearsAlexander Mathiessen, Barbara Slatkowsky-Christensen, Tore K Kvien, Hilde Berner Hammer, Ida K Haugen
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
Objective To examine whether ultrasound predicts radiographic hand osteoarthritis (OA) progression after 5 years.
Methods We included 78 participants (71 women, mean (SD) age 67.8 (5.2) years) from the Oslo Hand OA cohort with ultrasound examination (gray-scale (GS) synovitis and power Doppler (PD) signals) at baseline and conventional radiographs and clinical examination at baseline and 5-year follow-up. Radiographic progression was defined as an increase in global OA according to the Kellgren–Lawrence (KL) scale or progression of individual radiographic OA features. We examined whether baseline ultrasound features and clinical examination predicted radiographic progression using generalised estimating equations, adjusted for age, sex, body mass index and follow-up time.
Results Radiographic progression occurred in 17.9% joints for KL, 12.1% for joint space narrowing, 11.7% for osteophytes and 4.5% for erosions. Ultrasound-detected inflammation predicted KL progression, and dose–response associations were observed for GS synovitis grade 1 (OR=2.8, 95% CI 1.8 to 4.2), grade 2 (OR=3.6, 95% CI 2.2 to 5.8) and grade 3 (OR=15.2, 95% CI 6.9 to 33.6), and for PD signal grade 1 (OR=2.9, 95% CI 1.2 to 6.8) and grades 2–3 (OR=12.0, 95% CI 3.5 to 41.0). Significant associations were also observed between ultrasound inflammation and progression of all individual radiographic features, and between clinical soft tissue swelling at baseline and radiographic progression.
Conclusions Ultrasound-detected GS synovitis and PD signals were significantly associated with radiographic progression after 5 years. This study supports the use of ultrasound as a tool to detect patients with hand OA who are likely to progress.
- OARSI Clinical Trials Recommendations: Knee imaging in clinical trials in osteoarthritisSummary
Significant advances have occurred in our understanding of the pathogenesis of knee osteoarthritis (OA) and some recent trials have demonstrated the potential for modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply knee imaging in knee OA trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance (QA)/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
Full text available at Science Direct.
- OARSI Clinical Trials Recommendations: Hip imaging in clinical trials in osteoarthritisSummary
Imaging of hip in osteoarthritis (OA) has seen considerable progress in the past decade, with the introduction of new techniques that may be more sensitive to structural disease changes. The purpose of this expert opinion, consensus driven recommendation is to provide detail on how to apply hip imaging in disease modifying clinical trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for magnetic resonance imaging (MRI)); commonly encountered problems (including positioning, hardware and coil failures, artifacts associated with various MRI sequences); quality assurance/control procedures; mea- surement methods; measurement performance (reliability, responsiveness, and validity); recommen- dations for trials; and research recommendations.
Full text available at Science Direct.
- Ultrasonographic predictors for clinical and radiological progression in knee osteoarthritis after 2 years of follow-upKaren Bevers, Johanna E. Vriezekolk, Johannes W. J. Bijlsma, Cornelia H. M. van den Ende and Alfons A. den Broeder
Objective The aim of this study was to investigate the association between a set of US features and radiographic and clinical progression of knee OA after 2 years of follow-up.
Methods A total of 125 patients fulfilling ACR clinical criteria for knee OA underwent US examination of the most symptomatic knee. The US protocol included assessment of synovial hypertrophy, joint effusion, infrapatellar bursitis, Baker’s cyst, medial meniscus protrusion and cartilage thickness. Clinical progression was defined using the inverse Osteoarthritis Research Society International responder criteria or progression to total knee replacement. Radiological progression was defined as a 52 point increase in Altman score or progression to total knee replacement. Regression analyses were performed with baseline ultra- sonographic features as independent variables and progression (two separate models for clinical progression and radiographic progression) as the dependent variable.
Results A total of 31 (25%) patients fulfilled the criteria of clinical progression and 60 (48%) patients fulfilled the criteria of radiological progression. The presence of Baker’s cyst showed a statistically significant association with clinical [odds ratio (OR) 3.07 (95% CI 1.21, 7.78)] as well as radiological [OR 2.84 (95% CI 1.17, 6.90)] progression. Synovial hypertrophy showed a weaker but consistent association with clinical as well as radiological progression [OR 2.11 (95% CI 0.80, 5.57)]. Conclusion. We demonstrated a longitudinal association between Baker’s cyst (and to a lesser extent synovial hypertrophy) at baseline and radiological and clinical progression after 2 years.
Full manuscript at Rheumatology Oxford Journals
- Synovitis in knee osteoarthritis: a precursor of disease?I Atukorala, C K Kwoh, A Guermazi, F W Roemer, R M Boudreau, M J Hannon, D J Hunter
Objectives It is unknown whether joint inflammation precedes other articular tissue damage in osteoarthritis. Therefore, this study aims to determine if synovitis precedes the development of radiographic knee osteoarthritis (ROA).
Methods The participants in this nested case–control study were selected from persons in the Osteoarthritis Initiative with knees that had a Kellgren Lawrence grading (KLG)=0 at baseline (BL). These knees were evaluated annually with radiography and non-contrast-enhanced MRI over 4 years. MRIs were assessed for effusion-synovitis and Hoffa-synovitis. Case knees were defined by ROA (KLG≥2) on the postero-anterior knee radiographs at any assessment after BL. Radiographs were assessed at P0 (time of onset of ROA), 1 year prior to P0 (P-1) and at BL. Controls were participants who did not develop incident ROA (iROA) from BL to 48 months).
Results 133 knees of 120 persons with ROA (83 women) were matched to 133 control knees (83 women). ORs for occurrence of iROA associated with the presence of effusion-synovitis at BL, P-1 and P0 were 1.56 (95% CI 0.86 to 2.81), 3.23 (1.72 to 6.06) and 4.7 (1.10 to 2.95), respectively. The ORs for the occurrence of iROA associated with the presence of Hoffa-synovitis at BL, P-1 and P0 were 1.80 (1.1 to 2.95), 2.47 (1.45 to 4.23) and 2.40 (1.43 to 4.04), respectively.
Conclusions Effusion-synovitis and Hoffa-synovitis strongly predicted the development of iROA.
- Targeting tumour necrosis factor alleviates signs and symptoms of inflammatory osteoarthritis of the kneeWalter P Maksymowych, Anthony S Russell, Peter Chiu, Alex Yan, Niall Jones, Tracey Clare and Robert GW Lambert
Inflammation associated with synovial expression of TNFα is a recognised feature of osteoarthritis (OA), although no studies have yet reported beneficial effects of anti-TNFα therapy on clinical manifestations of inflammation in OA.
Methods We conducted an open-label evaluation of adalimumab over 12 weeks in 20 patients with OA of the knee and evidence of effusion clinically. Inclusion criteria included daily knee pain for the month preceding study enrolment and a summed pain score of 125 to 400 mm visual analogue scale on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain subscale. The primary outcome was the Osteoarthritis Research Society International/Outcome Measures in Rheumatology Clinical Trials (OARSI/OMERACT) response criterion at week 12. Secondary outcomes included the WOMAC pain score 20% and 50% improvement, WOMAC stiffness and function scores, patient and physician global visual analogue scale, as well as target joint swelling.
Results Treatment was well tolerated and completed by 17 patients with withdrawals unrelated to lack of efficacy or adverse events. By intention to treat, an OARSI/OMERACT response was recorded in 14 (70%) patients. WOMAC pain 20% and 50% responses were recorded in 14 (70%) patients and eight (40%) patients, respectively. Significant improvement was observed in mean WOMAC pain, stiffness, function, physician and patient global, as well as target joint swelling at 12 weeks (P < 0.0001 for all). After treatment discontinuation, 16 patients were available for assessment at 22 weeks and OARSI/OMERACT response compared with baseline was still evident in 10 (50%) patients.
Conclusion Targeting TNFα may be of therapeutic benefit in OA and requires further evaluation in controlled trials.
Full article at Biomed Central
- Glucosamine Supplements May Increase Intraocular Pressure
An over-the-counter treatment for joint pain commonly prescribed by rheumatologists and other physicians may increase intraocular pressure, a new study suggests.
The treatment, glucosamine sulfate taken in supplements, could increase the risk of glaucoma, according to H. Esfandiari of the University of Medical Sciences, Iran, and colleagues in the journal Eye. They called on ophthalmologists to “directly ask patients about its usage and carry out medication discontinuation trial[s] in uncontrolled cases” of glaucoma.
Full article at Rheumatology Network
- Findings Do Not Support Steroid Injections for Knee Osteoarthritis
Among patients with knee osteoarthritis, an injection of a corticosteroid every 3 months over 2 years resulted in significantly greater cartilage volume loss and no significant difference in knee pain compared with patients who received a placebo injection, according to a study published by JAMA.
Full article at DG News - Rheumatology
Full abstract at The JAMA Network