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. 2017 Dec 19;19(1):281.
doi: 10.1186/s13075-017-1486-7.

Association between ultrasound-detected synovitis and knee pain: a population-based case-control study with both cross-sectional and follow-up data

Aliya Sarmanova  1   2 , Michelle Hall  2   3 , Gwen S Fernandes  1   2   4 , Archan Bhattacharya  1   4   3 , Ana M Valdes  1   2   5 , David A Walsh  1   2   4   5 , Michael Doherty  1   2   4   5 , Weiya Zhang  6   7   8   9
Affiliations

Association between ultrasound-detected synovitis and knee pain: a population-based case-control study with both cross-sectional and follow-up data

Aliya Sarmanova et al. Arthritis Res Ther. .

Abstract

Background: An important role for synovial pathology in the initiation and progression of knee osteoarthritis has been emphasised recently. This study aimed to examine whether ultrasonography-detected synovial changes associate with knee pain (KP) in a community population.

Methods: A case-control study was conducted to compare people with early KP (n = 298), established KP (n = 100) or no KP (n = 94) at baseline. Multinomial logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) between groups adjusted for radiographic osteoarthritis (ROA) severity and other confounding factors. After 1 year, 255 participants with early and established KP completed the follow-up questionnaire for changes in KP. Logistic regression with adjustment was used to determine predictors of KP worsening.

Results: At baseline, effusion was associated with early KP (OR 2.64, 95% CI 1.57-4.45) and established KP (OR 5.07, 95% CI 2.74-9.38). Synovial hypertrophy was also associated with early KP (OR 5.43, 95% CI 2.12-13.92) and established KP (OR 13.27, 95% CI 4.97-35.43). The association with effusion diminished when adjusted for ROA. Power Doppler signal was uncommon (early KP 3%, established KP 2%, controls 0%). Baseline effusion predicted worsening of KP at 1 year (OR 1.95, 95% CI 1.05-3.64). However, after adjusting for ROA, the prediction was insignificant (adjusted OR 0.95, 95% CI 0.44-2.02).

Conclusions: Ultrasound effusion and synovial hypertrophy are associated with KP, but only effusion predicts KP worsening. However, the association/prediction is not independent from ROA. Power Doppler signal is uncommon in people with KP. Further study is needed to understand whether synovitis is directly involved in different types of KP.

Keywords: Cohort study; Knee pain; Osteoarthritis; Synovial changes; Synovitis; Ultrasound.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Nottingham University Hospitals NHS Trust and the Nottingham Research Ethics Committee 1 (8 April 2014, Ref. 14/EM/0015) and registered on ClinicalTrials.gov (14 March 2014, NCT02098070). All participants signed the consent form.

Consent for publication

Not applicable.

Competing interests

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Mean effusion (left) and mean synovial hypertrophy (right) for each group. Note: For global X-ray score (horizontal axis), the scale was categorised as < 5, 5–9.99, 10–14.99 and > 15. Vertical error bars indicate standard error of the mean
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