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Synovitis (knee osteoarthritis) associated with low vitamin D – Dec 2016

Associations between clinical evidence of inflammation and synovitis in symptomatic knee osteoarthritis: A substudy of the VIDEO trial.

Arthritis Care Res (Hoboken). 2016 Dec 20. doi: 10.1002/acr.23162. [Epub ahead of print]
Wallace G1, Cro S2, Doré C2, King L3, Kluzek S1, Price A1, Roemer F4, Guermazi A5, Keen R6, Arden N7.
1The University of Oxford, Oxford, United Kingdom.
2MRC Clinical Trials Unit at University College London, London, United Kingdom.
3University Hospital Southampton, Southampton, United Kingdom.
4Boston University School of Medicine, Boston, MA, USA and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany.
5Boston University School of Medicine, Boston, MA, USA.
6University College London Hospitals, London, United Kingdom and The Royal National Orthopaedic Hospital, Stanmore, United Kingdom.
7The University of Oxford, Oxford, United Kingdom and The University of Southampton, Southampton, United Kingdom.

Objective Painful knee osteoarthritis (KOA) has been associated with joint inflammation. There is however little literature correlating signs of localised inflammation with Contrast-enhanced (CE) Magnetic resonance imaging (MRI) of synovium. This study examined the relationship between clinical and functional markers of localised knee inflammation and CE MRI based synovial scores.

Methods Patients with symptomatic KOA were enrolled into the randomised, double-blind, Vitamin D Evaluation in Osteoarthritis (VIDEO) trial. In this cross-sectional substudy, associations between validated MRI based semi-quantitative synovial scores of the knee and the following markers of inflammation were investigated; self-reported pain and stiffness, effusion, warmth, joint line tenderness, erythrocyte sedimentation rate, radiographic severity and functional ability tests.

Results 107 patients satisfied the inclusion criteria of complete data and were included in the analysis. Significant associations were found between the number of regions affected by synovitis and WOMAC pain, effusion and joint line tenderness. Each additional region affected by synovitis was associated with an increase in WOMAC pain (1.82; 95% CI 0.05-3.58; p=0.04) and the association with extent of medial synovitis was particularly strong (3.21; 95% CI 0.43-5.99; p=0.02). Extent of synovitis was positively associated with effusion (OR=1.69; 95% CI 1.37-2.08, p<0.01), and negatively associated with joint line tenderness (RR= 0.87; 95% CI 0.84-0.90; p<0.01).

Conclusion There is a strong positive association between synovitis, and self-reported patient pain and clinically detectable effusion. Non-operative treatments directed at management of inflammation and future trials targeting the synovial tissue for treating KOA should consider these two factors as potential inclusion criteria. This article is protected by copyright. All rights reserved.

PMID: 27998036 DOI: 10.1002/acr.23162 publisher rents PDF for $6