A Standardized, Pragmatic Approach to Knee Ultrasound for Clinical Research in Osteoarthritis: The Johnston County Osteoarthritis Project

Yerich, Nadiya V.; Álvarez, Carolina; Schwartz, Todd A.; Savage-Guin, S.; Renner, Jordan B.; Bakewell, Catherine J.; Kohler, Minna J.; Lin, Jyh Dong; Samuels, Jonathan; Nelson, Amanda

doi:10.1002/acr2.11159

Cited by 17 publications

(22 citation statements)

References 40 publications

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“…We also demonstrated a positive association between synovial abnormalities and presence and severity of ROA. These results accord with previous findings [ 22 , 48 , 50 ], and reinforce that synovial changes are involved in knee OA.…”

Section: Discussionsupporting

confidence: 93%

“…Few studies have reported the prevalence of ultrasound-detected synovial abnormalities in community-based samples who were not selected on the basis of knee problems [ 19 – 22 ]. In Newcastle in the UK, effusion was detected in 24% and 20% of right and left knees, respectively, among 311 participants aged 61 to 63 years [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the Nottingham Knee Pain and Related Health in the Community Study in the UK, the prevalence was 23.9% for synovial hypertrophy, 50.9% for effusion, and 0.7% for PDS in 163 participants with no knee pain or ROA [ 21 ]. In the Johnston County Osteoarthritis Project, evidence of effusion/synovitis on ultrasound was found in 80.3% of 396 knees of 203 participants using a semi-quantitative assessment atlas [ 22 ]. The prevalence of synovial abnormalities in our study was comparable with these previous studies, suggesting similar findings in diverse populations (China, USA, UK, and Italy).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Power Doppler (PD) ultrasound modes provide a unique opportunity to detect indirect signs of increased vascularization, which reflects with high sensitivity joint inflammatory activity [ 17 ]. However, there are few epidemiological studies that describe the prevalence of knee synovial abnormalities on ultrasound or examine the relation of these features to knee symptoms and radiographic osteoarthritis (ROA) in the general population [ 18 – 22 ]. Lack of such data makes it difficult to interpret the diagnostic information provided by ultrasound in people who have symptoms that are possibly attributable to synovial abnormalities.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population—the Xiangya Osteoarthritis Study

et al. 2021

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Background There is paucity of data on the prevalence of ultrasound-detected synovial abnormalities in the general population, and the relationship between synovial changes and knee pain remains unclear. We examined the prevalence of synovial abnormalities on ultrasound and the relationship of these features with knee pain and radiographic osteoarthritis (ROA) in a community sample. Methods Participants aged 50 years or over were from the Xiangya Osteoarthritis Study, a community-based cohort study. Participants were questioned about chronic knee pain and underwent (1) ultrasonography of both knees to determine presence of synovial hypertrophy (≥ 4 mm), effusion (≥ 4 mm), and Power Doppler signal [PDS; yes/no]; and (2) standard radiographs of both knees (tibiofemoral and patellofemoral views) to determine ROA. Results There were 3755 participants (mean age 64.4 years; women 57.4%). The prevalence of synovial hypertrophy, effusion, and PDS were 18.1% (men 20.2%; women 16.5%), 46.6% (men 49.9%; women 44.2%), and 4.9% (men 4.9%; women 5.0%), respectively, and increased with age (P for trend < 0.05). Synovial abnormalities were associated with knee pain, with adjusted odds ratios (aORs) of 2.39 (95% confidence interval [CI] 2.00–2.86) for synovial hypertrophy, 1.58 (95%CI 1.39–1.80) for effusion, and 4.36 (95%CI 3.09–6.17) for PDS. Similar associations with ROA were observed, the corresponding aORs being 4.03 (95%CI 3.38–4.82), 2.01 (95%CI 1.76–2.29), and 6.49 (95%CI 4.51–9.35), respectively. The associations between synovial hypertrophy and effusion with knee pain were more pronounced among knees with ROA than those without ROA, and the corresponding P for interaction were 0.004 and 0.067, respectively. Conclusions Knee synovial hypertrophy and effusion are more common and increase with age, affecting men more than women. All three ultrasound-detected synovial abnormalities associate both with knee pain and ROA, and knee synovial hypertrophy or effusion and ROA may interact to increase the risk of knee pain.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population—the Xiangya Osteoarthritis Study

et al. 2021

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“…Patients with osteoarthritis will most commonly seek treatment from a physician because of joint pain [1], joint effusion and/or inability to move freely. Physicians rely on joint pain assessment [2, 3], radiography, ultrasound [4, 5], and other imaging modalities to diagnose osteoarthritis [6]. The most common method employed is x-ray to visualize joint bones and the joint space [7]; however, this technique does not directly assess the cartilage, which is one of the first tissues that degenerate during early osteoarthritis.…”

Section: Introductionmentioning

confidence: 99%

Osteoarthritis Early-, Mid- and Late-Stage Progression in the Rat Medial Meniscus Transection Model

McKinney

Pucha

et al. 2021

Preprint

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Osteoarthritis is a degenerative disease of synovial joints affecting all tissues, including the articular cartilage and underlying subchondral bone. Osteoarthritis animal models can recapitulate aspects of human disease progression and are commonly used to test the development of drugs, biomaterials, and cell therapies for treatment. The rat medial meniscus transection (MMT) model is a surgically induced post-traumatic osteoarthritis model and is one of the most commonly used models for therapeutic development; however, it is typically used to evaluate the efficacy of therapies to prevent disease development rather than testing the treatment of disease progression in already established disease. We describe herein, the qualitative and quantitative changes to articular cartilage, subchondral bone, and formation of osteophytes in rats at early- (3-weeks post-surgery), mid- (6-weeks post-surgery) and late- (12-weeks post-surgery) stages of osteoarthritis progression. Tibiae of MMT-operated animals showed loss of proteoglycan and fibrillation formation on articular cartilage surfaces as early as 3-weeks post-surgery. Using a contrast-enhanced microCT technique, quantitative, 3-dimensional analysis of the tibiae showed that the articular cartilage initially thickened at 3- and 6-weeks post-surgery and then decreased at 12-weeks post-surgery. This decrease in cartilage thickness corresponded with increased lesions in the articular cartilage, including fully degraded surfaces down to the subchondral bone layer. In this rat MMT model, subchondral bone thickening was significant at 6-weeks post-surgery and seem to follow cartilage damage. Osteophytes were found at 3-weeks post-surgery, which coincided with articular cartilage degradation. Cartilaginous osteophytes preceded mineralization suggesting that these marginal tissue growths most likely occurred through endochondral ossification. The use of the rat MMT model has predominantly been used out to 3-weeks, and most studies determine the effect of therapies to delay or prevent the onset of osteoarthritis. We provide evidence that an extension of the rat MMT model out to 6 and 12 weeks resembled more severe phenotypes of human osteoarthritis. The mid- to late-stages of rat MMT model can be used to evaluate the therapeutic efficacy of novel treatments to treat the progression of established disease --- since patients typically present in the clinic when the disease is established and becomes symptomatic, thus evaluating the efficacy of new treatments at the late stage will be important for eventual clinical translation.

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Test–Retest Reliability and Sensitivity to Change of Ultrasound‐Based Methods of Measuring Synovial Inflammation in Knee Osteoarthritis

Philpott

Birmingham

Dima

et al. 2022

Arthritis Care & Research

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Objectives. To assess test-retest reliability of musculoskeletal ultrasound (US) measures of inflammation in patients with knee osteoarthritis (OA) and to assess the sensitivity to change of US measures of inflammation in patients with knee OA.Methods. To mimic a common clinical scenario, 36 patients (n = 70 knees) with symptomatic knee OA who were in stable condition underwent 2 assessments within 14 days by different operators and different US machines, graded by a single rater. Test-retest reliability was measured using Cohen's kappa coefficient, intraclass correlation coefficient (ICC), and absolute agreement parameters. A total of 51 patients (n = 72 knees) were tested immediately before and 21-28 days after intraarticular glucocorticoid injection to investigate sensitivity to change and longitudinal construct validity. Paired t-tests and standardized response mean (SRM) were used to assess sensitivity to change. Multivariate linear regression was used to investigate longitudinal construct validity of US with Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scores, while adjusting for covariates.Results. US measures of inflammation demonstrated moderate (κ = 0.41, 0.60) to substantial (κ = 0.61, 0.80) agreement. Quantitative measures of synovitis and effusion demonstrated good test-retest reliability (ICC 2,1 0.71, 0.92). US measures of synovitis and effusion demonstrated low-to-moderate sensitivity to change (SRM -0.29, -0.50). The associations between changes in US measures and KOOS pain scores over time were low, and 95% confidence intervals included zero.Conclusion. In a clinical setting, US measures of inflammatory features of knee OA have substantial reliability and low-to-moderate sensitivity to change, whereas measures of structural OA features are less reliable. Longitudinal construct validity of US measures of synovitis and effusion to KOOS pain scores is not strongly supported.

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A Standardized, Pragmatic Approach to Knee Ultrasound for Clinical Research in Osteoarthritis: The Johnston County Osteoarthritis Project

Cited by 17 publications

References 40 publications

Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population—the Xiangya Osteoarthritis Study

Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population—the Xiangya Osteoarthritis Study

Osteoarthritis Early-, Mid- and Late-Stage Progression in the Rat Medial Meniscus Transection Model

Test–Retest Reliability and Sensitivity to Change of Ultrasound‐Based Methods of Measuring Synovial Inflammation in Knee Osteoarthritis

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