Associations between MRI-defined structural pathology and generalized and localized knee pain – the Oulu Knee Osteoarthritis study

Kaukinen, Päivi; Podlipská, Jana; Guermazi, Ali; Niinimäki, Jaakko; Lehenkari, Petri; Roemer, Frank W.; Nieminen, Miika T.; Koski, Juhani M.; Arokoski, Jari; Saarakkala, Simo

doi:10.1016/j.joca.2016.05.001

Cited by 48 publications

(49 citation statements)

References 36 publications

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“…This latter observation is consistent with reports that SV correlates with radiographic OA (21), and that MRI-detected synovitis may be a risk factor for OA incidence and progression (31–33). In contrast to several prior studies (34, 35), in our study SV did not correlate with OA pain (not shown), possibly because our MR protocol involved global synovial examination, whereas pain has been most closely correlated with peripatellar synovitis (36, 37). Finally, baseline sUA distinguished both mild progressors with JSN>0.2mm, and fast progressors with JSN>0.5mm over 24 months, from non-progressors through AUC analyses.…”

Section: Discussioncontrasting

confidence: 99%

Serum Urate Levels Predict Joint Space Narrowing in Non‐Gout Patients With Medial Knee Osteoarthritis

Krasnokutsky

Oshinsky

Attur

et al. 2017

Arthritis & Rheumatology

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Objective OA pathogenesis includes both mechanical and inflammatory features. Studies have implicated synovial fluid urate (UA) as a potential OA biomarker, possibly reflecting chondrocyte damage. Whether serum urate (sUA) levels reflect/contribute to OA is unknown. We investigated whether sUA predicts OA progression in a non-gout knee OA population. Methods Eighty-eight subjects with medial knee OA (BMI <33) but without gout were included. Baseline sUA was measured in previously banked serum. At 0 and 24 months, subjects underwent standardized weight-bearing fixed-flexion posteroanterior knee radiographs to determine joint space width (JSW) and Kellgren-Lawrence (KL) grades. Joint space narrowing (JSN) was determined as JSW change from 0 to 24 months. Twenty-seven subjects underwent baseline contrast-enhanced 3T knee MRI for synovial volume (SV) assessment. Results sUA correlated with JSN in both univariate (r=0.40, p≤0.01) and multivariate analyses (r=0.28, p=0.01). There was a significant difference in mean JSN after dichotomizing at sUA of 6.8 mg/dL, the solubility point for serum urate, even after adjustment (JSN of 0.90 mm for sUA≥6.8; JSN of 0.31 mm for sUA<6.8, p<0.01). Baseline sUA distinguished progressors (JSN>0.2mm) and fast progressors (JSN>0.5mm) from nonprogressors (JSN≤0.0mm) in multivariate analyses (area under the receiver operating characteristic curve 0.63, p=0.03; AUC 0.62, p=0.05, respectively). sUA correlated with SV (r=0.44, p<0.01), a possible marker of JSN, though this correlation did not persist after controlling for age, gender and BMI (r=0.13, p=0.56). Conclusions In non-gout patients with knee OA, sUA predicted future JSN and may serve as a biomarker for OA progression.

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Section: Discussioncontrasting

confidence: 99%

Serum Urate Levels Predict Joint Space Narrowing in Non‐Gout Patients With Medial Knee Osteoarthritis

Krasnokutsky

Oshinsky

Attur

et al. 2017

Arthritis & Rheumatology

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“…Cartilage damages identified by US were previously correlated with degenerative cartilage changes found by arthroscopy, but the lack of US findings does not exclude degenerative changes [30]. The association of the hyaline cartilage damageor loss with pain was demonstrated in US and MRI studies [2,13,[31][32][33]. In our study we found that cartilage damage was the most important predictor for knee pain, especially for pain evaluated by VAS.…”

Section: Inter-observer Agreementmentioning

confidence: 44%

“…Synovitis was considered to be an important predictor for pain [5]. In contrast to these findings, studies using MRI showed only moderate [31] or no [33] correlation/ association between effusion/synovitis and pain. The presence of the 2 types of pain -mechanical pain during joint movements and inflammatory pain related to flares -can partially explain the differences between studies.…”

Section: Inter-observer Agreementmentioning

confidence: 94%

“…In our study, we evaluated the global level of pain as we did not focus on specific physical activities, which probably explains the differences with other studies. Kaukine et al [33], using MRI as the imaging technique for investigation of the knee OA, found a strong correlation between the presence of osteophytes and pain level. Only the anterior extrusion of the medial meniscus was associated with medial pain after adjustment for other MRI findings.…”

Section: Inter-observer Agreementmentioning

confidence: 99%

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Pain in bilateral knee osteoarthritis – correlations between clinical examination, radiological, and ultrasonographical findings.

et al. 2016

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Aims: The aim of the study was to evaluate the correlations between clinical symptoms (pain), physical examination, ultrasound (US), and radiological findings in patients with bilateral knee osteoarthritis (OA). Material and methods: Knee pain was appreciated during medial and lateral palpation of each knee joint and using visual analogue scale (VAS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). US evaluation (osteophytes, meniscal protrusion, synovial fluid, femoral hyaline cartilage thickness) and radiological assessment (osteophytes, femoral-tibial space, Kellgren-Lawrence [K-L] score, enthesopathies) were performed by two examiners blinded to the clinical results and to each other. All these findings were scored with a five-point scale. Results: A total of 52 consecutive patients aged 63.44±9.49 were examined, 33 (80.5%) being females. In patients with bilateral knee OA the pain, evaluated by WOMAC score and VAS, was correlated with the presence of osteophytes and cartilage thickness but no association with medial meniscal protrusion and effusion was demonstrated. Pain produced by palpation of the knee was strongly associated with the presence of medial osteophytes. VAS and WOMAC scores increased with the severity of radiological and US findings. The presence of osteophytes and articular cartilage damage at US examination were strongly and positively correlated with radiological K-L score. US examiners agreement was good for osteophytes and moderate for meniscal protrusion, cartilage damage, and synovial fluid. The cartilage damage score was the only independent predictor for VAS scale; for WOMAC score the sex, cartilage damage, the presence of medial osteophytes and lateral meniscal protrusion were the independent predictors. Conclusion: Pain intensity was correlated with the severity of US findings, cartilage damage score being an independent predictor for both VAS and WOMAC scores. Medial osteophytes and lateral meniscal protrusion and are independent predictors for WOMAC score.

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“…Many changes occur in bone, including attrition, sclerosis, formation of osteophytes, cysts, and marrow lesions [1, 3]. Excessive bone remodelling has been linked to cartilage degeneration [4, 5] and pain [6] from early on in disease [7], but the nature of the relationship between both tissues and how lesions progress over time remains unclear [8, 9]. This is partly because cartilage loss frequently progresses prior to development of symptoms and partly because available tools are insensitive and do not permit early diagnosis [10].…”

Section: Introductionmentioning

confidence: 99%

Automated assessment of bone changes in cross-sectional micro-CT studies of murine experimental osteoarthritis

2017

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ObjectiveThe degradation of articular cartilage, which characterises osteoarthritis (OA), is usually paired with excessive bone remodelling, including subchondral bone sclerosis, cysts, and osteophyte formation. Experimental models of OA are widely used to investigate pathogenesis, yet few validated methodologies for assessing periarticular bone morphology exist and quantitative measurements are limited by manual segmentation of micro-CT scans. The aim of this work was to chart the temporal changes in periarticular bone in murine OA by novel, automated micro-CT methods.MethodsOA was induced by destabilisation of the medial meniscus (DMM) in 10-week old male mice and disease assessed cross-sectionally from 1- to 20-weeks post-surgery. A novel approach was developed to automatically segment subchondral bone compartments into plate and trabecular bone in micro-CT scans of tibial epiphyses. Osteophyte volume, as assessed by shape differences using 3D image registration, and by measuring total epiphyseal volume was performed.ResultsSignificant linear and volumetric structural modifications in subchondral bone compartments and osteophytes were measured from 4-weeks post-surgery and showed progressive changes at all time points; by 20 weeks, medial subchondral bone plate thickness increased by 160±19.5 μm and the medial osteophyte grew by 0.124±0.028 μm3. Excellent agreement was found when automated measurements were compared with manual assessments.ConclusionOur automated methods for assessing bone changes in murine periarticular bone are rapid, quantitative, and highly accurate, and promise to be a useful tool in future preclinical studies of OA progression and treatment. The current approaches were developed specifically for cross-sectional micro-CT studies but could be applied to longitudinal studies.

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Associations between MRI-defined structural pathology and generalized and localized knee pain – the Oulu Knee Osteoarthritis study

Abstract: Hoffa's synovitis and osteophytes were strongly associated with the presence of knee pain. Medial pain was associated most often with medially located structural pathologies.

Cited by 48 publications

References 36 publications

Serum Urate Levels Predict Joint Space Narrowing in Non‐Gout Patients With Medial Knee Osteoarthritis

Serum Urate Levels Predict Joint Space Narrowing in Non‐Gout Patients With Medial Knee Osteoarthritis

Pain in bilateral knee osteoarthritis – correlations between clinical examination, radiological, and ultrasonographical findings.

Automated assessment of bone changes in cross-sectional micro-CT studies of murine experimental osteoarthritis

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