Effusion-synovitis worsening mediates the association between body mass index and Kellgren-Lawrence progression in obese individuals: data from the Osteoarthritis Initiative

Banuls-Mirete, M.; Lombardi, Alecio; Posis, Alexander Ivan B; Shadyab, Aladdin H.; Chang, Eric Y.; Lane, Nancy E.; Gumá, Mónica

doi:10.1016/j.joca.2022.05.011

Cited by 12 publications

(8 citation statements)

References 49 publications

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“…Knee effusion, but not Baker's cysts, were frequent in patients with pain due to OA also in another MRI study, after allowance is made for the severity of radiographic OA (7). In addition, presence of synovitis and effusion was associated with knee OA progression, particularly among obese individuals (8). These and our results suggest that knee effusion should be included among MRI features of clinically relevant OA.…”

Section: N Patients and Methodssupporting

confidence: 76%

Magnetic resonance imaging as a structural refinement to the American College of Rheumathology clinical classification criteria for knee osteoarthritis

Minetti¹,

Parodi

Banderali

et al. 2022

Reumatismo

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Objective: To evaluate if fulfilment of the definition of osteoarthritis (OA) based on the American College of Rheumatology (ACR) clinical criteria corresponds to pathological knee findings evaluated by magnetic resonance imaging (MRI). To evaluate if any such criteria is associated with a specific MRI pattern. Methods: Forty-six consecutive patients aged 50 years or more referred by their general practitioners (GPs) to a radiology department because of non-traumatic knee pain underwent MRI using a dedicated low field (0.2 T) machine. Results: MRI results were compared against the ACR criteria for knee OA. Patients with knee pain fulfilling the ACR criteria showed more severe synovial fluid effusion (OR 6.2, 95% CI 2.02 to 19.1), cartilage lesions in the medial area (OR 2.4, 95% CI 1.2 to 5) and higher mean number of osteophytes (OR 2.3, 95% CI 1.1 to 4.5). The association between single criteria and MRI features was more difficult to establish. Nonetheless, crepitus at joint movement was associated with synovial fluid effusion (p=0.02); bone enlargement was more frequent in patients with lesions of the posterior cruciate ligament (p=0.0001); no palpable warmth was associated with cartilage lesions (p=0.02), and morning stiffness shorter than 30 minutes was associated with the surface of bone edema (p=0.02). Conclusions: The ACR clinical criteria identify patients showing the most important features of OA. The association between individual clinical ACR criteria and OA pathology depicted by MRI may be difficult to explain on the basis of anatomical changes and needs further evaluation.

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Section: N Patients and Methodssupporting

confidence: 76%

Magnetic resonance imaging as a structural refinement to the American College of Rheumathology clinical classification criteria for knee osteoarthritis

Minetti¹,

Parodi

Banderali

et al. 2022

Reumatismo

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“…Furthermore, overweight significantly increased the odds of having effusion-synovitis – but not of having Hoffa-synovitis – two years prior to incident radiographic knee OA compared to normal weight [ 38 ]. A mediation study found that the effect of BMI on knee OA progression was mediated by effusion-synovitis progression, but not by Hoffa-synovitis progression [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, overweight and obese persons had a higher prevalence of effusion- and Hoffa-synovitis that correlated with cartilage composition and most features of semi-quantitative WORMS [ 11 ]. However, a recent study found no significant association between BMI categories and prevalence of effusion-synovitis or size of Hoffa-synovitis [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two features of the MRI OsteoArthritis Knee Score (MOAKS) that are related to synovitis were semi-quantitatively assessed [ 19 ]. The MOAKS was employed in numerous previous studies [ 11 , 12 , 20 – 22 ] and is reliable and sensitive to change [ 23 ]. “Effusion-synovitis” represents a composite of synovial thickening and intraarticular joint fluid, as these cannot be distinguished on standard T2/IW/PD (proton density)-weighted images [ 24 ].…”

Section: Methodsmentioning

confidence: 99%

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Effect of weight loss on knee joint synovitis over 48 months and mediation by subcutaneous fat around the knee: data from the Osteoarthritis Initiative

Löffler,

Ngarmsrikam,

Giesler

et al. 2024

BMC Musculoskelet Disord

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Background Obesity influences the development of osteoarthritis via low-grade inflammation. Progression of local inflammation (= synovitis) increased with weight gain in overweight and obese women compared to stable weight. Synovitis could be associated with subcutaneous fat (SCF) around the knee. Purpose of the study was to investigate the effect of weight loss on synovitis progression and to assess whether SCF around the knee mediates the relationship between weight loss and synovitis progression. Methods We included 234 overweight and obese participants (body mass index [BMI] ≥ 25 kg/m2) from the Osteoarthritis Initiative (OAI) with > 10% weight loss (n = 117) or stable overweight (< ± 3% change, n = 117) over 48 months matched for age and sex. In magnetic resonance imaging (MRI) at baseline and 48 months, effusion-synovitis and Hoffa-synovitis using the MRI Osteoarthritis Knee Score (MOAKS) and average joint-adjacent SCF (ajSCF) were assessed. Odds-ratios (ORs) for synovitis progression over 48 months (≥ 1 score increase) were calculated in logistic regression models adjusting for age, sex, baseline BMI, Physical Activity Scale for the Elderly (PASE), and baseline SCF measurements. Mediation of the effect of weight loss on synovitis progression by local SCF change was assessed. Results Odds for effusion-synovitis progression decreased with weight loss and ajSCF decrease (odds ratio [OR] = 0.61 and 0.56 per standard deviation [SD] change, 95% confidence interval [CI] 0.44, 0.83 and 0.40, 0.79, p = 0.002 and 0.001, respectively), whereas odds for Hoffa-synovitis progression increased with weight loss and ajSCF decrease (OR = 1.47 and 1.48, CI 1.05, 2.04 and 1.02, 2.13, p = 0.024 and 0.038, respectively). AjSCF decrease mediated 39% of the effect of weight loss on effusion-synovitis progression. Conclusions Effusion-synovitis progression was slowed by weight loss and decrease in local subcutaneous fat. Hoffa-synovitis characterized by fluid in the infrapatellar fat pad increased at the same time, suggesting a decreasing fat pad rather than active synovitis. Decrease in local subcutaneous fat partially mediated the systemic effect of weight loss on synovitis.

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“…A case-control study based on Osteoarthritis Initiative (OAI) data showed worsening MOAKS scores of effusion-synovitis were highly associated with knee OA progression over a 4-year period, particularly among obese individuals [odds ratio (OR) 34.1; 95% confidence interval (CI) 4.2–274.8, p = 0.001]. 5 A retrospective cohort study, also using the OAI database, found a positive association between sustained knee synovitis (scored by ACLOAS and MOAKS) and greater progression of cartilage abnormalities related to OA. 6 Another OAI-based study showed statin therapy in patients for cardiovascular disease-related indications may be protective against OA-related subchondral bone marrow lesions assessed by MOAKS in individuals with generalized OA phenotype.…”

Section: Recent Developments In Semiquantitative and Quantitative Mri...mentioning

confidence: 99%

Latest advancements in imaging techniques in OA

Hayashi

Roemer

Link

et al. 2022

Therapeutic Advances in Musculoskeletal

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The osteoarthritis (OA) research community has been advocating a shift from radiography-based screening criteria and outcome measures in OA clinical trials to a magnetic resonance imaging (MRI)-based definition of eligibility and endpoint. For conventional morphological MRI, various semiquantitative evaluation tools are available. We have lately witnessed a remarkable technological advance in MRI techniques, including compositional/physiologic imaging and automated quantitative analyses of articular and periarticular structures. More recently, additional technologies were introduced, including positron emission tomography (PET)-MRI, weight-bearing computed tomography (CT), photon-counting spectral CT, shear wave elastography, contrast-enhanced ultrasound, multiscale X-ray phase contrast imaging, and spectroscopic photoacoustic imaging of cartilage. On top of these, we now live in an era in which artificial intelligence is increasingly utilized in medicine. Osteoarthritis imaging is no exception. Successful implementation of artificial intelligence (AI) will hopefully improve the workflow of radiologists, as well as the level of precision and reproducibility in the interpretation of images.

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Effusion-synovitis worsening mediates the association between body mass index and Kellgren-Lawrence progression in obese individuals: data from the Osteoarthritis Initiative

Cited by 12 publications

References 49 publications

Magnetic resonance imaging as a structural refinement to the American College of Rheumathology clinical classification criteria for knee osteoarthritis

Magnetic resonance imaging as a structural refinement to the American College of Rheumathology clinical classification criteria for knee osteoarthritis

Effect of weight loss on knee joint synovitis over 48 months and mediation by subcutaneous fat around the knee: data from the Osteoarthritis Initiative

Latest advancements in imaging techniques in OA

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