With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction

Abstract

BackgroundBraces are used to treat pain in patellofemoral joint osteoarthritis (PFJOA). In a trial, we previously reported pain improvement after 6-weeks brace use. The pain reduction did not correlate with changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. Studies show that changes in the synovium on dynamic contrast enhanced (DCE) MRI are more closely associated with symptom change than static synovial volume changes. We hypothesised change in synovitis assessed using dynamic imaging could explain the reduction in pain.MethodOne hundred twenty-six men and women aged 40–70 years with painful radiographically confirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. Pain assessment and DCE-MRI were performed at baseline and 6 weeks. DCE data was analysed using Tofts’s equation. Pain measures included a VAS of pain on nominated aggravating activity (VASNA), and the KOOS pain subscale. Paired t-tests were used to determine within person change in outcome measures and Spearman’s correlation coefficients were used to determine the correlation between change in pain and change in the DCE parameters.ResultsMean age of subjects was 55.5 years (SD = 7.5) and 57% were female. There was clear pain improvement in the brace users compared to controls (VASNA − 16.87 mm, p = <0.001). There was no significant change to the dynamic synovitis parameters among brace users nor was pain change correlated with change in dynamic synovitis parameters.ConclusionThe reduction in knee pain following brace wearing in patients with PFJOA is not explained by changes in synovitis.Trial registrationTrial registration number UK. ISRCTN50380458/Registered 21.5.2010.

Intra-articular injection of triamcinolone acetonide releasing biomaterial microspheres inhibits pain and inflammation in an acute arthritis model

“…However, pain symptoms are often observed before signs of inflammation are present in a joint developing RA, and increased pain sensitivity of non-inflamed sites has been observed in RA patients (Lee et al., 2009), while synovitis and pain do not always correlate (Forslind & Svensson, 2016). This discrepancy between inflammation and pain was also found in knee OA patients, where pain intensity poorly correlated with the degree of inflammation (Siebuhr et al., 2014; Petersen et al., 2016; Swaminathan et al., 2017; Riis et al., 2017). This may be related to the observation that both in RA and OA, pain can arise from pain signals by the peripheral (joint), spinal and supraspinal pain pathways (Zhang & Lee, 2018; O'Neill & Felson, 2018).…”

Exploring longitudinal associations of histologically assessed inflammation with symptoms and radiographic damage in knee osteoarthritis: combined results of three prospective cohort studies

“…Nevertheless, other studies, using imaging modalities for synovitis assessment, have shown associations between inflammation and clinical outcomes 7,11 . Furthermore, synovitis is known to fluctuate, and this fluctuation has shown correlations to fluctuations in clinical outcomes 25,26 , although conflicting evidence exists 27,28 . The discrepancy with our results may be caused by the fact that inflammation was only assessed once, while clinical aspects were assessed multiple times during follow-up.…”

Modelo de atención para el tratamiento de pacientes con osteoartritis del primer al tercer nivel

“…Posteriormente, con la ayuda de las respuestas del cuestionario se tomó en consideración la ubicación de la vivienda y poder adquisitivo, con lo cual se pudo manejar un programa de recomendaciones centrado en el paciente con el mayor aprovechamiento del entorno en todos los niveles. 21,22 Valoración sicológica Los diagnósticos fueron obtenidos de la primera intervención mediante entrevista clínica y cuestionario. 23,24,25 Y para la última evaluación se utilizó la escala clinimétrica de Yessavage y la entrevista clínica.…”