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. 2005 May 5;64(12):1703–1709. doi: 10.1136/ard.2005.037994

EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: Prevalence of inflammation in osteoarthritis

M D'Agostino 1, P Conaghan 1, M Le Bars 1, G Baron 1, W Grassi 1, E Martin-Mola 1, R Wakefield 1, J Brasseur 1, A So 1, M Backhaus 1, M Malaise 1, G Burmester 1, N Schmidely 1, P Ravaud 1, M Dougados 1, P Emery 1
PMCID: PMC1755310  PMID: 15878903

Abstract

Objectives: To assess the prevalence of inflammation in subjects with chronic painful knee osteoarthritis (OA), as determined by the presence of synovitis or joint effusion at ultrasonography (US); and to evaluate the correlation between synovitis, effusion, and clinical parameters.

Methods: A cross sectional, multicentre, European study was conducted under the umbrella of EULAR-ESCISIT. Subjects had primary chronic knee OA (ACR criteria) with pain during physical activity ⩾30 mm for at least 48 hours. Clinical parameters were collected by a rheumatologist and an US examination of the painful knee was performed by a radiologist or rheumatologist within 72 hours of the clinical examination. Ultrasonographic synovitis was defined as synovial thickness ⩾4 mm and diffuse or nodular appearance, and a joint effusion was defined as effusion depth ⩾4 mm.

Results: 600 patients with painful knee OA were analysed. At US 16 (2.7%) had synovitis alone, 85 (14.2%) had both synovitis and effusion, 177 (29.5%) had joint effusion alone, and 322 (53.7%) had no inflammation according to the definitions employed. Multivariate analysis showed that inflammation seen by US correlated statistically with advanced radiographic disease (Kellgren-Lawrence grade ⩾3; odds ratio (OR) = 2.20 and 1.91 for synovitis and joint effusion, respectively), and with clinical signs and symptoms suggestive of an inflammatory "flare", such as joint effusion on clinical examination (OR = 1.97 and 2.70 for synovitis and joint effusion, respectively) or sudden aggravation of knee pain (OR = 1.77 for joint effusion).

Conclusion: US can detect synovial inflammation and effusion in painful knee OA, which correlate significantly with knee synovitis, effusion, and clinical parameters suggestive of an inflammatory "flare".

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Figure 1.

Figure 1

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 Synovitis at ultrasonography in subjects with painful knee OA: distribution of synovial thickness.

Figure 2.

Figure 2

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 Effusion depth on ultrasonography in subjects with painful knee OA: distribution of effusion depth.

Figure 3.

Figure 3

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 Relationship between ultrasonography synovial thickness and effusion depth using linear regression.

Figure 4.

Figure 4

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 Synovitis (A) and joint effusion (B) on US in subjects with painful knee OA. (A) Synovitis in a longitudinal scan (suprapatellar recess). (B) Joint effusion in a longitudinal scan (suprapatellar recess): S, synovitis; E, effusion.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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