Association of Pain in Knee Osteoarthritis With Distinct Patterns of Synovitis
Association of Pain in Knee Osteoarthritis With Distinct Patterns of Synovitis
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DOI：
10.1002/art.38965
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发表时间：
2015-03-01
影响因子：
13.3
通讯作者：
Kloppenburg, M.
中科院分区：
文献类型：
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作者：
de Lange-Brokaar, B. J. E.;Ioan-Facsinay, A.;Kloppenburg, M.
Objective.明确膝关节骨性关节炎（OA）患者滑膜炎在对比增强磁共振成像（CE-MRI）上的可能模式及其与疼痛和严重程度的关系。共纳入86例症状性膝关节OA（Kellgren/Lawrence影像学评分3）患者（平均年龄62岁，66%为女性，中位体重指数29 kg/m2）。采用T1加权钆螯合物增强MRI和脂肪抑制对11个膝关节部位的滑膜炎程度进行半定量评分（总分范围0-22）。采用3份标准化问卷对自我报告的疼痛进行评估。主成分分析（PCA）被用来调查模式（位置和严重程度）的滑膜炎。随后，在校正的逻辑回归模型中评估这些模式与疼痛测量和放射学严重程度的相关性。在86例患者中观察到滑膜炎，CE-MRI显示滑膜炎一般为轻度（中位滑膜炎总评分7，范围0-16）。疼痛视觉模拟量表的中位疼痛评分为53（范围0-96），疼痛膝关节损伤和骨关节炎结局评分（KOOS）为51.4（范围2.8-97.2），持续疼痛间歇性和持续性骨关节炎疼痛（ICOAP）评分为35（范围0-75），间歇性疼痛ICOAP评分为40.6（范围0-87.5）。主成分分析提取了3个组分，解释了53.4%的方差。组分1的特征为7个部位的滑膜炎（主要累及内侧髌旁），与KOOS疼痛子量表和ICOAP持续疼痛子量表评分相关。部件2的特征为4个部位（主要是前交叉韧带附近部位）的滑膜炎，但与疼痛指标或影像学严重程度无关。组件3的特征是3个部位的滑膜炎（主要在游离体部位），与放射学严重程度相关。观察膝关节OA滑膜炎的不同类型。包括几个髌骨部位的模式与疼痛相关，而其他模式则无相关性，表明膝关节OA患者的疼痛感知是局部反应。
Objective. To determine possible patterns of synovitis on contrast-enhanced magnetic resonance imaging (CE-MRI) and its relation to pain and severity in patients with radiographic knee osteoarthritis (OA).Methods. In total, 86 patients (mean age 62 years, 66% women, median body mass index 29 kg/m(2)) with symptomatic knee OA (Kellgren/Lawrence radiographic score 3) were included. T1-weighted, gadolinium-chelate-enhanced MRI with fat suppression was used to semiquantitatively score the extent of synovitis at 11 knee sites (total score range 0-22). Self-reported pain was assessed with 3 standardized questionnaires. Principal components analysis (PCA) was used to investigate patterns (the location and severity) of synovitis. Subsequently, these patterns were assessed for associations with pain measures and radiographic severity in adjusted logistic regression models.Results. Synovitis was observed in 86 patients and was found to be generally mild on CE-MRI (median total synovitis score 7, range 0-16). The median pain scores were 53 (range 0-96) on the visual analog scale for pain, 51.4 (range 2.8-97.2) on the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, 35 (range 0-75) on the Intermittent and Constant Osteoarthritis Pain (ICOAP) score for constant pain, and 40.6 (range 0-87.5) on the ICOAP score for intermittent pain. PCA resulted in extraction of 3 components, explaining 53.4% of the variance. Component 1 was characterized by synovitis at 7 sites (mainly medial parapatellar involvement) and was associated with scores on the KOOS pain subscale and the ICOAP constant pain subscale. Component 2 was characterized by synovitis at 4 sites (mainly the site adjacent to the anterior cruciate ligament), but was not associated with pain measures or with radiographic severity. Component 3, characterized by synovitis at 3 sites (mainly at the loose body site), was associated with radiographic severity.Conclusion. Different patterns of synovitis in knee OA were observed. The pattern that included several patellar sites was associated with pain, whereas other patterns showed no association, suggesting that pain perception in patients with knee OA is a localized response.