Association of Changes in Effusion-Synovitis With Progression of Cartilage Damage Over Eighteen Months in Patients With Osteoarthritis and Meniscal Tear

Abstract

Objective: Synovitis is a feature of knee osteoarthritis (OA) and meniscal tear and has been associated with articular cartilage damage. This study was undertaken to examine the associations of baseline effusion-synovitis and changes in effusion-synovitis with changes in cartilage damage in a cohort with OA and meniscal tear.

Methods: We analyzed data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of surgery versus physical therapy for treatment of meniscal tear. We performed semiquantitative grading of effusion-synovitis and cartilage damage on magnetic resonance imaging, and dichotomized effusion-synovitis as none/small (minimal) and medium/large (extensive). We assessed the association of baseline effusion-synovitis and changes in effusion-synovitis with changes in cartilage damage size and depth over 18 months, using Poisson regression models. Analyses were adjusted for patient demographic characteristics, treatment, and baseline cartilage damage.

Results: We analyzed 221 participants. Over 18 months, effusion-synovitis was persistently minimal in 45.3% and persistently extensive in 21.3% of the patients. The remaining 33.5% of the patients had minimal synovitis on one occasion and extensive synovitis on the other. In adjusted analyses, patients with extensive effusion-synovitis at baseline had a relative risk (RR) of progression of cartilage damage depth of 1.7 (95% confidence interval [95% CI] 1.0-2.7). Compared to those with persistently minimal effusion-synovitis, those with persistently extensive effusion-synovitis had a significantly increased risk of progression of cartilage damage depth (RR 2.0 [95% CI 1.1-3.4]).

Conclusion: Our findings indicate that the presence of extensive effusion-synovitis is associated with subsequent progression of cartilage damage over 18 months. The persistence of extensive effusion-synovitis over time is associated with the greatest risk of concurrent cartilage damage progression.

© 2018, American College of Rheumatology.

Figures

Figure 1:

Flow diagram illustrating selection of subjects for this analysis

Figure 2.

MRI Grading of Effusion-synovitis (A-D) Axial fat-suppressed proton-density weighted MR images through the suprapatellar pouch, showing different grades of effusion-synovitis. (A) Grade 0, with no joint effusion-synovitis. (B) Grade 1 effusion-synovitis is depicted with mild distension of the joint cavity by fluid-equivalent signal within the suprapatellar pouch (arrows). (C) Grade 2 effusion-synovitis with moderate distension of the joint cavity (arrows). (D) Grade 3 effusion-synovitis with marked capsular distention.

Figure 3:

Diagram of outcome, change in cartilage damage over time Adapted from Hunter et al, Osteoarthritis and Cartilage 2011.(14) Reprinted with permission

Figure 4:

Relative Risk for association of change in effusion-synovitis on change in cartilage damage over 18 months. Adjusted for age, sex, BMI, and baseline cartilage damage and treatment