Patellar skin surface temperature by thermography reflects knee osteoarthritis severity

Anna E Denoble, Norine Hall, Carl F Pieper, Virginia B Kraus, Anna E Denoble, Norine Hall, Carl F Pieper, Virginia B Kraus

Abstract

Background: Digital infrared thermal imaging is a means of measuring the heat radiated from the skin surface. Our goal was to develop and assess the reproducibility of serial infrared measurements of the knee and to assess the association of knee temperature by region of interest with radiographic severity of knee Osteoarthritis (rOA).

Methods: A total of 30 women (15 Cases with symptomatic knee OA and 15 age-matched Controls without knee pain or knee OA) participated in this study. Infrared imaging was performed with a Meditherm Med2000™ Pro infrared camera. The reproducibility of infrared imaging of the knee was evaluated through determination of intraclass correlation coefficients (ICCs) for temperature measurements from two images performed 6 months apart in Controls whose knee status was not expected to change. The average cutaneous temperature for each of five knee regions of interest was extracted using WinTes software. Knee x-rays were scored for severity of rOA based on the global Kellgren-Lawrence grading scale.

Results: The knee infrared thermal imaging procedure used here demonstrated long-term reproducibility with high ICCs (0.50-0.72 for the various regions of interest) in Controls. Cutaneous temperature of the patella (knee cap) yielded a significant correlation with severity of knee rOA (R = 0.594, P = 0.02).

Conclusion: The skin temperature of the patellar region correlated with x-ray severity of knee OA. This method of infrared knee imaging is reliable and as an objective measure of a sign of inflammation, temperature, indicates an interrelationship of inflammation and structural knee rOA damage.

Keywords: inflammation; infrared imaging; knee; osteoarthritis; thermography.

Figures

Figure 1.
Figure 1.
Infrared image analysis. To identify regions of interest on the infrared thermal images, it was necessary to localize the patella. For this purpose, two knee images were acquired, one without and subsequently one with a 2 cm anatomic marker (silver sticker) applied to the center of the patella (shown on left). This marker blocked temperature radiation and was readily recognized on the thermal images as a black circle (shown on right). This image facilitated alignment of an acetate diagram centered on the patella in order to quantify mean temperatures for specific regions of interest: P-patellar; M-medial; L-lateral; LM-lower medial; LL-lower lateral; and the overall knee.
Figure 2.
Figure 2.
Patellar temperature and radiographic OA. Whisker and box plots depict the mean, 25th and 75th percentiles, minimum and maximum temperatures in the two osteoarthritis subgroups, Kellgren-Lawrence (KL2 and KL3) for the patellar region of interest.

References

    1. Braverman IM. The cutaneous microcirculation. J Investig Dermatol Symp Proc. 2000 Dec;5(1):3–9.
    1. Bonelli RM, Koltringer P. Autonomic nervous function assessment using thermal reactivity of microcirculation. Clin Neurophysiol. 2000 Oct;111(10):1880–8.
    1. Vainer BG. FPA-based infrared thermography as applied to the study of cutaneous perspiration and stimulated vascular response in humans. Phys Med Biol. 2005 Dec 7;50(23):R63–94.
    1. Anderson ME, Moore TL, Lunt M, Herrick AL. The ‘distal-dorsal difference’: a thermographic parameter by which to differentiate between primary and secondary Raynaud’s phenomenon. Rheumatology (Oxford) 2007;46(3):533–8.
    1. Maeda M, Kachi H, Ichihashi N, Oyama Z, Kitajima Y. The effect of electrical acupuncture-stimulation therapy using thermography and plasma endothelin (ET-1) levels in patients with progressive systemic sclerosis (PSS) J Dermatol Sci. 1998 Jun;17(2):151–5.
    1. Bruehl S, Lubenow TR, Nath H, Ivankovich O. Validation of thermography in the diagnosis of reflex sympathetic dystrophy. Clin J Pain. 1996 Dec;12(4):316–25.
    1. Devereaux MD, Parr GR, Thomas DP, Hazleman BL. Disease activity indexes in rheumatoid arthritis; a prospective, comparative study with thermography. Ann Rheum Dis. 1985 Jul;44(7):434–7.
    1. Spalding SJ, Kwoh CK, Boudreau R, et al. Three-dimensional and thermal surface imaging produces reliable measures of joint shape and temperature: a potential tool for quantifying arthritis. Arthritis Res Ther. 2008;10(1):R10.
    1. Varju G, Pieper CF, Renner JB, Kraus VB. Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods. Rheumatology. 2004;43(7):915–9.
    1. Warashina H, Hasegawa Y, Tsuchiya H, et al. Clinical, radiographic, and thermographic assessment of osteoarthritis in the knee joints. Ann Rheum Dis. 2002 Sep;61(9):852–4.
    1. Esselinckx W, Bacon PA, Ring EF, Crooke D, Collins AJ, Demottaz D. A thermographic assessment of three intra-articular prednisolone analogues given in rheumatoid synovitis. Br J Clin Pharmacol. 1978 May;5(5):447–51.
    1. Collins AJ, Cosh JA. Temperature and biochemical studies of joint inflammation. A preliminary investigation. Ann Rheum Dis. 1970 Jul;29(4):386–92.
    1. Dieppe PA, Sathapatayavongs B, Jones HE, Bacon PA, Ring EF. Intra-articular steroids in osteoarthritis. Rheumatol Rehabil. 1980 Nov;19(4):212–7.
    1. Ring EF, Dieppe PA, Bacon PA. The thermographic assessment of inflammation and anti-inflammatory drugs in osteoarthritis. Br J Clin Pract. 1981 Jul–Aug;35(7–8):263–4.
    1. Zazirnyi IM, Mahomedov OM, Drobotun OV, Ievseienko VH. [Effect of chondroprotectors in the treatment and prophylaxis of the knee joint osteoarthrosis] Lik Sprava. 2000 Oct–Dec;(7–8):50–2.
    1. Ring EF, Collins AJ, Bacon PA, Cosh JA. Quantitation of thermography in arthritis using multi-isothermal analysis. II. Effect of nonsteroidal anti-inflammatory therapy on the thermographic index. Ann Rheum Dis. 1974 Jul;33(4):353–6.
    1. Collins AJ, Ring EF, Cosh JA, Bacon PA. Quantitation of thermography in arthritis using multi-isothermal analysis. I. The thermographic index. Ann Rheum Dis. 1974 Mar;33(2):113–5.
    1. Bacon PA, Collins AJ, Ring EF. Letter: Treatment of acute gout. Br Med J. 1974 May 18;2(5915):387.
    1. Um SW, Kim MS, Lim JH, Kim SY, Seo KM, Nam TC. Thermographic evaluation for the efficacy of acupuncture on induced chronic arthritis in the dog. J Vet Med Sci. 2005 Dec;67(12):1283–4.
    1. Eckstein F, Buck RJ, Burstein D, et al. Precision of 3.0 Tesla Quantitative Magnetic Resonance Imaging of cartilage morphology in a multi center clinical trial. Ann Rheum Dis. 2008;67(12):1683–8.
    1. Mazzuca SA, Hellio Le, Graverand MP, Vignon E, et al. Performance of a non-fluoroscopically assisted substitute for the Lyon schuss knee radiograph: quality and reproducibility of positioning and sensitivity to joint space narrowing in osteoarthritic knees. Osteoarthritis Cartilage. 2008 Dec;16(12):1555–9.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502.
    1. Charles HC, Kraus VB, Ainslie M, Hellio Le, Graverand-Gastineau MP. Optimization of the fixed-flexion knee radiograph. Osteoarthritis Cartilage. 2007 Nov;15(11):1221–4.
    1. Fleiss J. The Design and Analysis of Clinical Experiments. New York: Wiley; 1986.
    1. Cosh JA, Lindsay DJ, Davies ER, Ring FJ. The technetium scintigram as an indicator of syovial vascularity in rheumatoid arthritis: its comparison with the results of temperature measurement. Ann Rheum Dis. 1970 Nov;29(6):691.

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