Synovial changes detected by ultrasound in people with knee osteoarthritis - a meta-analysis of observational studies

A Sarmanova, M Hall, J Moses, M Doherty, W Zhang, A Sarmanova, M Hall, J Moses, M Doherty, W Zhang

Abstract

Objectives: To examine the prevalence of synovial effusion, synovial hypertrophy and positive Doppler signal (DS) detected by ultrasound (US) in people with knee osteoarthritis (OA) and/or knee pain compared to that in the general population.

Method: A systematic literature search was undertaken in Medline, EMBASE, Allied and Complementary Medicine, PubMed Web of Science, and SCOPUS databases in May 2015. Frequencies of US abnormalities in people with knee OA/pain, in the general population or asymptomatic controls were pooled using the random effects model. Publication bias and heterogeneity between studies were examined.

Results: Twenty four studies in people with knee pain/OA and five studies of the general population or asymptomatic controls met the inclusion criteria. The pooled prevalence of US effusion, synovial hypertrophy and positive DS in people with knee OA/pain were 51.5% (95% CI 40.2 to 62.8), 41.5% (26.3-57.5) and 32.7% (8.34-63.24), respectively, which were higher than those in the general population or asymptomatic controls (19.9% (95%CI 7.8-35.3%), 14.5% (0-58.81), and 15.8 (3.08-35.36), respectively). People with knee OA (ACR criteria or radiographic OA) had greater prevalence of US abnormalities than people with knee pain (P = 0.037, P = 0.010 and P = 0.009, respectively).

Conclusions: US detected effusion, synovial hypertrophy and DS are more common in people with knee OA/pain, compared to the general population. These abnormalities relate more to presence of OA structural changes than to pain.

Keywords: Meta-analysis; Osteoarthritis; Synovial; Synovitis; Ultrasound.

Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Study selections.
Fig. 2
Fig. 2
Forest plot showing the subgroup analysis by overall quality score for the prevalence of DS in people with knee OA/pain. P – prevalence rates, 95% CI – lower and upper confidence limits of the 95% confidence interval around the mean prevalence rate. The diamond in the forest plot denotes the summary prevalence and its edges the respective 95% CIs. Three groups from the study by Hall were included: (1) – people with symptomatic OA, (2) – people with radiographic OA, (3) – people with knee pain.

References

    1. Hayashi D., Roemer F.W., Katur A., Felson D.T., Yang S.O., Alomran F. Imaging of synovitis in osteoarthritis: current status and outlook. Semin Arthritis Rheum. 2011;41:116–130.
    1. Attur M., Samuels J., Krasnokutsky S., Abramson S.B. Targeting the synovial tissue for treating osteoarthritis (OA): where is the evidence? Best Pract Res Clin Rheumatol. 2010;24:71–79.
    1. Roemer F.W., Guermazi A., Felson D.T., Niu J.B., Nevitt M.C., Crema M.D. Presence of MRI-detected joint effusion and synovitis increases the risk of cartilage loss in knees without osteoarthritis at 30-month follow-up: the MOST study. Ann Rheum Dis. 2011;70:1804–1809.
    1. Atukorala I., Kwoh C.K., Guermazi A., Roemer F.W., Boudreau R.M., Hannon M.J. Synovitis in knee osteoarthritis: a precursor of disease? Ann Rheum Dis. 2014
    1. Conaghan P.G., D'Agostino M.A., Le Bars M., Baron G., Schmidely N., Wakefield R. Clinical and ultrasonographic predictors of joint replacement for knee osteoarthritis: results from a large, 3-year, prospective EULAR study. Ann Rheum Dis. 2010;69:644–647.
    1. Iagnocco A. Imaging the joint in osteoarthritis: a place for ultrasound? Best Pract Res Clin Rheumatol. 2010;24:27–38.
    1. Karim Z., Wakefield R.J., Quinn M., Conaghan P.G., Brown A.K., Veale D.J. Validation and reproducibility of ultrasonography in the detection of synovitis in the knee: a comparison with arthroscopy and clinical examination. Arthritis Rheum. 2004;50:387–394.
    1. Ulasli A.M., Yaman F., Dikici O., Karaman A., Kacar E., Demirdal U.S. Accuracy in detecting knee effusion with clinical examination and the effect of effusion, the patient's body mass index, and the clinician's experience. Clin Rheumatol. 2014;33:1139–1143.
    1. Walther M., Harms H., Krenn V., Radke S., Faehndrich T.P., Gohlke F. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum. 2001;44:331–338. 2<331::AID-ANR50>;2–0.
    1. Labanauskaite G., Sarauskas V. Correlation of power Doppler sonography with vascularity of the synovial tissue. Med Kaunas Lith. 2003;39:480–483. Lithuanian.
    1. Tarhan S., Unlu Z. Magnetic resonance imaging and ultrasonographic evaluation of the patients with knee osteoarthritis: a comparative study. Clin Rheumatol. 2003;22:181–188.
    1. Aleo E., Barbieri F., Sconfienza L., Zampogna G., Garlaschi G., Cimmino M.A. Ultrasound versus low-field magnetic resonance imaging in rheumatic diseases: a systematic literature review. Clin Exp Rheumatol. 2014;32:S91–S98.
    1. Joshua F., Edmonds J., Lassere M. Power Doppler ultrasound in musculoskeletal disease: a systematic review. Semin Arthritis Rheum. 2006;36:99–108.
    1. Koski J.M. Doppler imaging and histology of the synovium. J Rheumatol. 2012;39:452–453.
    1. Wells G., Shea B., O'Connell D. The Ottawa Hospital; Ottawa (ON): 2007. Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Non-randomized Studies in Meta-analysis. Available from:
    1. Reeves BC, Deeks JJ, Higgins JP, Wells TGA. Including non-randomized studies. In: Cochrane Handbook for Systematic Reviews of Interventions Higgins J, Green S Eds.: The Cochrane Collaboration 2011: chapter 13. Available from: .
    1. Higgins J.P., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.
    1. Higgins J.P., Thompson S.G. Controlling the risk of spurious findings from meta-regression. Stat Med. 2004;23:1663–1682.
    1. Harris R., Bradburn M., Deeks J., Harbord R., Altman D., Sterne J. METAN: fixed and random effects meta-analysis. Stata J. 2008;8:3–28.
    1. Steichen T.J. Tests for publication bias in meta-analysis. Stata Tech Bull. 1998:9–15.
    1. Harbord R.M., Harris R.J., Sterne J.A.C. Updated tests for small-study effects in meta-analyses. Stata J. 2009;9:197–210.
    1. Nyaga V.N., Arbyn M., Aerts M. Metaprop: a Stata command to perform meta-analysis of binomial data. Archives Public Health. 2014;72:39.
    1. Chaimani A., Mavridis D., Salanti G. A hands-on practical tutorial on performing meta-analysis with Stata. Evid Based Ment Health. 2014;17:111–116.
    1. Martino F., Angelelli G., Ettorre G.C., Macarini L., Patella V., Moretti B. The normal aspect of the suprapatellar bursa in echography of the knee. Radiol Med. 1992;83:43–48. Italian.
    1. Mielke G., Brandruplukanow A., Bandilla K., Berg D., Higer P., Loch E.G. Sonography of the knee-joint – normal findings and changes in rheumatoid-arthritis. Ultraschall Med. 1990;11:40–43. German.
    1. Svetlova M.S., Vezikova N.N. Clinical, instrumental, and laboratory characteristics of early stages of gonarthrosis. Ter Arkh. 2010;82:54–58. Russian.
    1. Blankstein A., Ganel A., Mirovsky Y., Chechick A., Dudkiewicz I. Early diagnosis of generalized knee pain and osteoarthritis by ultrasound. Aktuelle Traumatol. 2006;36:175–179.
    1. Malas F.U., Kara M., Kaymak B., Akinci A., Özçakar L. Ultrasonographic evaluation in symptomatic knee osteoarthritis: clinical and radiological correlation. Int J Rheum Dis. 2014;17:536–540.
    1. Zivanovic S., Rackov L.P., Vucetic D., Mijuskovic Z. Arthrosonography and the biomarker cartilage oligomeric matrix protein in the detection of knee osteoarthrosis effusion. J Med Biochem. 2009;28:108–115.
    1. Hall M., Doherty S., Courtney P., Latief K., Zhang W., Doherty M. Synovial pathology detected on ultrasound correlates with the severity of radiographic knee osteoarthritis more than with symptoms. Osteoarthritis Cartilage. 2014;22:1627–1633.
    1. de Miguel Mendieta E., Cobo Ibanez T., Uson Jaeger J., Bonilla Hernan G., Martin Mola E. Clinical and ultrasonographic findings related to knee pain in osteoarthritis. Osteoarthritis Cartilage. 2006;14:540–544.
    1. Wu P.T., Shao C.J., Wu K.C., Wu T.T., Chern T.C., Kuo L.C. Pain in patients with equal radiographic grades of osteoarthritis in both knees: the value of gray scale ultrasound. Osteoarthritis Cartilage. 2012;20:1507–1513.
    1. Abraham A.M., Pearce M.S., Mann K.D., Francis R.M., Birrell F. Population prevalence of ultrasound features of osteoarthritis in the hand, knee and hip at age 63 years: the Newcastle thousand families birth cohort. BMC Musculoskelet Disord. 2014;15:162.
    1. D'Agostino M.A., Iagnocco A., Aegerter P., Kleyer A., Zwerina J., Perricone C. Does subclinical inflammation contribute to impairment of function of knee joints in aged individuals? High prevalence of ultrasound inflammatory findings. Rheumatol Oxf. 2015;54:1622–1629.
    1. Schmidt W.A., Schmidt H., Schicke B., Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 2004;63:988–994.
    1. Picerno V., Filippou G., Bertoldi I., Adinolfi A., Di Sabatino V., Galeazzi M. Prevalence of Baker's cyst in patients with knee pain: an ultrasonographic study. Reumatismo. 2013;65:264–270.
    1. Artul S., Khazin F., Hakim J., Habib G. Ultrasonographic findings in a large series of patients with knee pain. J Clin Imaging Sci. 2014;4:45.
    1. Naredo E., Cabero F., Palop M.J., Collado P., Cruz A., Crespo M. Ultrasonographic findings in knee osteoarthritis: a comparative study with clinical and radiographic assessment. Osteoarthritis Cartilage. 2005;13:568–574.
    1. Chan K.K., Sit R.W., Wu R.W., Ngai A.H. Clinical, radiological and ultrasonographic findings related to knee pain in osteoarthritis. PLoS One. 2014;9:e92901.
    1. Song I.H., Althoff C.E., Hermann K.G., Scheel A.K., Knetsch T., Burmester G.R. Contrast-enhanced ultrasound in monitoring the efficacy of a bradykinin receptor 2 antagonist in painful knee osteoarthritis compared with MRI. Ann Rheum Dis. 2009;68:75–83.
    1. Iagnocco A., Meenagh G., Riente L., Filippucci E., Delle Sedie A., Scire C.A. Ultrasound imaging for the rheumatologist XXIX. Sonographic assessment of the knee in patients with osteoarthritis. Clin Exp Rheumatol. 2010;28:643–646.
    1. D'Agostino M.A., Conaghan P., Le Bars M., Baron G., Grassi W., Martin-Mola E. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: prevalence of inflammation in osteoarthritis. Ann Rheum Dis. 2005;64:1703–1709.
    1. Filippucci E., Salaffi F., Carotti M., Grassi W. Doppler ultrasound imaging techniques for assessment of synovial inflammation. Rep Med Imaging. 2013;6:83–91.
    1. Joshua F., Lassere M., Bruyn G.A., Szkudlarek M., Naredo E., Schmidt W.A. Summary findings of a systematic review of the ultrasound assessment of synovitis. J Rheumatol. 2007;34:839–847.
    1. Harbord R.M., Egger M., Sterne J.A. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med. 2006;25:3443–3457.
    1. Guermazi A., Niu J., Hayashi D., Roemer F.W., Englund M., Neogi T. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study) BMJ. 2012;345:e5339.
    1. Terslev L., D'Agostino M.A., Brossard M., Aegerter P., Balint P., Backhaus M. Which knee and probe position determines the final diagnosis of knee inflammation by ultrasound? Results from a European multicenter study. Ultraschall Med. 2012;33:E173–E178.
    1. Zivanovic S., Petrovic-Rackov L., Zivanovic A. Arthrosonography and biomarkers in the evaluation of destructive knee cartilage osteoarthrosis. Srp Arh Celok Lek. 2009;137:653–658.

Source: PubMed

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