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Liu K, Li X, Weng Q, Wang Y, Wei J, Zeng C, Lei G, Jiang T. Diagnostic Accuracy of Ultrasound for Assessment of Synovial Abnormalities Among Patients With Knee Pain: A Meta-Analysis. Arthritis Care Res (Hoboken) 2024; 76:295-303. [PMID: 37522287 DOI: 10.1002/acr.25205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/20/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Synovial abnormalities, which are modifiable treatment targets for knee pain, affect ~25% of adults. Ultrasound is a safe, inexpensive, and easily accessible imaging modality for assessing synovial abnormalities, but its diagnostic accuracy is still controversial. We conducted a meta-analysis by comparing ultrasound with the "reference standard" method, ie, magnetic resonance imaging (MRI), in assessing synovial abnormalities among patients with knee pain. METHODS PubMed, Embase, and Web of Science were searched from inception to January 7, 2022, to retrieve studies including patients with knee pain for evaluating 1) the diagnostic accuracy of ultrasound versus MRI for synovial abnormalities (synovitis and synovial effusion) and 2) the correlations of synovial abnormalities assessed by ultrasound and MRI. The summary of diagnostic accuracy was analyzed using the bivariate model, and the correlation coefficients were pooled using the random effects model. RESULTS Fourteen studies were included, representing a total of 755 patients. The pooled sensitivity, specificity, and area under the curve were 0.88 (95% confidence interval [95% CI] 0.65-0.96), 0.70 (95% CI 0.51-0.84), and 0.81 (95% CI 0.77-0.84) for synovitis and 0.90 (95% CI 0.81-0.95), 0.86 (95% CI 0.77-0.92), and 0.94 (95% CI 0.91-0.96) for synovial effusion, respectively. Strong correlations between ultrasound- and MRI-diagnosed synovitis (r = 0.64, 95% CI 0.56-0.71) and synovial effusion (r = 0.63, 95% CI 0.52-0.73) were observed. CONCLUSION Ultrasound demonstrated a promising accuracy in detecting synovial abnormalities among patients with knee pain. The use of ultrasound provides equivalent synovial information to MRI but is less expensive and more accessible. Therefore, it is recommended as an adjuvant for managing patients with knee pain during diagnostic strategy and individualized treatment decision-making.
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Affiliation(s)
- Ke Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qianlin Weng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ting Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Ultrasonography, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Oo WM, Linklater J, Bennell KL, Yu SP, Duong V, Hunter DJ. Inflammatory ultrasound features as prognostic factors of pain and functional outcomes following intra-articular platelet-rich plasma in knee osteoarthritis. Int J Rheum Dis 2023; 26:1540-1546. [PMID: 37309612 PMCID: PMC10946528 DOI: 10.1111/1756-185x.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 05/05/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
AIM To explore inflammatory ultrasound predictors of improvements in pain and function over 2, 6, and 12 months following administration of intra-articular platelet-rich plasma (PRP) in knee osteoarthritis (OA). METHOD Patients with painful mild-moderate radiographic knee OA from a subset of the RESTORE RCT underwent ultrasound assessment according to the standardized OMERACT scanning protocol to detect inflammatory features such as synovitis, synovial hypertrophy, and effusion with power Doppler. The study knee was treated with 3 once-weekly PRP injections obtained after centrifugation at 1500 g for 5 min. Numerical Rating Score (NRS), Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) function sub-score were used to measure pain and functional severity. Separate linear regression models were performed to determine whether baseline ultrasound-detected features of inflammation predicted the improvement in pain and function following PRP injection in both unadjusted and adjusted models for confounders. RESULTS Forty-four participants were included, with 25 (56.8%) being female. In an unadjusted model, higher OMERACT scores for inflammatory features such as global synovitis and/or effusion were significantly associated with greater improvement in all outcomes measured at 2 months but not at 6 and 12 months for pain measures. Only global synovitis showed significant association with functional improvement at 2 and 12 months. Similar findings were observed in the adjusted model. CONCLUSION Ultrasound indices of knee inflammation predicted short-term improvements in pain severity and both short- and longer-term improvements in function following intra-articular PRP injection.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Physical Medicine and Rehabilitation, Mandalay General HospitalUniversity of Medicine, MandalayMandalayMyanmar
| | - James Linklater
- Department of Musculoskeletal ImagingCastlereagh Sports Imaging CentreSt. Leonards, SydneyNew South WalesAustralia
| | - Kim L. Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine Dentistry & Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Shirley P. Yu
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
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Park EH, Fritz J. The role of imaging in osteoarthritis. Best Pract Res Clin Rheumatol 2023; 37:101866. [PMID: 37659890 DOI: 10.1016/j.berh.2023.101866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 09/04/2023]
Abstract
Osteoarthritis is a complex whole-organ disorder that involves molecular, anatomic, and physiologic derangement. Advances in imaging techniques have expanded the role of imaging in evaluating osteoarthritis and functional changes. Radiography, magnetic resonance imaging, computed tomography (CT), and ultrasonography are commonly used imaging modalities, each with advantages and limitations in evaluating osteoarthritis. Radiography comprehensively analyses alignment and osseous features, while MRI provides detailed information about cartilage damage, bone marrow edema, synovitis, and soft tissue abnormalities. Compositional imaging derives quantitative data for detecting cartilage and tendon degeneration before structural damage occurs. Ultrasonography permits real-time scanning and dynamic joint evaluation, whereas CT is useful for assessing final osseous detail. Imaging plays an essential role in the diagnosis, management, and research of osteoarthritis. The use of imaging can help differentiate osteoarthritis from other diseases with similar symptoms, and recent advances in deep learning have made the acquisition, management, and interpretation of imaging data more efficient and accurate. Imaging is useful in monitoring and predicting the prognosis of osteoarthritis, expanding our understanding of its pathophysiology. Ultimately, this enables early detection and personalized medicine for patients with osteoarthritis. This article reviews the current state of imaging in osteoarthritis, focusing on the strengths and limitations of various imaging modalities, and introduces advanced techniques, including deep learning, applied in clinical practice.
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Affiliation(s)
- Eun Hae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, USA; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, New York, USA.
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Hip effusions or iliopsoas hematomas on ultrasound in identifying hip fractures in the emergency department. Am J Emerg Med 2023; 64:129-136. [PMID: 36521235 DOI: 10.1016/j.ajem.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE We evaluated the sensitivity, specificity, predictive values, and likelihood ratios of hip effusion and/or iliopsoas hematoma on point-of-care ultrasound (POCUS) performed by ultrasound fellows and fellowship trained emergency providers to identify hip fractures in emergency department (ED) patients with a high suspicion of hip fracture. METHODS This was a prospective observational study of a convenience sample of patients with high suspicion of hip fracture at two academic EDs between 2018 and 2021. Patients with negative x-rays who did not receive further imaging with magnetic resonance imaging (MRI) or computed tomography (CT) were excluded. Sonographers were blinded to clinical data and ED imaging results. At the primary site, 8 ultrasound fellows and 4 emergency ultrasound fellowship-trained emergency providers performed the ultrasonographic examinations. At the secondary site, 2 ultrasound fellows, 4 emergency ultrasound-fellowship trained physicians, and 1 sports medicine fellowship-trained emergency provider performed the ultrasonographic examinations. A positive ultrasound was defined as either the presence of a hip effusion or iliopsoas hematoma on the affected extremity. The primary outcome measures were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) of POCUS findings for identification of a hip fracture compared with a ranked composite reference standard consisting of x-ray, CT, or magnetic resonance imaging (MRI); the highest-level test performed for each patient was used for comparison. RESULTS Among 213 patients analyzed, all 213 received an x-ray, 116 received a CT scan, and 14 received an MRI; 113/213 x-rays (53.1%), 35/116 CT scans (30.2%), and 7/14 MRIs (50.0%) were positive for a hip fracture. A total of 123 patients were diagnosed with a hip fracture (57.7%). There were 13 false negative x-ray results. Overall, compared with the reference standard of x-ray, CT, or MRI, POCUS had a sensitivity of 97% (95% CI: 94%, 100%), specificity of 70% (95% CI: 61%, 79%), PPV of 82% (95% CI: 75%, 88%), and NPV of 94% (95% CI: 88%, 100%) in the identification of hip fractures; with a positive likelihood ratio of 3.22 (95% CI: 2.35, 4.43) and negative likelihood ratio of 0.05 (95% CI: 0.02, 0.12). CONCLUSION In a convenience sample of ED patients with high clinical suspicion for hip fracture, the presence of a hip effusion and/or iliopsoas hematoma on POCUS performed by expert emergency ultrasonographers showed high sensitivity in diagnosing patients with a hip fracture.
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Oo WM, Hunter DJ. Efficacy, Safety, and Accuracy of Intra-articular Therapies for Hand Osteoarthritis: Current Evidence. Drugs Aging 2023; 40:1-20. [PMID: 36633823 DOI: 10.1007/s40266-022-00994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
The lifetime risk of symptomatic hand osteoarthritis (OA) is 39.8%, with one in two women and one in four men developing the disease by age 85 years and no disease-modifying drug (DMOAD) available so far. Intra-articular (IA) therapy is one of the options commonly used for symptomatic alleviation of OA disease as it can circumvent systemic exposure and potential side effects of oral medications. The current narrative review focuses on the efficacy and safety profiles of the currently available IA agents in hand OA (thumb-base OA or interphalangeal OA) such as corticosteroids and hyaluronic acid (HA), as well as the efficacy and safety of IA investigational injectates in phase 2/3 clinical trials such as prolotherapy, platelet-rich plasma, stem cells, infliximab, interferon-? and botulinum toxin, based on the published randomized controlled trials on PubMed database. The limited published literature revealed the short-term symptomatic benefits of corticosteroids in interphalangeal OA while long-term data are lacking. Most of the short-term studies showed no significant difference between corticosteroids and hyaluronic acid in thumb-base OA, usually with a faster onset of pain relief in the corticosteroid group and a slower but greater (statistically insignificant) pain improvement in the HA group. The majority of studies in investigational agents were limited by small sample size, short-term follow-up, and presence of serious side effects. In addition, we reported higher accuracy rates of drug administrations under imaging guidance than landmark guidance (blind method), and then briefly describe challenges for the long-term efficacy and prospects of IA therapeutics.
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Affiliation(s)
- Win Min Oo
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar.
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia.
| | - David J Hunter
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia
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Liu K, Li X, Weng Q, Lei G, Jiang T. Diagnostic accuracy of ultrasound for the assessment of Baker's cysts: a meta-analysis. J Orthop Surg Res 2022; 17:535. [PMID: 36510299 PMCID: PMC9743685 DOI: 10.1186/s13018-022-03430-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Baker's cyst is the most common cystic disease of the knee, and a fast and accurate diagnosis of Baker's cyst is essential for a better management. Ultrasound is a rapid, portable, widely available, inexpensive and noninvasive imaging modality. However, the diagnostic accuracy of ultrasound on Baker's cyst still remains undetermined. We conducted the first meta-analysis to comprehensively assess the accuracy of ultrasound for the detection of Baker's cyst. METHODS PubMed, Embase and Web of Science were searched from inception to July 14, 2022, without language restrictions. Studies providing cross-tabulations of ultrasound versus pathology (gold standard) or MRI (standard imaging technique) for diagnosis of Baker's cyst were included. Indicators for the diagnostic accuracy of ultrasound, including sensitivity, specificity and area under the curve, were calculated using a bivariate model. Sensitivity analysis was conducted to evaluate the heterogeneity and robustness of the results. RESULTS A total of 13 studies with 1,011 subjects (mean age 32.2 years; men 53.5%) met the inclusion criteria. The pooled sensitivity, specificity and area under the curve of ultrasound for diagnosis of Baker's cyst, compared with pathology, were 0.97 (95% confidence intervals: 0.73-1.00), 1.00 (0.98-1.00) and 1.00 (0.99-1.00), respectively. The pooled estimates of ultrasound versus MRI were 0.94 (0.87-0.98) for sensitivity, 1.00 (0.83-1.00) for specificity and 0.97 (0.95-0.98) for area under the curve. Sensitivity analysis did not change the results materially. CONCLUSION Ultrasound shows excellent diagnostic accuracy for the assessment of Baker's cyst and provides similar diagnostic information (absent or present) compared to MRI. Because of its advantages of low cost, portability and accessibility, ultrasound is likely to be a choice of imaging technique for screening Baker's cyst in clinical and population settings as well as in follow-ups.
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Affiliation(s)
- Ke Liu
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Qianlin Weng
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ting Jiang
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China ,grid.216417.70000 0001 0379 7164Department of Ultrasonography, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008 Hunan China
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Mathiessen A, Hammer HB, Terslev L, Kortekaas MC, D'Agostino MA, Haugen IK, Bruyn GA, Filippou G, Filippucci E, Kloppenburg M, Mancarella L, Mandl P, Möller I, Mortada MA, Naredo E, Sedie AD, Sexton J, Wittoek R, Iagnocco A, Ellegaard K. Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study. Arthritis Care Res (Hoboken) 2022; 74:2005-2012. [PMID: 34137211 DOI: 10.1002/acr.24734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). METHODS The Outcome Measures in Rheumatology Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores. A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with 6 sonographers testing inflammatory and structural features in 12 hand OA patients. We used Cohen's kappa for intrareader and Light's kappa for interreader reliability for all features except PD, in which prevalence-adjusted bias-adjusted kappa (PABAK) was applied. Percentage agreement was also assessed. RESULTS The web-based reliability exercise demonstrated substantial intra- and interreader reliability for all inflammatory features (κ > 0.64). In the patient-based exercise, intra- and interreader reliability, respectively, varied: SH κ = 0.73 and 0.45; JE κ = 0.70 and 0.55; PD PABAK = 0.90 and 0.88; PIP joint cartilage κ = 0.56 and 0.45; and STT osteophytes κ = 0.62 and 0.36. Percentage close agreement was high for all features (>85%). CONCLUSION With ultrasound, substantial to excellent intrareader reliability was found for inflammatory features of hand OA. Interreader reliability was moderate, but overall high close agreement between readers suggests that better reliability is achievable after further training. Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less reliability and the latter is not endorsed.
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Affiliation(s)
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | | | | | | | | | | | | | | | | | | | - Peter Mandl
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - Ruth Wittoek
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Karen Ellegaard
- Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
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Abstract
Knee osteoarthritis is rising in prevalence, and more imaging studies are being requested to evaluate these patients. Although conventional radiographs of the knee are the most widely requested and available studies, other imaging modalities such as MRI, CT, and ultrasound may also be used. This article reviews commonly used imaging modalities, advantages and limitations of each, and their clinical applicability in diagnosing and monitoring knee osteoarthritis. New and advanced imaging techniques are also discussed as possible methods of early diagnosis and improved understanding of osteoarthritis pathophysiology.
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Affiliation(s)
- Preeti A Sukerkar
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| | - Zoe Doyle
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
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Oo WM, Linklater JM, Bennell KL, Daniel MS, Pryke D, Wang X, Yu SP, Deveza L, Duong V, Hunter DJ. Reliability and Convergent Construct Validity of Quantitative Ultrasound for Synovitis, Meniscal Extrusion, and Osteophyte in Knee Osteoarthritis With MRI. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1559-1573. [PMID: 34569080 DOI: 10.1002/jum.15840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 05/25/2023]
Abstract
AIMS To determine: 1) inter-rater reliability of quantitative measurements of ultrasound-detected synovitis, meniscal extrusion, and osteophytes; and 2) construct (convergent) validity via correlations and absolute agreements between ultrasound- and gold-standard magnetic resonance imaging (MRI)-outcomes in knee osteoarthritis. METHODS Dynamic ultrasound images for supra-patellar synovitis, meniscal extrusion, and osteophytes were acquired and quantified by a physician operator, musculoskeletal ultrasonographer, and medical student independently. On the same day, 3T MRI images were acquired. Effusion-synovitis, meniscal extrusion, and osteophytes were quantified on sagittal or coronal proton-density-weighted fat-suppressed noncontrast TSE sequences, respectively. Intra-class correlation coefficients (ICCs), Pearson's correlations (r), and Bland-Altman plots were used to analyze inter-rater reliability, and correlations, and agreements between the two imaging modalities. RESULTS Eighty-nine participants [48 females (53.9%)] with mean (standard deviation) age of 61.5 ± 6.9 years were included. The inter-rater reliability was excellent for osteophytes (ICC range = 0.90-0.96), meniscal extrusion (ICC range = 0.90-0.93), and synovitis (ICC range = 0.86-0.88). The correlations between ultrasound pathologies and their MRI counterparts were very strong (ICC range = 0.85-0.98) except for lateral meniscal extrusion [0.66 (95% CI, 0.52-0.76)]. Bland-Altman plots showed 0.01, 0.05, 0.10, 0.53, and 0.60 mm larger size in ultrasound medial tibial and medial femoral osteophytes, medial meniscal extrusions, synovitis, and lateral meniscal extrusions with 95% limits of agreements [±0.39, ±0.44, ±0.85, ±0.70, and ±0.90 (SDs)] than MRI measures, respectively. The lines of equality were within 95% CI of the mean differences (bias) only for medial osteophytes and medial meniscal extrusion. CONCLUSION The quantitative assessment of synovitis, meniscal extrusion, and osteophytes generally showed excellent inter-rater reliability and strong correlations with MRI-based measurements. Absolute agreement was strong for medial tibiofemoral pathologies.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney, NSW, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia
| | - Matthew S Daniel
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Danielle Pryke
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney, NSW, Australia
| | - Xia Wang
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Shirley P Yu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Leticia Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia
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Nevalainen MT, Pitkänen MM, Saarakkala S. Diagnostic Performance of Ultrasonography for Evaluation of Osteoarthritis of Ankle Joint: Comparison With Radiography, Cone-Beam CT, and Symptoms. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1139-1146. [PMID: 34378811 DOI: 10.1002/jum.15803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/09/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine the diagnostic performance of ultrasonography (US) for evaluation of the ankle joint osteoarthritic (OA) changes. Cone-beam computed tomography (CT) was used as the gold standard and US performance was compared with conventional radiography (CR). As a secondary aim, associations between the imaging findings and ankle symptoms were assessed. METHODS US was performed to 51 patients with ankle OA. Every patient had prior ankle CR and underwent cone-beam CT during the same day as US examination. On US, effusion/synovitis, osteophytes, talar cartilage damage, and tenosynovitis were evaluated. Comparison to respective imaging findings on CR and cone-beam CT was then performed. Single radiologist blinded to other modalities assessed all the imaging studies. Symptoms questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), was available for 48 patients. RESULTS US detected effusion/synovitis of the talocrural joint with 45% sensitivity and 90% specificity. For the detection of anterior talocrural osteophytes, US sensitivity was 78% and specificity 79%. For the medial talocrural osteophytes, they were 39 and 83%, and for the lateral talocrural osteophytes 54 and 100%, respectively. Considering cartilage damage of the talus, US yielded a low sensitivity of 18% and high specificity of 97%. Overall, the performance of US was only moderate and comparable to CR. The imaging findings showed only weak associations with ankle symptoms. CONCLUSIONS The ability of US to detect ankle OA is only moderate. Interestingly, performance of CR also remained moderate. The associations between imaging findings and WOMAC score seem to be weak in ankle OA.
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Affiliation(s)
- Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu
- Medical Research Center Oulu, University of Oulu, Oulu
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu
| | | | - Simo Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu
- Medical Research Center Oulu, University of Oulu, Oulu
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu
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A deep-learning framework for metacarpal-head cartilage-thickness estimation in ultrasound rheumatological images. Comput Biol Med 2021; 141:105117. [PMID: 34968861 DOI: 10.1016/j.compbiomed.2021.105117] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic disease characterized by erosive symmetrical polyarthritis. Bone and cartilage are the main joint targets of this disease. Cartilage damage is one of the most relevant determinants of physical disability in RA patients. Cartilage damage is nowadays assessed by clinicians, which manually measure cartilage thickness in ultrasound (US) imaging. This poses issues relevant to intra-and inter-observer variability. Relying on the acquisition of metacarpal-head US images from 38 subjects, this work addresses the problem of automatic cartilage-thickness measurement by designing a new deep-learning (DL) framework. METHODS The framework consists of a Convolutional Neural Network (CNN), responsible for regressing cartilage-interface distance fields, followed by a post-processing step to delineate the two cartilage interfaces from the predicted distance fields and compute the cartilage thickness. RESULTS Our framework achieved encouraging results with a mean absolute difference (ADF) of 0.032 (±0.026) mm against manual thickness annotation by an expert clinician. When evaluating the intra-observer variability, we obtained an ADF = 0.036 (±0.028) mm. CONCLUSION The proposed framework achieved an ADF against manual annotation that was comparable to the intra-observer variability, proving the potential of DL in the field. SIGNIFICANCE This work is the first to address the problem of automatic cartilage-thickness estimation in US rheumatological images with DL, paving the way for future research in the field. From a clinical perspective, the proposed framework proved to be a valuable tool to support the clinical routine increasing the reproducibility of cartilage thickness measurements.
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Schadler P, Lohberger B, Thauerer B, Faschingbauer M, Kullich W, Stradner MH, Husic R, Leithner A, Steinecker-Frohnwieser B. Fatty Acid-Binding Protein 4 (FABP4) Is Associated with Cartilage Thickness in End-Stage Knee Osteoarthritis. Cartilage 2021; 13:1165S-1173S. [PMID: 34218665 PMCID: PMC8804752 DOI: 10.1177/19476035211011520] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND There is no single blood biomarker for the staging of knee osteoarthritis (KOA). The purpose of this study was to assess the relationship of obesity, serum biomarkers, the hip-knee-ankle angle (HKAA) with sonographic cartilage thickness. METHODS We conducted a cross-sectional study of n = 33 patients undergoing knee arthroplasty. Body mass index (BMI) was recorded, and patients were grouped based on BMI. Serum blood samples were collected, and the following biomarkers were measured using the ELISA technique (subgroup of n = 23): oxidized low-density lipoprotein (oxLDL), soluble receptor for advanced glycation end-products (sRAGE), fatty acid-binding protein 4 (FABP4), membrane-bound phospholipase A2 (PLA2G2A). The HKAA was analyzed on full-length limb standing x-ray images. Cartilage thickness was assessed on ultrasound images. Multivariable regression analysis was performed to account for confounding. RESULTS After adjusting for age, gender, and HKAA, obese patients had thicker medial femoral cartilage (β = 0.165, P = 0.041). Furthermore, lateral cartilage thickness was negatively correlated with FABP4 level after adjusting for of age, gender, BMI, and HKAA (β = -0.006, P = 0.001). Confirming previous studies, after adjustment, FABP4 level was associated with a higher BMI group (β = 42.99, P < 0.001). None of the other markers (oxLDL, PLA2G2A, and sRAGE) was associated with BMI or cartilage thickness. DISCUSSION Our results indicate that BMI has a weak, positive association with cartilage thickness in end-stage KOA patients. FABP4 levels were negatively associated with cartilage thickness. While our study is limited by a small sample size, these results further highlight the role of FABP4 as promising biomarkers of burden of disease in KOA.
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Affiliation(s)
- Paul Schadler
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Paul Schadler, Research Laboratory,
Department of Orthopaedics and Trauma, Medical University of Graz,
Auenbruggerplatz 5-7, Graz, 8036, Austria.
| | - Birgit Lohberger
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria,Ludwig Boltzmann Institute for
Arthritis and Rehabilitation, Saalfelden, Austria
| | - Bettina Thauerer
- Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Saalfelden, Austria
| | | | - Werner Kullich
- Department for Rehabilitation, Ludwig
Boltzmann Institute for Arthritis and Rehabilitation, Saalfelden, Austria
| | - Martin Helmut Stradner
- Division of Rheumatology and
Immunology, Department of Internal Medicine, Medical University of Graz, Graz,
Austria
| | - Rusmir Husic
- Division of Rheumatology and
Immunology, Department of Internal Medicine, Medical University of Graz, Graz,
Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma,
Medical University of Graz, Graz, Austria
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Molyneux P, Bowen C, Ellis R, Rome K, Frecklington M, Carroll M. Evaluation of osteoarthritic features in peripheral joints by ultrasound imaging: A systematic review. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100194. [DOI: 10.1016/j.ocarto.2021.100194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 01/15/2023] Open
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Yan H, Guo J, Zhou W, Dong C, Liu J. Health-related quality of life in osteoarthritis patients: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2021; 27:1859-1874. [PMID: 34465255 DOI: 10.1080/13548506.2021.1971725] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this meta-analysis was to compare health-related quality of life (HRQoL) of Osteoarthritis (OA) patients and controls. A systematic literature search was performed on PubMed, Web of Science and EMBASE from database inception to 7 January 2020. Random effect model was performed to summarize the scores of each domain and the forest plot was used to compare the scores of OA patients with healthy controls. Subgroup analyses were conducted to explore the source of heterogeneity. Statistical analyses were executed using Review Manager (version 5.1). In total, six studies were included in this study, including 7094 patients with OA and 12 100 healthy controls, which were all reliable to summarize the scores of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Meta-analyses found that pooled mean HRQoL score for the SF-36 each domain (physical function, physical role function, body pain, general health, vitality, social function, emotional role function, mental health) was lower in patients with OA than in healthy controls, especially the score in the dimension of physical role function. OA have a substantial impact HRQoL. HRQoL is a significant component of measuring overall health, which contributes to formulate successful self-disease management plan, patient-centered care, and develop effective interventions target confidence.
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Affiliation(s)
- Hongsheng Yan
- Department of Orthopaedics, Jiangsu Rugao Boai Hospital, Nantong, Jiangsu, China
| | - Jiaxin Guo
- Nursing Department, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.,Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.,Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Wei Zhou
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.,Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Chen Dong
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.,Research Center of Gerontology and Longevity, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jun Liu
- Department of Orthopaedics, Jiangsu Rugao Boai Hospital, Nantong, Jiangsu, China
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Philpott HT, Birmingham TB, Pinto R, Primeau CA, Arsenault D, Lanting B, Zhu Y, Appleton CT. Synovitis is associated with constant pain in knee osteoarthritis: a cross-sectional study of OMERACT knee ultrasound scores. J Rheumatol 2021; 49:89-97. [PMID: 34393106 DOI: 10.3899/jrheum.210285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the association between ultrasound (US)-detected knee inflammation and intermittent and constant pain experiences in patients with knee osteoarthritis (OA). METHODS Participants with radiographically early- (KL ≤ 2) and late-stage (KL ≥ 3) disease and frequent symptoms underwent musculoskeletal US measures of inflammation using the OMERACT knee US scoring system. Pain experiences were captured using the Intermittent and Constant OA Pain (ICOAP) tool. We assessed the association between US-synovitis and ICOAP pain experiences using a series of linear, logistic, or multinomial logistic regression models (as appropriate for each variable), while adjusting for age, sex, body mass index (BMI), and radiographic stage. Secondary analyses were performed similarly by radiographic stage. RESULTS Pain and synovitis measures from 248 patients (453 knees) were included. Worse synovitis was associated with higher ICOAP constant pain scores (β 8.05 [95%CI 0.67, 15.43]), but not intermittent pain scores. Moderate-to-severe synovitis was associated with a 4.73-fold increased relative risk [95%CI 1.06, 8.80] of a constant pain pattern. In secondary analyses, moderate-to-severe synovitis in early radiographic OA was associated with 2.70-higher odds [95%CI 1.04, 7.02] of any constant pain, 3.28-higher odds [95%CI 1.43, 7.52] of any intermittent pain, and with higher intermittent (β 10.47 [95%CI 1.03, 19.91]) and constant (β 12.62 [95%CI 3.02, 22.23]) pain scores. No associations identified for synovitis in those with late radiographic OA. CONCLUSION In patients with knee OA, moderate-to-severe synovitis is most strongly associated with constant pain. Inflammation may play context-specific roles across pain experiences, especially in earlier radiographic stages of knee OA.
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Affiliation(s)
- Holly T Philpott
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Trevor B Birmingham
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Ryan Pinto
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Codie A Primeau
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Dominique Arsenault
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Brent Lanting
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Yayuan Zhu
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - C Thomas Appleton
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
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Obotiba AD, Swain S, Kaur J, Doherty M, Zhang W, Abhishek A. Reliability of detection of ultrasound and MRI features of hand osteoarthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 61:542-553. [PMID: 34086885 PMCID: PMC8824416 DOI: 10.1093/rheumatology/keab470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To systematically review the literature on inter- and intra-rater reliability of scoring ultrasound and MRI changes in hand osteoarthritis (OA). METHODS Medline, EMBASE, CINHAL, Web of Science and AMED were searched from inception to January 2020. Kappa (K), weighted Kappa (Kw) and intra-class correlation coefficients (ICC) for dichotomous, semi-quantitative and summated scores respectively, and their 95% confidence intervals (CI) were pooled using random-effects model. Heterogeneity between studies was assessed and reliability estimates were interpreted using Landis-Koch's classification. RESULTS Fifty studies met the inclusion criteria (33 ultrasound, 21 MRI). The pooled K(95% CI) for inter-rater reliability was substantial for ultrasound-detected osteophytes [0.66 (0.54, 0.79)], grey-scale synovitis (GSS) [0.64 (0.32, 0.97)], and power Doppler (PD) [0.76, (0.47, 1.05)]; whereas intra-rater reliability was almost perfect for osteophytes [0.82 (0.80, 0.84)], central bone erosions (CBEs) [0.83 (0.78, 0.89)], and effusion [0.83 (0.74, 0.91)]; and substantial for GSS [0.64 (0.49, 0.79)] and PD [0.70 (0.59, 0.80)].Inter-rater reliability for dichotomous assessment was substantial for MRI-detected CBEs [0.75 (0.67, 0.83)] and synovitis [0.69 (0.51, 0.87)]; slight for osteophytes [0.14 (0.04, 0.25)]; and almost perfect for sum score of osteophytes, CBEs, joint space narrowing (JSN), and bone marrow lesions (BMLs) (0.81-0.89). Intra-rater reliability was almost perfect for sum score of MRI synovitis [0.92 (0.87, 0.96)], BMLs [0.88 (0.78, 0.98)], osteophytes [0.86 (0.74, 0.98)], CBEs [0.83 (0.66, 1.00)] and JSN [0.91 (0.87, 0.91)]. CONCLUSION Ultrasound and MRI are reliable in detecting hand OA features. Ultrasound may be preferred due to low-cost and increasing availability.
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Affiliation(s)
- Abasiama D Obotiba
- Correspondence to: Abasiama D. Obotiba, A26, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK. E-mail:
| | - Subhashisa Swain
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
- Department of Primary Care, University of Oxford
| | - Jaspreet Kaur
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
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Lee LS, Chan PK, Fung WC, Chan VWK, Yan CH, Chiu KY. Imaging of knee osteoarthritis: A review of current evidence and clinical guidelines. Musculoskeletal Care 2021; 19:363-374. [PMID: 33387447 DOI: 10.1002/msc.1536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is one of the most common and debilitating degenerative joint diseases worldwide. While radiography is the most commonly used imaging modality, it is associated with drawbacks which newer modalities such as magnetic resonance imaging (MRI) and ultrasound could overcome. Nevertheless, the role of imaging in clinical practice and research in knee OA has not been clearly defined. Furthermore, guidelines on imaging in knee OA from different authoritative bodies have not been compared in previous studies. Therefore, the present review aims to summarise existing evidence and compare guidelines on the use of different imaging modalities in evaluating knee OA. METHODS This is a narrative review based on a search of published clinical guidelines and the PubMed database for articles published between 1 January 1990 and 31 May 2020. RESULTS There is no broad consensus on the value of imaging in patients with typical OA presentation. If imaging is required, current evidence and clinical guidelines support the use of radiography and MRI as first- and second-line diagnostic modalities respectively. Since radiographic OA features have limited sensitivity and do not manifest in early stages, MRI is the preferred option for whole-joint evaluation in OA research. Discrepancies exist regarding the use of alternative imaging modalities including ultrasound, computed tomography and nuclear medicine. CONCLUSION Radiography and MRI are the imaging modalities of choice. Other modalities have their respective advantages, and more research is warranted for the standardisation of image acquisition and interpretation methodology, in order to evaluate their validity, reliability and responsiveness in OA research.
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Affiliation(s)
- Lok Sze Lee
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Wing Chiu Fung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent Wai Kwan Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong SAR, China
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Clausen S, Kjær S, Fredberg U, Terslev L, Hartvigsen J, Arnbak B. Ultrasound imaging in patients with hip pain and suspected hip osteoarthritis: an inter-rater and intra-rater reliability study. BMJ Open 2020; 10:e038643. [PMID: 33154052 PMCID: PMC7646344 DOI: 10.1136/bmjopen-2020-038643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objectives of this study were to asses (1) inter-rater and intrarater reliability of ultrasound imaging in patients with hip osteoarthritis, and (2) agreement between ultrasound and X-ray findings of hip osteoarthritis using validated Outcome Measures in Rheumatology ultrasound definitions for pathology. DESIGN An inter-rater and intrarater reliability study. SETTING A single-centre study conducted at a regional hospital. PARTICIPANTS 50 patients >39 years of age referred for radiography due to hip pain and suspected hip osteoarthritis were included. Exclusion criteria were previous hip surgery in the painful hip, suspected fracture or malignant changes in the hip. INTERVENTION Bilateral ultrasound examinations (n=92) were performed continuously by two experienced operators blinded to clinical information and other imaging findings. After 4-6 weeks, one operator reassessed the images. X-rays were assessed by a third imaging specialist. PRIMARY AND SECONDARY OUTCOME MEASURES Inter-rater and intrarater reliability and agreement between ultrasound imaging and X-ray were assessed using Cohen's ordinal kappa statistics for binary categorical variables and weighted kappa for ordered categorical variables. RESULTS Kappa values (κ) for inter-rater reliability were 0.9 and 0.8 for hip effusion/synovitis and osteoarthritis grading, respectively. For acetabular and femoral osteophytes, femoral cartilage changes and labrum changes κ ranged from 0.4 to 0.7. Intrarater reliability had κ equal or higher compared with inter-rater reliability. Agreement between ultrasound and X-ray findings ranged from κ=0.2 to κ=0.5. CONCLUSION This study demonstrated substantial to almost perfect reliability on the most common ultrasound findings related to hip osteoarthritis and osteoarthritis grading. Agreement on the grade of osteoarthritis between ultrasound and X-ray was moderate. Overall, these results support ultrasound imaging as a reliable tool in the assessment of hip osteoarthritis.
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Affiliation(s)
- Stine Clausen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Radiology, Lillebaelt Hospital Vejle, Vejle, Denmark
| | - Søren Kjær
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- The Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
| | - Bodil Arnbak
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
- Department of Radiology, Lillebaelt Hospital Vejle, Vejle, Denmark
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Abstract
PURPOSE OF REVIEW This narrative review summarizes the last 5 years of published, peer-reviewed research on the use of musculoskeletal ultrasound (US) in osteoarthritis (OA). RECENT FINDINGS Multiple features relevant to OA can be visualized on US, including synovitis, erosion, enthesitis, osteophytes, cartilage damage, meniscal extrusion, and popliteal cysts. US can be used to confirm a diagnosis of OA or make an alternate diagnosis in the clinical setting. When a standardized protocol is used, US is a reliable modality for assessment of the features of OA. Findings on US can predict progression and response to therapy in OA of the hand and knee and can allow characterization of risk factors in a cost-effective, non-invasive, repeatable manner. US is becoming more widely used in OA imaging and has clear value in addition to radiography and clinical assessment. US will likely prove useful in defining phenotypes and providing treatment guidance in OA.
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Affiliation(s)
- Amanda E Nelson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.
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20
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Brom M, Gandino IJ, Zacariaz Hereter JB, Scolnik M, Mollerach FB, Ferreyra Garrott LG, Marin J, Ruta SO, Rosa JE, García-Mónaco RD, Soriano ER. Performance of Ultrasonography Compared to Conventional Radiography for the Diagnosis of Osteoarthritis in Patients With Knee Pain. Front Med (Lausanne) 2020; 7:319. [PMID: 32719803 PMCID: PMC7347788 DOI: 10.3389/fmed.2020.00319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose: To investigate the performance of ultrasonography (US) for the detection of knee osteoarthritis (OA) in patients suffering from knee pain, compared to conventional radiographs. Methods: Cross-sectional study performed at a university teaching hospital. Consecutive patients complaining of unilateral or bilateral mechanical knee pain who signed an informed consent were included. All patients underwent simultaneously an ultrasonographic and a radiographic evaluation of the knee. Exclusion criteria were age under 18 years, prior diagnosis of knee OA, diagnosis of inflammatory arthritis, history of knee surgery or trauma, severe knee deformities, and corticosteroid injection within the last 2 months. The diagnostic properties of US for the detection of knee OA were evaluated using radiological data as the reference method. Evaluated test properties were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the positive and negative likelihood ratio (LR+ and LR–). Results: Three-hundred twenty-two knees (281 patients) were included. Radiographic degenerative changes were present in 56.8% (183) of the evaluated knees. Regarding the diagnostic properties of the US, the presence of either osteophytes or the compromise of the femoral hyaline cartilage had the best sensitivity to detect OA (95%), with a NPV of 92% and a LR– of 0,07, while the combined identification of osteophytes and compromise of the femoral hyaline cartilage had the best specificity (94%), with 94% PPV and a LR+ of 13. Conclusion: US demonstrated an excellent sensitivity with an adequate specificity for the detection of radiographic knee OA.
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Affiliation(s)
- Martin Brom
- Rheumatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio J Gandino
- Rheumatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Marina Scolnik
- Rheumatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Josefina Marin
- Rheumatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago O Ruta
- Rheumatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Javier E Rosa
- Rheumatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Enrique R Soriano
- Rheumatology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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21
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Yerich NV, Alvarez C, Schwartz TA, Savage-Guin S, Renner JB, Bakewell CJ, Kohler MJ, Lin J, Samuels J, Nelson AE. A Standardized, Pragmatic Approach to Knee Ultrasound for Clinical Research in Osteoarthritis: The Johnston County Osteoarthritis Project. ACR Open Rheumatol 2020; 2:438-448. [PMID: 32597564 PMCID: PMC7368135 DOI: 10.1002/acr2.11159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/21/2020] [Indexed: 11/05/2022] Open
Abstract
Objective This study sought to develop and employ a comprehensive and standardized ultrasound (US) protocol and scoring atlas for the evaluation of features relevant to knee osteoarthritis (KOA) in a community‐based cohort in the United States, with the goals of demonstrating feasibility, reliability, and validity. Methods We utilized data from the fourth follow‐up (2016‐2018) of the Johnston County OA Project, which includes individuals with (~50%) and without radiographic KOA. All participants underwent standardized knee radiography and completed standard questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS). Bilateral knee US images were obtained by a trained sonographer using a standardized protocol and scored by trained rheumatologists using an atlas developed for this study. A total of 396 knees were each scored by two readers according to the atlas. Associations between US features, radiographic findings (graded by an expert radiologist), and KOOS scores were assessed. Results Overall interreader reliability for US scoring was fair to moderate. The strongest correlations between US and radiographic features were seen for osteophytes, and similarly strong correlations were seen between US osteophytes and overall radiographic Kellgren‐Lawrence Grade, demonstrating criterion validity. Features of effusion/synovitis and osteophytes were most associated with KOOS pain and impaired function. Conclusion US is a feasible, reliable, and valid method to assess features relevant to KOA in clinical and research settings. The protocol and atlas developed in this study can be utilized to evaluate KOA in a standardized fashion in future clinical studies, enabling greater utilization of this valuable modality in osteoarthritis.
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Affiliation(s)
| | | | | | | | | | | | | | - Janice Lin
- Stanford Health Care, Palo Alto, California
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22
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Oo WM, Linklater JM, Bennell KL, Pryke D, Yu S, Fu K, Wang X, Duong V, Hunter DJ. Are OMERACT Knee Osteoarthritis Ultrasound Scores Associated With Pain Severity, Other Symptoms, and Radiographic and Magnetic Resonance Imaging Findings? J Rheumatol 2020; 48:270-278. [PMID: 32414954 DOI: 10.3899/jrheum.191291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the associations of Outcome Measures in Rheumatology (OMERACT) ultrasound scores for knee osteoarthritis (OA) with pain severity, other symptoms, and OA severity on radiographs and magnetic resonance imaging (MRI). METHODS Participants with symptomatic and mild to moderate radiographic knee OA underwent baseline dynamic ultrasound (US) assessment according to standardized OMERACT scanning protocol. Using the published US image atlas, a physician operator obtained semiquantitative or binary scores for US pathologies. Clinical severity was measured on numerical rating scale (NRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscores. OA severity was assessed using the Kellgren-Lawrence (KL) grade on radiographs and MRI Osteoarthritis Knee Score (MOAKS) on noncontrast-enhanced MRI. Separate linear regression models were used to determine associations of US OA pathologies with pain and KOOS subscores, and Spearman correlations were used for US scores with KL grade and MOAKS. RESULTS Eighty-nine participants were included. Greater synovial hypertrophy, power Doppler (PD), and meniscal extrusion scores were associated with worse NRS pain [β 0.92 (95% CI 0.25-1.58), β 0.73 (95% CI 0.11-1.35), and β 1.01 (95% CI 0.22-1.80), respectively]. All greater US scores, except for cartilage grade, demonstrated significant associations with worse KOOS symptoms, whereas only PD and meniscal extrusion were associated with worse KOOS pain. All US scores, except for PD, were significantly correlated with KL grade. US pathologies, except for cartilage, revealed moderate to good correlation with their MOAKS counterparts, with US synovitis having the greatest correlation (0.69, 95% CI 0.60-0.78). CONCLUSION OMERACT US scores revealed significant associations with pain severity, KL grade, and MOAKS.
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Affiliation(s)
- Win Min Oo
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney;
| | - James M Linklater
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Kim L Bennell
- K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Danielle Pryke
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Shirley Yu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Kai Fu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Xia Wang
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Vicky Duong
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - David J Hunter
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
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23
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Oo WM, Linklater JM, Bennell KL, Yu S, Fu K, Wang X, Duong V, Hunter DJ. Superb Microvascular Imaging in Low-Grade Inflammation of Knee Osteoarthritis Compared With Power Doppler: Clinical, Radiographic and MRI Relationship. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:566-574. [PMID: 31917042 DOI: 10.1016/j.ultrasmedbio.2019.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Abstract
We compared the assessment of active synovitis in knee osteoarthritis (OA) by utilising superb microvascular imaging (SMI) and conventional power Doppler (cPD) techniques, and then correlated each technique with paients' symptoms, radiographic features and magnetic resonance imaging (MRI)-detected synovitis. A subgroup of participants with symptomatic knee OA underwent dynamic ultrasound assessment for semi-quantitative scores for SMI and cPD in the suprapatellar, medial and lateral parapatellar knee recesses. Knee pain and other symptoms were evaluated with the knee injury and osteoarthritis outcome score (KOOS). OA severity was assessed using the Kellgren and Lawrence grade (KLG) on radiograph and effusion-synovitis and Hoffa's synovitis score of MRI osteoarthritis knee score on non-contrast-enhanced MRI sequences. The χ2 test and κ statistics were conducted to compare detectability of SMI and cPD for low-grade inflammation, and the Spearman's correlation and Fisher's r to z transformation were conducted to compare correlations of both techniques with symptoms and imaging severity. A total of 89 participants were included in the analyses. SMI increased the detection rate by 25.5% for grade 0 cPD, by 35.4% for grade 1 cPD and by 9% for grade 2 cPD. SMI showed significant correlations with KOOS symptoms, KLG, MRI effusion-synovitis and Hoffa's synovitis scores (r = -0.24 [-0.45, -0.01]; r = 0.31 [0.10, 0.50]; r = 0.49 [0.33, 0.63]; and r = 0.54 [0.37, 0.68]). The cPD was significantly correlated with KOOS pain, other symptoms, MRI effusion-synovitis and Hoffa's synovitis (r = -0.23 [-0.44, -0.01]; r = -0.29 [-0.49, -0.06]; r = 0.46 [0.28, 61], r = 0.46 [0.25, 0.63]). However, no significant differences were detected in their extent of correlations. SMI can detect low-grade inflammation implicated in OA disease better than cPD and reveal a significant correlation with symptoms, radiographic features and MRI synovitis. The added clinical value of SMI over cPD is still not clear.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia.
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St. Leonards, Sydney, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Shirley Yu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Kai Fu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Xia Wang
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia
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Kauppinen K, Pylväläinen J, Pamilo K, Helminen O, Haapea M, Saarakkala SS, Nevalainen MT. Association between grayscale sonographic and clinical findings in severe knee osteoarthritis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:75-81. [PMID: 31580500 DOI: 10.1002/jcu.22779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To assess whether ultrasonographic (US) findings associate with clinical findings in severe knee osteoarthritis (OA). Association of US findings with side-of-knee pain and inter-reader agreement of knee US were also evaluated. METHODS One-hundred-two patients (in total 123 knees) with severe knee OA were recruited for this cross-sectional study. US was performed by a single observer, and on 53 knees by two independent observers to assess inter-reader reliability. Preoperative clinical data was available for 69 knees. Cutoff values were applied to dichotomize US and clinical findings. The Chi-square test, Mann-Whitney test, and prevalence- and bias-adjusted kappa (PABAK) were applied for statistical analyses. RESULTS Seven of 99 associations tested were statistically significant. Associations were observed between range of flexion and lateral femoral (P = .009) and tibial (P = .001) osteophytes, mediolateral instability and damage to the lateral femoral cartilage (P = .014) and damage to the lateral meniscus (P = .031), and alignment and damage to the lateral femoral cartilage (P < .001), lateral tibial osteophytes (P = .037), and damage to the lateral meniscus (P < .001). A strong association was observed between medial-sided pain and same-sided cartilage damage and osteophytes (P < .001). That inter-reader agreement was excellent on the medial side of the knee joint (PABAK = 0.811-0.887). CONCLUSIONS US findings show a rather poor association with clinical OA findings. Inter-reader agreement of knee US is excellent on the medial side.
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Affiliation(s)
- Kyösti Kauppinen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juho Pylväläinen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Olli Helminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Simo S Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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Chio CC, Siu MK, Tai YT, Chen TG, Ho WP, Chen JT, Tsai HC, Chen RM. Renal insufficiency plays a crucial association factor in severe knee osteoarthritis-induced pain in patients with total knee replacement: A retrospective study. Medicine (Baltimore) 2020; 99:e19125. [PMID: 32028438 PMCID: PMC7015635 DOI: 10.1097/md.0000000000019125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Pain, the main symptom of osteoarthritis (OA), can lead to functional disability in patients with knee OA. Understanding the association factors related to knee pain is important since preventing OA-induced disabilities can be achieved by modifying these pain-associated issues. Therefore, this study was aimed to investigate the association factors for OA-induced knee pain in Taiwanese patients who received total knee replacements (TKR).In this retrospective study, 357 subjects who had undergone TKR at the Taipei Municipal Wan-Fang Hospital were recruited. The distribution of pain severity among patients with knee OA was evaluated. Demographic data and clinical parameters were analyzed to determine relationships between these variables and the severity of knee OA pain.Of the 357 patients studied, 54% and 33% had moderate and severe knee pain, respectively. Furthermore, a multivariate logistic regression analysis revealed that serum creatinine (>1.5 mg/dL) and an estimated glomerular filtration rate (eGFR) (<60 mL/min/1.73 m) were significantly associated with severe knee pain in OA patients. A significant correlation between severe knee pain and serum creatinine or eGFR was demonstrated by Pearson correlations.Taken together, the renal insufficiency defined by an elevated serum creatinine or a low eGFR in OA patients who required TKR was associated with severe knee pain. These variables must be considered while treating knee OA pain, especially in those patients with severe pain.
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Affiliation(s)
- Chung-Ching Chio
- Department of Neurosurgery, Chi Mei Medical Center, Tainan
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital
| | - Man-Kit Siu
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Centro Hospitalar Conde de Sáo Januário, Macau Special Administrative Region, China
| | - Yu-Ting Tai
- Department of Anesthesiology, Wan-Fang Hospital
| | | | - Wei-Pin Ho
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital
| | - Jui-Tai Chen
- Department of Anesthesiology, Shuang Ho Hospital
| | - Hsiao-Chien Tsai
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei Medical University
| | - Ruei-Ming Chen
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei Medical University
- TMU Research Center of Cancer Translational Medicine, Taipei, Taiwan
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26
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Zhou L, Gu X. Correlation of ultrasonography synovitis with disease activity and clinical response to etanercept treatment in juvenile idiopathic arthritis patients. ACTA ACUST UNITED AC 2019; 52:e8565. [PMID: 31778437 PMCID: PMC6886362 DOI: 10.1590/1414-431x20198565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
This study aimed to investigate the correlation of ultrasonography (US) of synovitis with disease activity and clinical response to etanercept (ETN) in juvenile idiopathic arthritis (JIA) patients. Eighty-two JIA patients who underwent ETN treatment for 24 weeks were consecutively enrolled. US evaluations of 28 joints (shoulder, elbow, wrist, metacarpophalangeal, and proximal interphalangeal of hands and knee) at baseline were performed using grey-scale US and power doppler (PD) US, and US synovitis was defined as grey-scale abnormalities or PD abnormalities. Clinical response was assessed according to the ACRpedi 50 response criteria. In total, 2296 joints were scanned and 608 (26.5%) joints presented US synovitis, which was numerically higher than clinical synovitis (513 (22.3%)). The mean number of joints showing synovitis on US was 7.42±3.35, which was also numerically higher than that of clinical synovitis (6.26±2.70). The number of joints showing synovitis on US was positively correlated with C-reactive protein, erythrocyte sedimentation rate, number of joints with active disease, number of joints with limited range of motion, physician's global assessment of disease activity, parent/patient global assessment of overall well-being, and childhood health assessment questionnaire score. Most interestingly, the baseline number of joints showing synovitis on US was increased in ACRpedi 50 response JIA patients compared to non-response JIA patients, and it serves as an independent predictive factor for higher clinical response to ETN treatment. In conclusion, US is a more sensitive test to evaluate subclinical synovitis and disease activity in JIA patients, and US synovitis might serve as a marker for predicting increased clinical response rate to ETN treatment.
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Affiliation(s)
- Li Zhou
- Wuhan Children's Hospital, Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojie Gu
- Department of Ultrasound, Children's Hospital of Nanjing Medical University, Nanjing, China
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Oo WM, Deveza LA, Duong V, Fu K, Linklater JM, Riordan EA, Robbins SR, Hunter DJ. Musculoskeletal ultrasound in symptomatic thumb-base osteoarthritis: clinical, functional, radiological and muscle strength associations. BMC Musculoskelet Disord 2019; 20:220. [PMID: 31096953 PMCID: PMC6524278 DOI: 10.1186/s12891-019-2610-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background Thumb-base osteoarthritis (OA) is a common cause of pain and disability This study aimed to investigate the associations of musculoskeletal ultrasound OA pathologies with the extent of pain, function, radiographic scores, and muscle strength in symptomatic thumb-base osteoarthritis. Methods This is a cross-sectional study of an ongoing clinical trial with eligibility criteria including thumb-base pain on Visual Analogue Scale (VAS) ≥40 (0 to 100 mm), Functional Index for Hand OA (FIHOA) ≥ 6 (0 to 30) and Kellgren Lawrence (KL) grade ≥ 2. The most symptomatic side was scanned to measure synovitis and osteophyte severity using a 0–3 semi-quantitative score, power Doppler and erosion in binary score. A linear regression model was used for associations of ultrasound findings with VAS pain, FIHOA and hand grip and pinch strength tests after adjusting for age, gender, body mass index, disease duration and KL grade as appropriate. For correlation of ultrasound features with KL grade, OARSI ((Osteoarthritis Research Society International) osteophyte and JSN scores, Eaton grades, Spearman coefficients were calculated, and a significant test defined as a p-value less than 0.05. Results The study included 93 participants (mean age of 67.04 years, 78.5% females). Presence of power Doppler has a significant association with VAS pain [adjusted β coefficient = 11.29, P = 0.02] while other ultrasound pathologies revealed no significant associations with all clinical outcomes. In comparison to radiograph, ultrasonographic osteophyte score was significantly associated with KL grade [rs = 0.44 (P < 0.001)], OARSI osteophyte grade [rs = 0.35 (P = 0.001)], OARSI JSN grade [rs = 0.43 (P < 0.001)] and Eaton grade [rs = 0.30 (P < 0.01)]. Ultrasonographic erosion was significantly related with radiographic erosion [rs = − 0.49 (P = 0.001)]. Conclusion From a clinical perspective the significant relationship of power Doppler with pain severity in thumb base OA suggests this might be a useful tool in understanding pain aetiology. It is important to recognise that power Doppler activity was only detected in 14% of the study so this might be an important subgroup of persons to monitor more closely. Trial registration Registered at Australian New Zealand Clinical Trials Registry (ANZCTR), http://www.anzctr.org.au/, ACTRN12616000353493.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia.
| | - Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Kai Fu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney, Australia
| | - Edward A Riordan
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Sarah R Robbins
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
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Oo WM, Yu SPC, Daniel MS, Hunter DJ. Disease-modifying drugs in osteoarthritis: current understanding and future therapeutics. Expert Opin Emerg Drugs 2018; 23:331-347. [PMID: 30415584 DOI: 10.1080/14728214.2018.1547706] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) is a leading cause of pain and disability among adults with a current prevalence of around 15% and a predicted prevalence of 35% in 2030 for symptomatic OA. It is increasingly recognized as a heterogeneous multi-faceted joint disease with multi-tissue involvement of varying severity. Current therapeutic regimens for OA are only partially effective and often have significant associated toxicities. There are no disease-modifying drugs approved by the regulatory bodies. Areas covered: We reviewed the opportunities within key OA pathogenetic mechanism: cartilage catabolism/anabolism, pathological remodeling of subchondral bone and synovial inflammation to identify targeted disease-modifying osteoarthritis drugs, based on compounds currently in Phase II and III stages of clinical development in which x-ray and/or MRI was used as the structural outcome with/without symptomatic outcomes according to regulatory requirements. Expert opinion: Given the heterogeneity of the OA disease process and complex overlapping among these phenotypes, a 'one size fits all' approach used in most clinical trials would unlikely be practical and equally effective in all patients, as well as in all anatomical OA sites. On the other hand, it is a challenge to develop a targeted drug with high activity, specificity, potency, and bioavailability in the absence of toxicity for long-term use in this chronic disease of predominantly older adults. Further research and insight into evaluation methods for drug-targeted identification of early OA and specific characterization of phenotypes, improvement of methodological designs, and development/refinement of sensitive imaging and biomarkers will help pave the way to the successful discovery of disease-modifying drugs and the optimal administration strategies in clinical practice.
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Affiliation(s)
- Win Min Oo
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - Shirley Pei-Chun Yu
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - Matthew Sean Daniel
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - David John Hunter
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
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Triptolide prevents osteoarthritis via inhibiting hsa-miR-20b. Inflammopharmacology 2018; 27:109-119. [DOI: 10.1007/s10787-018-0509-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/15/2018] [Indexed: 12/15/2022]
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