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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] [What about the content of this article? (0)] [Affiliation(s)] [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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