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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction

Authors: Vikram Swaminathan, Matthew J Parkes, Michael J Callaghan, Terence W O’Neill, Richard Hodgson, Andrew D Gait, David T Felson

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Braces are used to treat pain in patellofemoral joint osteoarthritis (PFJOA). In a trial, we previously reported pain improvement after 6-weeks brace use. The pain reduction did not correlate with changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. Studies show that changes in the synovium on dynamic contrast enhanced (DCE) MRI are more closely associated with symptom change than static synovial volume changes. We hypothesised change in synovitis assessed using dynamic imaging could explain the reduction in pain.

Method

One hundred twenty-six men and women aged 40–70 years with painful radiographically confirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. Pain assessment and DCE-MRI were performed at baseline and 6 weeks. DCE data was analysed using Tofts’s equation. Pain measures included a VAS of pain on nominated aggravating activity (VASNA), and the KOOS pain subscale. Paired t-tests were used to determine within person change in outcome measures and Spearman’s correlation coefficients were used to determine the correlation between change in pain and change in the DCE parameters.

Results

Mean age of subjects was 55.5 years (SD = 7.5) and 57% were female. There was clear pain improvement in the brace users compared to controls (VASNA − 16.87 mm, p = <0.001). There was no significant change to the dynamic synovitis parameters among brace users nor was pain change correlated with change in dynamic synovitis parameters.

Conclusion

The reduction in knee pain following brace wearing in patients with PFJOA is not explained by changes in synovitis.

Trial registration

Trial registration number UK. ISRCTN50380458/Registered 21.5.2010.
Literature
1.
Callaghan MJ, Parkes MJ, Hutchinson CE, Gait AD, Forsythe LM, Marjanovic EJ, et al. A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions. Ann Rheum Dis. 2015;74:1164–1170. doi:10.​1136/​annrheumdis-2014-206376.
2.
Felson DT. Imaging abnormalities that correlate with joint pain. Brit J Sport Med. 2011;45(4):289–91.CrossRef
3.
Baker K, Grainger A, Niu J, Clancy M, Guermazi A, Crema M, et al. Relation of synovitis to knee pain using contrast-enhanced MRIs. Ann Rheum Dis. 2010;69(10):1779–83.CrossRefPubMed
4.
Hill A, Mehnert A, Crozier S, Leung C, Wilson S, McMahon K, et al. Dynamic breast MRI: image registration and its impact on enhancement curve estimation. Conf Proc IEEE Eng Med Biol Soc. 2006;1:3049–52.PubMed
5.
Yusuf E, Kortekaas MC, Watt I, Huizinga TW, Kloppenburg M. Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review. Ann Rheum Dis. 2011;70(1):60–7.CrossRefPubMed
6.
Musumeci G, Aiello FC, Szychlinska MA, Di Rosa M, Castrogiovanni P, Mobasheri A. Osteoarthritis in the XXIst century: risk factors and Behaviours that influence disease onset and progression. Int J Mol Sci. 2015;16(3):6093–112.CrossRefPubMedPubMedCentral
7.
Gait AD, Hodgson R, Parkes MJ, Hutchinson CE, O'Neill TW, Maricar N, et al. Synovial volume vs synovial measurements from dynamic contrast enhanced MRI as measures of response in osteoarthritis. Osteoarthr Cartilage. 2016;24(8):1392–8.CrossRef
8.
Axelsen MB, Stoltenberg M, Poggenborg RP, Kubassova O, Boesen M, Bliddal H, et al. Dynamic gadolinium-enhanced magnetic resonance imaging allows accurate assessment of the synovial inflammatory activity in rheumatoid arthritis knee joints: a comparison with synovial histology. Scand J Rheumatol. 2012;41(2):89–94.CrossRefPubMed
9.
Gait A, Hodgson R, Parkes M, Hutchinson C, O'Neill T, Maricar N, et al. Synovial volume vs. enhancement of synovium as measures of response in osteoarthritis. Osteoarthritis & Cartilage. 2016;submitted: OAC2920; in revision.
10.
Hunter DJ, Harvey W, Gross KD, Felson D, McCree P, Li L, et al. A randomized trial of patellofemoral bracing for treatment of patellofemoral osteoarthritis. Osteoarthr Cartil. 2011;19(7):792–800.CrossRefPubMedPubMedCentral
11.
O'Neill TW, Parkes MJ, Maricar N, Marjanovic EJ, Hodgson R, Gait AD, et al. Synovial tissue volume: a treatment target in knee osteoarthritis (OA). Ann Rheum Dis. 2015;
12.
13.
Hodgson RJ, O'Connor P, Moots R. MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology (Oxford). 2008;47(1):13–21.CrossRef
14.
Wenham CY, Balamoody S, Grainger AJ, Hensor EM, Draycott S, Hodgson R, et al. The responsiveness of novel, dynamic, contrast-enhanced magnetic resonance measures of total knee synovitis after intra-articular corticosteroid for painful osteoarthritis. Osteoarthr Cartil. 2014;22(10):1614–8.CrossRefPubMed
15.
Angst F, Aeschlimann A, Michel BA, Stucki G. Minimal clinically important rehabilitation effects in patients with osteoarthritis of the lower extremities. J Rheumatol. 2002;29(1):131–8.PubMed
16.
O'Neill TW, Parkes MJ, Maricar N, Marjanovic EJ, Hodgson R, Gait AD, et al. Response to: ‘Synovial tissue volume and reduction in pain following intra-articular steroid therapy’ by Wei et al. Ann Rheum Dis. 2015;
Metadata
Title
With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction
Authors
Vikram Swaminathan
Matthew J Parkes
Michael J Callaghan
Terence W O’Neill
Richard Hodgson
Andrew D Gait
David T Felson
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1691-1

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