Synovial inflammation in patients with different stages of knee osteoarthritis (original) (raw)
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Synovial tissue inflammation in early and late osteoarthritis
Annals of the Rheumatic Diseases, 2005
To compare selected immunohistological features of inflammation in synovial tissue from patients with early and late osteoarthritis (OA). Methods: Synovial tissue samples were obtained from 10 patients with knee pain, normal radiographs, and arthroscopic manifestations of OA (early OA), and from 15 patients with OA undergoing knee joint arthroplasty (late OA). Conventional immunohistochemical techniques were used to measure microscopic manifestations of inflammation. The inflammatory cell infiltrate, blood vessel formation, and angiogenic factors, NF-kB activation, expression of tumour necrosis factor a (TNFa) and interleukin 1b (IL1b), and the presence of cyclo-oxygenase (COX)-1 and COX-2 were quantified. Fibroblast-like synoviocytes (FLS) were isolated from early and late OA tissue samples to compare in vitro production of prostaglandin E 2 (PGE 2) Results: Synovial tissue from patients with early OA demonstrated significantly greater CD4+ (p = 0.017) and CD68+ (p,0.001) cell infiltration, blood vessel formation (p = 0.01), vascular endothelial growth factor (p = 0.001), and intercellular adhesion molecule-1 expression (p,0.001). Numbers of cells producing TNFa and IL1b were also significantly greater in early OA (p,0.001). Manifestations of inflammation in early OA were associated with increased expression of the NF-kB1 (p,0.001) and RelA (p = 0.015) subunits, and with increased COX-2 expression (p = 0.04). Cytokine-induced PGE 2 production by cultured FLS was similar in both groups. Conclusion: Increased mononuclear cell infiltration and overexpression of mediators of inflammation were seen in early OA, compared with late OA. Isolated FLS were functionally similar in both groups, consistent with microenvironmental differences in the synovial tissue during different phases of OA. These observations may have important therapeutic implications for some patients during the early evolution of OA.
Correlation between systemic markers of inflammation and local synovitis in knee osteoarthritis
Caspian Journal of Internal Medicine, 2019
Background: In the elderly population joint swelling, effusion and pain indicate local synovitis and the presence of inflammation. At present, no serum marker has been shown linking to knee synovitis in KOA. With regard to serum high sensitive C-reactive protein (hsCRP) as a measure of inflammation, this study aimed to determine the association of systemic inflammation with local synovitis, as well as with pain and muscle strength in KOA. Methods: The study population was selected consecutively among patients with KOA presented to Ayatollah Rouhani Hospital Rheumatology Clinic with knee joint synovitis. The diagnosis of KOA was confirmed according to the American College of Rheumatology diagnostic criteria. Data regarding radiographic, demographic and biochemical characteristics were provided and IL-17, IL-10, TGF-ß and hsCRP in serum and synovial fluid (SF) were measured in all patients. Stepwse linear regression models were used to determine the correlation between SF- hsCRP as a ...
Osteoarthritis and Cartilage, 2013
Objective: To evaluate the association between synovitis on contrast enhanced (CE) MRI with microscopic and macroscopic features of synovial tissue inflammation. Method: Forty-one patients (mean age 60 years, 61% women) with symptomatic radiographic knee OA were studied: twenty underwent arthroscopy (macroscopic features were scored (0e4), synovial biopsies obtained), twenty-one underwent arthroplasty (synovial tissues were collected). After haematoxylin and eosin staining, the lining cell layer, synovial stroma and inflammatory infiltrate of synovial tissues were scored (0e3). T1-weighted CE-MRI's (3 T) were used to semi-quantitatively score synovitis at 11 sites (0e22) according to Guermazi et al. Spearman's rank correlations were calculated. Results: The mean (SD) MRI synovitis score was 8.0 (3.7) and the total histology grade was 2.5 (1.6). Median (range) scores of macroscopic features were 2 (1e3) for neovascularization, 1 (0e3) for hyperplasia, 2 (0e4) for villi and 2 (0e3) for fibrin deposits. The MRI synovitis score was significantly correlated with total histology grade [r ¼ 0.6], as well as with lining cell layer [r ¼ 0.4], stroma [r ¼ 0.3] and inflammatory infiltrate [r ¼ 0.5] grades. Moreover, MRI synovitis score was also significantly correlated with macroscopic neovascularization [r ¼ 0.6], hyperplasia [r ¼ 0.6] and villi [r ¼ 0.6], but not with fibrin [r ¼ 0.3]. Conclusion: Synovitis severity on CE-MRI assessed by a new whole knee scoring system by Guermazi et al. is a valid, non-invasive method to determine synovitis as it is significantly correlated with both macroscopic and microscopic features of synovitis in knee OA patients.
BMC Musculoskeletal Disorders, 2011
Background: One of the sources of knee pain in osteoarthritis (OA) is believed to be related to local chronic inflammation of the knee joints, which involves the production of inflammatory cytokines such as tumor necrosis factor alpha (TNFα), interleukin (IL)-6, and nerve growth factor (NGF) in the synovial membrane, and these cytokines are believed to promote pathological OA. In the present study, correlations between proinflammatory cytokines in knee synovial fluid and radiographic changes and functional scores and pain scores among OA patients were examined. Methods: Synovial fluid was harvested from the knees of 47 consecutive OA patients, and the levels of TNFα, IL-6, and NGF were measured using enzyme-linked immunosorbent assays. Osteoarthritic knees were classified using Kellgren-Lawrence (KL) grading (1-4). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess self-reported physical function, pain, and stiffness. Results: TNFα and IL-6 were detectable in knee synovial, whereas NGF was not. TNFα was not correlated with the KL grade, whereas IL-6 had a significantly negative correlation. We observed differences in the correlations between TNFα and IL-6 with WOMAC scores and their subscales (pain, stiffness, and physical function). TNFα exhibited a significant correlation with the total score and its 3 subscales, whereas IL-6 exhibited a moderately significant negative correlation only with the subscale of stiffness.
APLAR Journal of Rheumatology, 2007
Objective: The objective of this pilot study was to describe clinical features, laboratory investigations and enhanced MRI features in patients presenting with undifferentiated inflammatory synovitis of the knee. Patient and methods: Fifteen patients with undifferentiated inflammatory synovitis of the knee joint were recruited for this study. All patients underwent full history-taking, detailed rheumatological examination, synovial fluid analysis including polarized microscopy, rheumatoid factor (RF), anti-nuclear antibody (ANA), anti-cyclic citrullinated peptide (CCP), C-reactive protein, and erythrocyte sedimentation rate. MRI/gadolinium-enhanced MRI was done for all patients with unilateral presentation and for the most symptomatic knee in cases of bilateral knee involvement. Results: Enhanced MRI showed the following findings: synovial enhancement and effusion 15/15, pannus formation 13/15, bone marrow edema 3/15, bone erosions 2/15, cartilaginous erosions 1/15, synovial cysts 2/ 15, Baker's cyst 2/15, periarticular soft tissue edema 3/15, and lipoma arborescencs 2/15. Conclusions: Undifferentiated synovitis of the knee is not necessarily a benign condition. It represents a diagnostic dilemma in rheumatological practice that deserves early identification and early treatment in order to prevent inevitable and irreversible articular damage if left untreated. The ability of MRI to detect early changes like bone marrow edema and bony and cartilaginous erosions (usually not obvious on plain X-rays) makes this a highly sensitive tool for evaluation of patients presenting with undifferentiated synovitis affecting the knee joint. When combined with gadolinium, it allows accurate assessment of the degree of synovial thickening (pannus) and picks up local intra-articular lesions especially in patients with unilateral disease.
Evolution of synovitis in osteoarthritic knees and its association with clinical features
Osteoarthritis and Cartilage, 2016
Objective: To investigate the course of synovitis on contrast-enhanced magnetic resonance images (CE-MRI) in osteoarthritic knees over 2 years, and its association with pain and cartilage deterioration. Design: Consecutive patients (n ¼ 39, mean age 61 years, 79% woman, median (range) body mass index (BMI) 29 (24e48) kg/mm 2) with clinical osteoarthritis (OA) were included. Baseline and follow-up CE-MRI (3 T) were scored paired in chronological order for synovitis (semi-quantitatively at 11 sites (range 0e22)), cartilage deterioration and bone marrow lesions (BMLs) (semi-quantitatively according to Knee Osteoarthritis Scoring System (KOSS)). Changes in sum scores were calculated. Cartilage deterioration was defined as change of !2 above the smallest detectable change (SDC). Pain was assessed by standardized questionnaires. Analysis of covariance (ANCOVA) and linear regression models were used to investigate association between synovitis change and cartilage deterioration and between synovitis change or cartilage deterioration and change in pain. Results: The total synovitis score did not change over 2 years (mean change 0.2 (standard deviation (SD) 3.2)), although changes in individual patients were observed. Cartilage deterioration was observed in 51% of patients. Synovitis change score was lower in patients without compared to patients with cartilage deterioration, taking BML change in account (mean difference À2.1 (À4.1 to À0.1)). Change in synovitis was not associated with change in pain, whereas cartilage deterioration was associated with change in Intermittent and Constant OsteoArthritis Pain (ICOAP) constant pain in adjusted models (unstandardised coefficient (B) (95% confidence interval (CI)) 2.8 (0.4e5.3)). Conclusions: In individual patients synovitis fluctuates during disease course. Synovitis change was not associated with change in pain. Increase in synovitis is associated with cartilage deterioration, suggesting a role for synovitis as a target for disease-modifying treatment.
Arthritis care & research, 2016
Objective Painful knee osteoarthritis (KOA) has been associated with joint inflammation. There is however little literature correlating signs of localised inflammation with Contrast-enhanced (CE) Magnetic resonance imaging (MRI) of synovium. This study examined the relationship between clinical and functional markers of localised knee inflammation and CE MRI based synovial scores. Methods Patients with symptomatic KOA were enrolled into the randomised, double-blind, Vitamin D Evaluation in Osteoarthritis (VIDEO) trial. In this cross-sectional substudy, associations between validated MRI based semi-quantitative synovial scores of the knee and the following markers of inflammation were investigated; self-reported pain and stiffness, effusion, warmth, joint line tenderness, erythrocyte sedimentation rate, radiographic severity and functional ability tests. Results 107 patients satisfied the inclusion criteria of complete data and were included in the analysis. Significant associations ...
Arthritis & Rheumatism, 2002
Objective. Serial synovial biopsy samples are increasingly being used for the evaluation of novel therapies for rheumatoid arthritis (RA). Most studies have used tissues from knee biopsies, but technical improvements have made serial small joint arthroscopy feasible as well. Theoretically, there could be differences in the features of synovial inflammation between various joints as a result of mechanical factors, differences in innervation, and other factors. We therefore undertook this study to compare the cell infiltrate in paired synovial biopsy samples from inflamed knee joints and paired inflamed small joints of patients with RA.
Synovitis and the risk of knee osteoarthritis: the most study
Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 2015
To identify the independent relation of synovitis with incident radiographic knee osteoarthritis (OA) after adjusting for other structural factors known to cause synovitis. We examined MRIs from knees that developed incident radiographic OA from the Multicenter Osteoarthritis Study (MOST) and compared these case knees with controls that did not develop OA. We examined baseline MRIs for knees developing OA at any time up to 84 months follow-up. We scored lesions in cartilage, meniscus, bone marrow and synovitis. Synovitis scores were summed (0-9) across 3 regions, suprapatellar, infrapatellar and intercondylar region, each of which was scored 0-3. After bivariate analyses examining each factor's association with incidence, we carried out multivariable regression analyses adjusting for age, sex, BMI, alignment and cartilage and meniscal damage. We studied 239 case and 731 control knees. In bivariate analyses, cartilage lesions, meniscal damage, synovitis and bone marrow lesions we...
Osteoarthritis : the role of synovitis
2015
Osteoarthritis is a prevalent disease causing pain and disability. It’s aetiology is unknown and no curative treatment is available. Osteoarthritis research is complicated due to heterogeneity of the disease, slow progression and poor association of clinical features with radiographic abnormalities, imaging modality of choice until now. In this thesis the role of synovitis in osteoarthritis is studied in relationship with clinical features and structural damage. The studies described made especially use of data derived a prospective follow-up study in symptomatic hand osteoarthritis patients. Synovitis detected on ultrasound was associated with clinical features and with progression of structural damage after 2.3 years in hand osteoarthritis. In erosive osteoarthritis, a subtype of hand osteoarthritis, more synovitis was found in all hand joints, even in non-erosive joints, when compared to joints of patients without erosive osteoarthritis. Also, associations were found between syno...