Home Page - About the Arthritis Center -Hopkins Rheumatology - Myositis Center - Vasculitis Center - Scleroderma Center
|
| |||
  |
|||
| Radiographic Progression | |||
|
OP0014 SYNOVITIS IS NOT CORRELATED WITH THE LEVEL OF SYMPTOMATIC SEVERITY IN PAINFUL KNEE OSTEOARTHRITIS PATIENTS
Arthroscopic progression of knee osteoarthritis (OA) has been shown to correlate with inflammatory synovitis. Therefore, clinical recognition of synovitis would be valuable in the treatment of knee OA. In this study, Ayral et al investigate whether the degree of synovitis correlates with clinical assessments of pain, stiffness, and physical function. Methods: 506 patients with primary knee OA of the medial compartment having pain of the signal knee on at least 30 days in the past 2 months, medial joint space width > 2mm, and at least 10% of one cartilage surface of the medial compartment affected by superficial fibrillation, were enrolled. The SFA was used to score medial chondropathy and the WOMAC OA index subscales were used to score pain, stiffness, and function. Results: |
|||
| Variables | Normal (n=252) |
Reactive (n=145) |
Inflammatory (n=109) |
| SFA score (0-100) |
30 + 19 | 38 + 20 | 41 + 18 |
| WOMAC Pain (0-4) |
2.6 + 0.8 | 2.6 + 0.7 | 2.7 + 0.7 |
| WOMAC Stiffness (0-4) |
2.7 + 1.0 | 2.8 + 0.9 | 2.8 + 1.0 |
| WOMAC Function (0-4) |
2.6 + 0.7 | 2.6 + 0.7 | 2.7 + 0.7 |
Conclusions: Although severe chondropathy is correlated with synovitis in patients with knee OA, these data suggest no clear correlation between the presence and intensity of synovitis and symptomatic severity.
Editorial Comment: It is well accepted that the severity of radiographic disease in OA is not correlated with the severity of symptoms. This study carries the observation a step further, demonstrating good correlation of severity of chondropathy with synovitis but not with symptoms. This disconnect between symptoms and radiography/pathobiology in OA makes treatment studies in OA very challenging.
THU0207 JOINT SPACE NARROWING IS POORLY CORRELATED WITH SYMPTOMS WORSENING IN KNEE-OSTEOARTHRITIS: RESULTS FROM THE PROSPECTIVE FOLLOW-UP OF 106, PLACEBO-TREATED PATIENTS FOR THREE YEARS
J.Y. Reginster, Y. Henrotin, O. Bruyere, C. Gonzalez, G. Giacovelli, L.C. Rovati
To date, no correlation has been found between severity of pain and radiographic progression in patients with osteoarthritis (OA). This study investigates whether there is a relationship over time between structural deterioration and symptoms in patients with OA.
Methods: 106 patients with knee OA in the placebo arm of a double-blind study were prospectively followed for 3 years. Values of the WOMAC index (total score and pain, function and stiffness scales), mean joint space width (digital image analysis) (JSW) and joint space narrowest point (magnification lens) (JN) were available at baseline and after 36 months.
Results: No significant correlation was observed, over the 3 -year period, between the changes in JSW and the changes in the global WOMAC score (p=0.68) or the pain (p=0.55), function (p=0.65) or stiffness (p=0.32) subscales. Similarly, no significant correlation was observed between the changes in JN and the global WOMAC score (p=0.45) or the pain (p=0.20), function (0.73) or stiffness (p=0.29) subscales. The percentage of variance in the symptomatic changes explained by the structural changes remained very poor.
Conclusion: Based on these data, there is no relationship between changes in JSW and severity of symptoms over time in patients with knee OA.
Editorial Comments: In cross-sectional studies of knee OA, the severity of radiographic changes has not correlated well with severity of pain. This well-designed prospective study now confirms that, over time, worsening joint space narrowing does not correlate with worsening pain in knee OA. We need to understand more about the mechanism(s) of pain in OA, and to correlate pain with other more sensitive imaging techniques such as MRI. In the meantime, defining outcomes for clinical trials in OA remain challenging.
