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Dima RS, Birmingham TB, Empey ME, Appleton CT. Imaging-based measures of synovitis in knee osteoarthritis: A scoping review and narrative synthesis. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100602. [PMID: 40235523 PMCID: PMC11999625 DOI: 10.1016/j.ocarto.2025.100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 03/12/2025] [Indexed: 04/17/2025] Open
Abstract
Background Synovitis has emerged as a tissue target of importance in OA research and is commonly evaluated with medical imaging. Objectives The purpose of this scoping review was to identify and describe the medical imaging techniques and definitions used by knee OA researchers to assess synovitis, summarize their advantages and disadvantages, and identify opportunities for future work. Eligibility criteria We included full-text peer-reviewed English publications including adults diagnosed with knee OA. Studies were included if one or more medical imaging modalities were used to assess synovitis in the knee.Studies of inflammatory arthritis, joint replacement, and synovial joints other than the knee were excluded. Animal studies and literature syntheses were also excluded. Sources MEDLINE, SCOPUS, and Google scholar databases were systematically searched for publications (2000-2023) using the following medical subject headings (MeSH): "osteoarthritis, knee", "magnetic resonance imaging", "ultrasonography", "synovitis". Results 1154 articles were identified from searching medical databases. After removal of duplicates, abstract screening, and full text reading, 251 articles were included in the final review. MRI is the most common modality employed to assess knee synovitis, followed by US imaging. Varied imaging techniques used in the assessment of joint synovitis may be targeting divergent constructs of synovial remodeling and inflammation, which complicates interpretation of results. Conclusions There is no consensus on the best method for imaging of knee synovitis in OA. Future work may benefit from the evaluation of synovitis separate from joint effusion, and their associations with histologic findings to discriminate between features of synovial inflammation and remodeling.
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Affiliation(s)
- Robert S. Dima
- Lawson Health Research Institute, St Joseph's Healthcare London, N6A 4V2, ON, Canada
| | - Trevor B. Birmingham
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada
| | - Mary-Ellen Empey
- Faculty of Health Sciences, University of Western Ontario, London, N6G 1H1, ON, Canada
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, N6A 5B5, ON, Canada
| | - C. Thomas Appleton
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 5C1, ON, Canada
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Domarkienė A, Kalytis L, Kanapienis G, Kurminas M, Tamošiūnas AE. Genicular Arteries Embolization for Patients with Osteoarthritis, Their Selection, and Follow-Up Based on MRI Findings. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:941. [PMID: 40428899 PMCID: PMC12112837 DOI: 10.3390/medicina61050941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2025] [Revised: 05/13/2025] [Accepted: 05/17/2025] [Indexed: 05/29/2025]
Abstract
Osteoarthritis (OA) is a leading cause of disability worldwide, with its prevalence rising due to aging populations. Management ranges from conservative treatments such as weight management and pharmacologic therapy to surgical interventions such as total joint replacement. However, treating moderate knee OA remains challenging for patients unresponsive to conservative care but not yet surgical candidates. Genicular artery embolization (GAE) has emerged as a minimally invasive procedure targeting abnormal angiogenesis and inflammation in OA. This article explores GAE's mechanism, patient-selection criteria, and effectiveness in pain reduction and functional improvement. Studies suggest that GAE has the potential to significantly improve pain and function in mild to moderate OA, with sustained benefits. Patient selection is crucial for optimal outcomes, with imaging playing a key role. While conventional MRI assesses structural damage, Dynamic Contrast-Enhanced MRI (DCE-MRI) offers superior insights by evaluating synovitis, quantifying cartilage degradation, and monitoring treatment response. Due to its strong correlation with pain scores and status as the best surrogate marker for inflammation in synovitis, DCE-MRI holds significant potential to enhance patient selection and treatment monitoring for GAE.
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Affiliation(s)
- Aurelija Domarkienė
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 01513 Vilnius, Lithuania; (L.K.); (M.K.); (A.E.T.)
- Center for Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Lukas Kalytis
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 01513 Vilnius, Lithuania; (L.K.); (M.K.); (A.E.T.)
| | - Gytis Kanapienis
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 01513 Vilnius, Lithuania; (L.K.); (M.K.); (A.E.T.)
| | - Marius Kurminas
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 01513 Vilnius, Lithuania; (L.K.); (M.K.); (A.E.T.)
- Center for Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Algirdas Edvardas Tamošiūnas
- Department of Radiology, Nuclear Medicine and Medical Physics, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, 01513 Vilnius, Lithuania; (L.K.); (M.K.); (A.E.T.)
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Nielsen CT, Henriksen M, Daugaard CL, Nybing JU, Hansen P, Müller F, Bliddal H, Boesen M, Gudbergsen H. The association between articular calcium crystal deposition and knee osteoarthritis, joint pain and inflammation: a cross-sectional study. Skeletal Radiol 2025:10.1007/s00256-025-04904-7. [PMID: 40082322 DOI: 10.1007/s00256-025-04904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 02/26/2025] [Accepted: 02/28/2025] [Indexed: 03/16/2025]
Abstract
OBJECTIVE To explore in a cross-sectional fashion if overweight individuals with knee osteoarthritis (OA) and intraarticular calcium crystal (CaC) deposits experience more knee joint inflammation and knee pain compared with individuals without CaC deposits. SUBJECTS AND METHODS We used pre-randomization imaging data from an RCT, the LOSE-IT trial. Participants with knee OA (clinical diagnosis of knee OA and KLG 1-3) had CT and 3 T MRI of the index knee. CaCs were assessed on CT using the Boston University Calcium Knee Score (BUCKS). The pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to assess knee pain and to estimate joint inflammation we used static and dynamic contrast-enhanced (DCE) MRI. An independent sample t-test was used to test for a significant difference in KOOS-pain and Analysis of Covariance (ANCOVA) models to test for differences in the static and DCE-MRI variables between the two groups. RESULTS Of the 158 participants with KOOS-pain available, 19 (12%) had CaC deposits, and of the 115 participants with MRI available, 13 (11.3%) had CaC deposits. We did not find a significant difference in mean KOOS-pain between the two groups; the mean difference was - 2.2 points (95%CI, - 10.86, 6.45). None of the MRI variables were associated with the presence of CaC deposits. Between-group differences were small for all MRI variables, with standardized mean differences ranging from small to medium (0.31-0.56). CONCLUSION In individuals with knee OA, we did not find an association between intraarticular CaC deposits and an increase in knee joint inflammation or knee pain.
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Affiliation(s)
- Camilla Toft Nielsen
- Department of Radiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Hospital, Entrance 7A, Nielsine Nielsens Vej 41A, 2400, Copenhagen, NV, Denmark.
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Nordre Fasanvej 57, Road 8, Entrance 19, 2000, Frederiksberg, Denmark.
- Department of Radiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev Hospital, Borgmester Ib Juuls Vej 17, Entrance 4, 4Th Floor, E2, 2730, Herlev, Denmark.
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Nordre Fasanvej 57, Road 8, Entrance 19, 2000, Frederiksberg, Denmark
| | - Cecilie Laubjerg Daugaard
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Nordre Fasanvej 57, Road 8, Entrance 19, 2000, Frederiksberg, Denmark
| | - Janus Uhd Nybing
- Department of Radiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Hospital, Entrance 7A, Nielsine Nielsens Vej 41A, 2400, Copenhagen, NV, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Hospital, Entrance 7A, Nielsine Nielsens Vej 41A, 2400, Copenhagen, NV, Denmark
| | - Felix Müller
- Department of Radiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev Hospital, Borgmester Ib Juuls Vej 17, Entrance 4, 4Th Floor, E2, 2730, Herlev, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Nordre Fasanvej 57, Road 8, Entrance 19, 2000, Frederiksberg, Denmark
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Hospital, Entrance 7A, Nielsine Nielsens Vej 41A, 2400, Copenhagen, NV, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg Hospital, Nordre Fasanvej 57, Road 8, Entrance 19, 2000, Frederiksberg, Denmark
- Department of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Build. 24 Q, 1St Floor, 1353, Copenhagen K, Denmark
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Clausen SH, Boesen M, Thorlund JB, Vach W, Lind M, Hölmich P, Hansen MS, Mohammadnejad A, Skou ST. Can Baseline MRI Findings Identify Who Responds Better to Early Surgery Versus Exercise and Education in Young Patients With Meniscal Tears? A Subgroup Analysis From the DREAM Trial. J Orthop Sports Phys Ther 2025; 55:1-11. [PMID: 39992184 DOI: 10.2519/jospt.2025.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
OBJECTIVE: To investigate whether magnetic resonance imaging (MRI) findings modified the outcomes of early surgery compared to exercise and education in young patients with meniscal tears. DESIGN: A secondary effect modifier analysis of a randomized controlled trial. METHODS: The primary outcome was change from baseline to 12 months in the mean score of 4 Knee injury and Osteoarthritis Outcome Score subscales (KOOS4). Three potential MRI-defined effect modifiers were predefined: (1) the type of meniscal tear (simple vs bucket handle or complex), (2) the meniscus affected (medial vs lateral), and (3) the presence of knee effusion/synovitis (yes/no). We used a linear mixed model to investigate the difference in mean change between the treatment groups, stratified by each of the 3 potential effect modifiers, and estimated the interactions. An adjusted effect difference ≥ 10 points (0-100 scale) was considered clinically relevant. RESULTS: Data from all participants (60 in the surgery group and 61 in the exercise group) were analyzed. The mean (SD) age was 29.7 (6.6) years, and 28% were female. A potential effect modification was observed for knee effusion/synovitis, with its presence implying an increase of the effect of early surgery by 11 points on the KOOS4 (P = .07). CONCLUSION: Knee effusion/synovitis on MRI potentially modified the treatment effect with a clinically relevant difference in change of the KOOS4 in patients with effusion/synovitis, favoring early surgery. We found no indication that patients with bucket handle or complex versus simple tears or medial versus lateral tears benefited more from early surgery. J Orthop Sports Phys Ther 2025;55(3):1-11. Epub 30 January 2025. doi:10.2519/jospt.2025.12994.
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Hill BG, Eble S, Moschetti WE, Schilling PL. The Discordance Between Pain and Imaging in Knee Osteoarthritis. J Am Acad Orthop Surg 2025:00124635-990000000-01248. [PMID: 39965186 DOI: 10.5435/jaaos-d-24-00509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/18/2024] [Indexed: 02/20/2025] Open
Abstract
INTRODUCTION Clinicians use imaging studies to help gauge the degree to which structural factors within the knee account for patients' pain and symptoms. We aimed to determine the degree to which commonly used structural features predict a patient's knee pain and symptoms. METHODS Using Osteoarthritis Initiative data, a 10-year study of 4,796 patients with knee osteoarthritis (KOA), participants' KOA was characterized by radiographs and MRI scans of the knee. Salient features were quantified with two established grading systems: (1) individual radiographic features (IRFs) and (2) MRI Osteoarthritis Knee Scores (MOAKS) from MRI scans. We paired participants' IRFs (24,256 readings) and MOAKS (2,851 readings) with side-specific Knee Injury and Osteoarthritis Outcome Scores (KOOS). We trained generalized linear models to predict KOOS from features measured in IRF and MOAKS. We repeated the analysis on four subsets of the cohort. The models' predictive performance was evaluated using root mean square errors and coefficient of determination (R2). RESULTS Neither radiographic features used to determine IRF grades nor MOAKS were predictive of patient pain or symptoms. MOAKS's performance was slightly more predictive of KOOS than IRF's. IRF's prediction of KOOS achieved a maximum R2 of 0.15 and 0.28 for MOAKS, indicating a low level of accuracy in predicting the target variable. DISCUSSION Commonly used structural features from radiographs and MRI scans cannot predict KOA pain and symptoms-even when imaging features are codified by established grading systems like IRF or MOAKS. The predictive performance of these models is even worse as symptom severity worsens. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Brandon G Hill
- From the Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH (Hill, Moschetti, and Schilling), the The Geisel School of Medicine at Dartmouth, Hanover, NH (Eble, Moschetti, and Schilling), and the VA White River Junction Health Care, Veterans Affairs, White River Junction, VT (Hill and Schilling)
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Griffith JF, Yip SWY, van der Heijden RA, Valenzuela RF, Yeung DKW. Perfusion Imaging of the Musculoskeletal System. Magn Reson Imaging Clin N Am 2024; 32:181-206. [PMID: 38007280 DOI: 10.1016/j.mric.2023.07.004] [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] [Indexed: 11/27/2023]
Abstract
Perfusion imaging is the aspect of functional imaging, which is most applicable to the musculoskeletal system. In this review, the anatomy and physiology of bone perfusion is briefly outlined as are the methods of acquiring perfusion data on MR imaging. The current clinical indications of perfusion related to the assessment of soft tissue and bone tumors, synovitis, osteoarthritis, avascular necrosis, Keinbock's disease, diabetic foot, osteochondritis dissecans, and Paget's disease of bone are reviewed. Challenges and opportunities related to perfusion imaging of the musculoskeletal system are also briefly addressed.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong.
| | - Stefanie W Y Yip
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Rianne A van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Raul F Valenzuela
- Department of Musculoskeletal Imaging, The University of Texas, MD Anderson Cancer Center, USA
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong
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Liu ZF, Zhang Y, Liu J, Wang YY, Chen M, Liu EY, Guo JM, Wang YH, Weng ZW, Liu CX, Yu CH, Wang XY. Effect of Traditional Chinese Non-Pharmacological Therapies on Knee Osteoarthritis: A Narrative Review of Clinical Application and Mechanism. Orthop Res Rev 2024; 16:21-33. [PMID: 38292459 PMCID: PMC10826518 DOI: 10.2147/orr.s442025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
Knee osteoarthritis (KOA) stands as a degenerative ailment with a substantial and escalating prevalence. The practice of traditional Chinese non-pharmacological therapy has become a prevalent complementary and adjunctive approach. A mounting body of evidence suggests its efficacy in addressing KOA. Recent investigations have delved into its underlying mechanism, yielding some headway. Consequently, this comprehensive analysis seeks to encapsulate the clinical application and molecular mechanism of traditional Chinese non-pharmacological therapy in KOA treatment. The review reveals that various therapies, such as acupuncture, electroacupuncture, warm needle acupuncture, tuina, and acupotomy, primarily target localized knee components like cartilage, subchondral bone, and synovium. Moreover, their impact extends to the central nervous system and intestinal flora. More perfect experimental design and more comprehensive research remain a promising avenue in the future.
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Affiliation(s)
- Zhi-Feng Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yang Zhang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Jing Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yu-Yan Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Mo Chen
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Er-Yang Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Jun-Ming Guo
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yan-Hua Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Zhi-Wen Weng
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Chang-Xin Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Chang-He Yu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Xi-You Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
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Chen S, Kang P, Zhao Z, Zhang H, Li J, Xu K, Gong D, Jiao F, Wang H, Zhang M. Danggui-Shaoyao-San (DSS) ameliorates the progression of osteoarthritis via suppressing the NF-κB signaling pathway: an in vitro and in vivo study combined with bioinformatics analysis. Aging (Albany NY) 2024; 16:648-664. [PMID: 38194722 PMCID: PMC10817397 DOI: 10.18632/aging.205410] [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: 05/01/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Osteoarthritis (OA) is a common chronic age-related joint disease characterized primarily by inflammation of synovial membrane and degeneration of articular cartilage. Accumulating evidence has demonstrated that Danggui-Shaoyao-San (DSS) exerts significant anti-inflammatory effects, suggesting that it may play an important role in the treatment of knee osteoarthritis (KOA). METHODS In the present study, DSS was prepared and analyzed by high-performance liquid chromatography (HPLC). Bioinformatics analyses were carried out to uncover the functions and possible molecular mechanisms by which DSS against KOA. Furthermore, the protective effects of DSS on lipopolysaccharide (LPS)-induced rat chondrocytes and cartilage degeneration in a rat OA model were investigated in vivo and in vitro. RESULTS In total, 114 targets of DSS were identified, of which 60 candidate targets were related to KOA. The target enrichment analysis suggested that the NF-κB signaling pathway may be an effective mechanism of DSS. In vitro, we found that DSS significantly inhibited LPS-induced upregulation of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), matrix metalloproteinase-3 (MMP3), and matrix metalloproteinase-13 (MMP13). Meanwhile, the degradation of collagen II was also reversed by DSS. Mechanistically, DSS dramatically suppressed LPS-induced activation of the nuclear factor kappa B (NF-κB) signaling pathway. In vivo, DSS treatment prevented cartilage degeneration in a rat OA model. CONCLUSIONS DSS could ameliorate the progression of OA through suppressing the NF-κB signaling pathway. Our findings indicate that DSS may be a promising therapeutic approach for the treatment of KOA.
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Affiliation(s)
- Shuai Chen
- Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
- Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou 510800, Guangdong, China
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Pan Kang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Zhuanglin Zhao
- Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
- Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou 510800, Guangdong, China
| | - Hongyi Zhang
- Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou 510800, Guangdong, China
| | - Jianliang Li
- Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Kun Xu
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200120, China
| | - Dawei Gong
- Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
- Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Feng Jiao
- Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou 510800, Guangdong, China
| | - Haibin Wang
- Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong, China
| | - Meng Zhang
- Henan Provincial People’s Hospital, Zhengzhou University People’s Hospital, Zhengzhou 450003, Henan, China
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Mostert JM, Dur NB, Li X, Ellermann JM, Hemke R, Hales L, Mazzoli V, Kogan F, Griffith JF, Oei EH, van der Heijden RA. Advanced Magnetic Resonance Imaging and Molecular Imaging of the Painful Knee. Semin Musculoskelet Radiol 2023; 27:618-631. [PMID: 37935208 PMCID: PMC10629992 DOI: 10.1055/s-0043-1775741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Chronic knee pain is a common condition. Causes of knee pain include trauma, inflammation, and degeneration, but in many patients the pathophysiology remains unknown. Recent developments in advanced magnetic resonance imaging (MRI) techniques and molecular imaging facilitate more in-depth research focused on the pathophysiology of chronic musculoskeletal pain and more specifically inflammation. The forthcoming new insights can help develop better targeted treatment, and some imaging techniques may even serve as imaging biomarkers for predicting and assessing treatment response in the future. This review highlights the latest developments in perfusion MRI, diffusion MRI, and molecular imaging with positron emission tomography/MRI and their application in the painful knee. The primary focus is synovial inflammation, also known as synovitis. Bone perfusion and bone metabolism are also addressed.
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Affiliation(s)
- Jacob M. Mostert
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niels B.J. Dur
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xiufeng Li
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Jutta M. Ellermann
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurel Hales
- Department of Radiology, Stanford University, Stanford, California
| | | | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California
| | - James F. Griffith
- Department of Imaging and Interventional Radiology Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rianne A. van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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De Marziani L, Boffa A, Orazi S, Andriolo L, Di Martino A, Zaffagnini S, Filardo G. Joint Response to Exercise Is Affected by Knee Osteoarthritis: An Infrared Thermography Analysis. J Clin Med 2023; 12:jcm12103399. [PMID: 37240505 DOI: 10.3390/jcm12103399] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/12/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Infrared thermography can be used to evaluate the inflammation characterizing the joint environment of OA knees, but there is limited evidence on the response to physical exercise. Identifying the response to exercise of OA knees and the influencing variables could provide important information to better profile patients with different knee OA patterns. Sixty consecutive patients (38 men/22 women, 61.4 ± 9.2 years) with symptomatic knee OA were enrolled. Patients were evaluated with a standardized protocol using a thermographic camera (FLIR-T1020) positioned at 1 m with image acquisition of an anterior view at baseline, immediately after, and at 5 min after a 2-min knee flexion-extension exercise with a 2 kg anklet. Patients' demographic and clinical characteristics were documented and correlated with the thermographic changes. This study demonstrated that the temperature response to exercise in symptomatic knee OA was affected by some demographic and clinical characteristics of the assessed patients. Patients with a poor clinical knee status presented with a lower response to exercise, and women showed a greater temperature decrease than men. Not all evaluated ROIs showed the same trend, which underlines the need to specifically study the different joint subareas to identify the inflammatory component and joint response while investigating knee OA patterns.
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Affiliation(s)
- Luca De Marziani
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Simone Orazi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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11
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Li P, Xie C, Liu Y, Wen Z, Nan S, Yu F. Quantitative analysis of local microcirculation changes in early osteonecrosis of femoral head: DCE-MRI findings. Front Surg 2023; 9:1003879. [PMID: 36733679 PMCID: PMC9888535 DOI: 10.3389/fsurg.2022.1003879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
Aim This study aims to quantitatively analyze the changes in local microcirculation in early osteonecrosis of the femoral head (ONFH) by dynamic contrast-enhanced (DCE) MRI and to explore the pathophysiological mechanisms of early ONFH. Patients and Methods We selected 49 patients (98 hips) aged 21-59 years who were clinically diagnosed with early ONFH. A total of 77 femoral heads were diagnosed with different degrees of necrosis according to the Association Research Circulation Osseous (ARCO) staging system, and 21 femoral heads were judged to be completely healthy. All patients underwent DCE-MRI scanning. Pseudocolor images and time-signal intensity curves were generated by Tissue 4D processing software. The volume transfer constant (K trans), extracellular extravascular space, also known as vascular leakage (V e), and transfer rate constant (K ep) of healthy and different areas of necrotic femoral heads were measured on perfusion parameter maps. The differences and characteristics of these parameters in healthy and different areas of necrotic femoral heads were analyzed. Results The signal accumulation in healthy femoral heads is lower than that of necrotic femoral heads in pseudocolor images. The time-signal intensity curve of healthy femoral heads is along the horizontal direction, while they all have upward trends for different areas of necrotic femoral heads. The mean value of K trans of healthy femoral heads was lower than the integration of necrotic, boundary, and other areas (F = 3.133, P = .036). The K ep value of healthy femoral heads was higher than the integration of lesion areas (F = 6.273, P = .001). The mean V e value of healthy femoral heads was smaller than that of the lesion areas (F = 3.872, P = .016). The comparisons of parameters between different areas and comparisons among healthy areas and lesion areas showed different results. Conclusion ONFH is a complex ischemic lesion caused by changes in local microcirculation. It mainly manifests as increased permeability of the vascular wall, blood stasis in the posterior circulation, high intraosseous pressure in the femoral head, and decreased arterial blood flow. The application of DCE-MRI scanning to quantitatively analyze the visual manifestations of microcirculation after early ONFH is an ideal method to study the microcirculation changes of necrotic femoral heads.
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Affiliation(s)
- Pinxue Li
- School of Medicine, Nankai University, Tianjin, China
| | - Congqin Xie
- Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Yubo Liu
- School of Medicine, Nankai University, Tianjin, China,Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Zhentao Wen
- Department of Orthopedics, Handan First Hospital, Handan, China
| | - Shaokui Nan
- Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Fangyuan Yu
- Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China,Correspondence: Fangyuan Yu
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12
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Eck BL, Yang M, Elias JJ, Winalski CS, Altahawi F, Subhas N, Li X. Quantitative MRI for Evaluation of Musculoskeletal Disease: Cartilage and Muscle Composition, Joint Inflammation, and Biomechanics in Osteoarthritis. Invest Radiol 2023; 58:60-75. [PMID: 36165880 PMCID: PMC10198374 DOI: 10.1097/rli.0000000000000909] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Magnetic resonance imaging (MRI) is a valuable tool for evaluating musculoskeletal disease as it offers a range of image contrasts that are sensitive to underlying tissue biochemical composition and microstructure. Although MRI has the ability to provide high-resolution, information-rich images suitable for musculoskeletal applications, most MRI utilization remains in qualitative evaluation. Quantitative MRI (qMRI) provides additional value beyond qualitative assessment via objective metrics that can support disease characterization, disease progression monitoring, or therapy response. In this review, musculoskeletal qMRI techniques are summarized with a focus on techniques developed for osteoarthritis evaluation. Cartilage compositional MRI methods are described with a detailed discussion on relaxometric mapping (T 2 , T 2 *, T 1ρ ) without contrast agents. Methods to assess inflammation are described, including perfusion imaging, volume and signal changes, contrast-enhanced T 1 mapping, and semiquantitative scoring systems. Quantitative characterization of structure and function by bone shape modeling and joint kinematics are described. Muscle evaluation by qMRI is discussed, including size (area, volume), relaxometric mapping (T 1 , T 2 , T 1ρ ), fat fraction quantification, diffusion imaging, and metabolic assessment by 31 P-MR and creatine chemical exchange saturation transfer. Other notable technologies to support qMRI in musculoskeletal evaluation are described, including magnetic resonance fingerprinting, ultrashort echo time imaging, ultrahigh-field MRI, and hybrid MRI-positron emission tomography. Challenges for adopting and using qMRI in musculoskeletal evaluation are discussed, including the need for metal artifact suppression and qMRI standardization.
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Affiliation(s)
- Brendan L. Eck
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Mingrui Yang
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John J. Elias
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - Carl S. Winalski
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Faysal Altahawi
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Naveen Subhas
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging, Cleveland Clinic, Cleveland, OH, USA
- Imaging Instute, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Phenotype Diversity of Macrophages in Osteoarthritis: Implications for Development of Macrophage Modulating Therapies. Int J Mol Sci 2022; 23:ijms23158381. [PMID: 35955514 PMCID: PMC9369350 DOI: 10.3390/ijms23158381] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/23/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic inflammation is implicated in numerous human pathologies. In particular, low-grade inflammation is currently recognized as an important mechanism of osteoarthritis (OA), at least in some patients. Among the signs of the inflammatory process are elevated macrophage numbers detected in the OA synovium compared to healthy controls. High macrophage counts also correlate with clinical symptoms of the disease. Macrophages are central players in the development of chronic inflammation, pain, cartilage destruction, and bone remodeling. However, macrophages are also involved in tissue repair and remodeling, including cartilage. Therefore, reduction of macrophage content in the joints correlates with deleterious effects in OA models. Macrophage population is heterogeneous and dynamic, with phenotype transitions being induced by a variety of stimuli. In order to effectively use the macrophage inflammatory circuit for treatment of OA, it is important to understand macrophage heterogeneity and interactions with surrounding cells and tissues in the joint. In this review, we discuss functional phenotypes of macrophages and specific targeting approaches relevant for OA treatment development.
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14
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Uflacker AB, Keefe N, Bruner ET, Avery A, Salzar R, Henderson K, Spratley M, Nacey N, Miller W, Grewal S, Chahin J, Safavian D, Haskal ZJ. Assessing the Effects of Geniculate Artery Embolization in a Non-Surgical Animal Model of Osteoarthritis. J Vasc Interv Radiol 2022; 33:1073-1082.e2. [PMID: 35659574 DOI: 10.1016/j.jvir.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To create a non-surgical animal model of osteoarthritis (OA) to evaluate effects of embolotherapy during geniculate artery embolization. MATERIALS AND METHODS Fluoroscopy-guided injections of 700mg Sodium-Monoiodoacetate were made into the left stifle in 6 rams. Kinematic data were collected pre/post-induction. 10-weeks post-induction, subjects 1, 4-6 underwent MRI with dynamic contrast enhancement (DCE-MRI), and angiography (subjects 1, 3, 4-6) with angiographic scoring to identify regions with greatest disease severity for superselective embolization (75-250μm microspheres, subjects 1, 3, 4, and 6). Target vessel size was measured. 24-weeks after angiography, DCE-MRI, angiography, and euthanasia were performed and bilateral stifles harvested. Medial/lateral tibial and femoral condyles, patella and synovium samples were cut, preserved, decalcified, and scored with OARSI criteria. Stifle and synovium WORMS and MOST scores were obtained. Ktrans and extracellular volume fraction (ve) were calculated from DCE-MRI along lateral synovial regions of interest. RESULTS Mean gross/microscopic pathological scores were elevated at 38/61. Mean synovitis score was elevated at 9.2. Mean pre/post-embolization angiographic scores were 5/3.8, respectively. Mean Superior/Transverse/Inferior Geniculate artery diameters(mm) were 3.1±1.21, 2.0±0.50, and 1.6±0.41. Mean Pre/post-embolization cartilage/synovitis scores were elevated at 35.13/73.3 and 5.5/9.2, respectively. Subjects 4-6 Ktrans/ve values were elevated at 0.049/0.38, 0.074/0.53, and 0.065/0.51. Altered gait of the hind limb was observed in all subjects post-induction, with reduced joint mobility. No skin or osteonecrosis were observed. CONCLUSION A non-surgical ovine animal knee OA model was created which allowed the collection of angiographic, histopathological, MRI and kinematic data were obtained to study the effects of geniculate artery embolization.
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Affiliation(s)
- Andre B Uflacker
- Medical University of South Carolina, Department of Radiology, Division of Vascular and Interventional Radiology
| | - Nicole Keefe
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Evelyn T Bruner
- Medical University of South Carolina, Department of Pathology & Laboratory Medicine
| | - Alexandra Avery
- Medical University of South Carolina, Department of Pathology & Laboratory Medicine
| | - Robert Salzar
- University of Virginia, Department of Engineering, Center for Applied Biomechanics
| | - Kyvory Henderson
- University of Virginia, Department of Engineering, Center for Applied Biomechanics
| | - Meade Spratley
- University of Virginia, Department of Engineering, Center for Applied Biomechanics
| | - Nicholas Nacey
- University of Virginia, Department of Radiology and Medical Imaging
| | - Wilson Miller
- University of Virginia, Department of Radiology and Medical Imaging
| | - Sukhdeep Grewal
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Jonathan Chahin
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Dana Safavian
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
| | - Ziv J Haskal
- University of Virginia, Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology
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15
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Extrusion, meniscal signal change, loss of shape, synovitis and bone marrow oedema are reliable scoring parameters to assess MRI appearance post meniscal transplant. Knee Surg Sports Traumatol Arthrosc 2022; 30:1527-1534. [PMID: 34459933 DOI: 10.1007/s00167-021-06720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Meniscal allograft transplantation (MAT) has shown good promise in restoring normal knee joint biomechanics in a meniscal deficient patient. However, MRI appearance of the meniscal allograft is often questioned and raises concerns of its viability and function. This paper aims to introduce and validate a new scoring system for MAT MRI appearance at 12 months [MRI appearance in Meniscal Transplant Score (MIMS)], using key changes such as extrusion, meniscal signal change, loss of shape, synovitis and bone marrow oedema. METHODS A retrospective analysis of 10 patients from a single surgeon series was conducted. All MAT were performed with soft tissue fixation technique. MRI was performed at 12 months post-transplant with two independent consultant musculoskeletal radiologists and one experienced meniscal transplant surgeon scoring the images obtained. Interobserver agreement and intraclass correlation were measured. RESULTS Interobserver agreement between examiners on individual features of the MIMS was superior for tibial bone oedema, substantial for meniscal extrusion and femoral bone oedema, moderate for meniscal shape and synovitis, and fair for meniscal signal changes. Absolute agreement between raters found good reliability (ICC = 0.774; 95% 0.359, 0.960) for single measures and excellent reliability (ICC = 0.911; 95% 0.627, 0.986) for average measures. CONCLUSION MIMS is a reliable method of evaluating the meniscal allograft transplant 12 months post-transplant. Further research with larger MAT cohort groups and patient reported outcome measures may be helpful to correlate its clinical significance and guide further management. LEVEL OF EVIDENCE Level III.
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16
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Sanchez-Lopez E, Coras R, Torres A, Lane NE, Guma M. Synovial inflammation in osteoarthritis progression. Nat Rev Rheumatol 2022; 18:258-275. [PMID: 35165404 PMCID: PMC9050956 DOI: 10.1038/s41584-022-00749-9] [Citation(s) in RCA: 469] [Impact Index Per Article: 156.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 02/06/2023]
Abstract
Osteoarthritis (OA) is a progressive degenerative disease resulting in joint deterioration. Synovial inflammation is present in the OA joint and has been associated with radiographic and pain progression. Several OA risk factors, including ageing, obesity, trauma and mechanical loading, play a role in OA pathogenesis, likely by modifying synovial biology. In addition, other factors, such as mitochondrial dysfunction, damage-associated molecular patterns, cytokines, metabolites and crystals in the synovium, activate synovial cells and mediate synovial inflammation. An understanding of the activated pathways that are involved in OA-related synovial inflammation could form the basis for the stratification of patients and the development of novel therapeutics. This Review focuses on the biology of the OA synovium, how the cells residing in or recruited to the synovium interact with each other, how they become activated, how they contribute to OA progression and their interplay with other joint structures.
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Affiliation(s)
- Elsa Sanchez-Lopez
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Roxana Coras
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Alyssa Torres
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Nancy E Lane
- Division of Rheumatology, Department of Medicine, University of California Davis, Davis, CA, USA
| | - Monica Guma
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
- San Diego VA Healthcare Service, San Diego, CA, USA.
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17
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Dainese P, Wyngaert KV, De Mits S, Wittoek R, Van Ginckel A, Calders P. Association between knee inflammation and knee pain in patients with knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2022; 30:516-534. [PMID: 34968719 DOI: 10.1016/j.joca.2021.12.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To systematically review the literature on the relationship between markers of inflammation and pain in patients with knee osteoarthritis (OA). METHODS We searched MEDLINE, Web of Science and EMBASE databases from inception until June 2021. Eligible articles had to report on the association between inflammation (as measured by effusion, synovitis, baker's cysts, cytokines and C-reactive protein) and pain in patients with radiographic knee OA. Two reviewers independently performed a screening on title and abstracts, data extraction and risk of bias assessment using the Newcastle-Ottawa Scale (NOS). A best evidence synthesis was conducted for each inflammatory sign included in this review. RESULTS 37 studies were included. Articles reported on the following measures: effusion or synovitis assessed via ultrasound (n = 9) or magnetic resonance imaging (MRI) (n = 17); baker's cyst (n = 3); cytokine concentrations (n = 11); and C-reactive protein levels (n = 4). The strength of the association between inflammation and pain does not exceed the moderate level (i.e., correlation coefficient values ranging from 0.19 to 0.61). Moderate levels of evidence were found for the association between synovitis (measured with ultrasound or contrast enhanced MRI) and pain. The levels of evidence between effusion (assessed via ultrasound), effusion/synovitis (assessed via non-contrast enhanced MRI), Baker's cyst, cytokines, C-reactive protein and pain were conflicting. CONCLUSIONS Different inflammatory markers are associated with pain but the correlation ranges from weak to moderate, and the quality of evidence from conflicting to moderate. Further research is needed to strengthen the level of evidence and to establish mechanisms.
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Affiliation(s)
- P Dainese
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - K V Wyngaert
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - S De Mits
- Department of Rheumatology, Ghent University, Ghent, Belgium
| | - R Wittoek
- Department of Rheumatology, Ghent University, Ghent, Belgium
| | - A Van Ginckel
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - P Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
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18
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MR Imaging Knee Synovitis and Synovial Pathology. Magn Reson Imaging Clin N Am 2022; 30:277-291. [DOI: 10.1016/j.mric.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Imaging of Synovial Inflammation in Osteoarthritis, From the AJR Special Series on Inflammation. AJR Am J Roentgenol 2021; 218:405-417. [PMID: 34286595 DOI: 10.2214/ajr.21.26170] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Synovitis, inflammation of the synovial membrane, is a common manifestation in osteoarthritis (OA) and is recognized to play a role in the complex pathophysiology of OA. Increased recognition of the importance of synovitis in the OA disease process and potential as a target for treatment has increased the need for non-invasive detection and characterization of synovitis using medical imaging. Numerous imaging methods can assess synovitis involvement in OA with varying sensitivity and specificity as well as complexity. This article reviews the role of contrast-enhanced MRI, conventional MRI, novel unenhanced MRI, gray-scale ultrasound (US), and power Doppler US in the assessment of synovitis in patients with OA. The role of imaging in disease evaluation as well as challenges in conventional imaging methods are discussed. We also provide an overview into the potential utility of emerging techniques for imaging of early inflammation and molecular inflammatory markers of synovitis, including quantitative MRI, superb microvascular imaging, and PET. The potential development of therapeutic treatments targeting inflammatory features, particularly in early OA, would greatly increase the importance of these imaging methods for clinical decision making and evaluation of therapeutic efficacy.
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20
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Lai-Zhao Y, Pitchers KK, Appleton CT. Transient anabolic effects of synovium in early post-traumatic osteoarthritis: a novel ex vivo joint tissue co-culture system for investigating synovium-chondrocyte interactions. Osteoarthritis Cartilage 2021; 29:1060-1070. [PMID: 33757858 DOI: 10.1016/j.joca.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a serious joint disease with no disease-modifying medical treatment. To develop treatments targeting synovium, we must improve our understanding of the effects of OA-related changes in synovial physiology on joint tissue outcomes. The aim of this study was to investigate the effects of synovial pathology due to post-traumatic OA (PTOA) on articular chondrocyte physiology. METHODS We first developed and validated a novel joint tissue co-culture system to model the biological interactions between synovium and articular chondrocytes. Whole-joint synovial tissue from a surgical rat model of PTOA vs sham and surgical-naïve controls was placed into a co-culture system with adult primary articular chondrocytes (n = 4-5). The effects of PTOA synovium on chondrocyte anabolic, inflammatory, and catabolic gene expression and sulfated glycosaminoglycan (sGAG) secretion and aggrecan synthesis were tested, and results from early and later stages of PTOA development were compared. RESULTS Synovial injury by arthrotomy (sham surgery) alone decreased primary chondrocyte expression of genes including Col2a1 (0.36 ± 0.15-fold) and Acan (0.41 ± 0.28-fold). Early PTOA synovium rescued the suppression of Acan, induced increased sGAG secretion (3.94 ± 0.44 μg/mL vs surgery-naïve 2.41 ± 0.55 and sham 2.92 ± 0.73 μg/mL controls), and upregulated Mmp3 (3.73 ± 2.62-fold) and Prg4 (4.93 ± 4.29-fold). These effects were lost with later stage PTOA synovium. CONCLUSIONS Early PTOA synovium induces transient anabolic responses in articular chondrocytes rather than pro-inflammatory responses that would require inhibition. These results suggest that PTOA synovium plays at least a partially protective role and that loss of these protective effects may contribute to PTOA progression.
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Affiliation(s)
- Y Lai-Zhao
- Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.
| | - K K Pitchers
- Department of Physiology and Pharmacology, The University of Western Ontario, Canada
| | - C T Appleton
- Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada; Department of Physiology and Pharmacology, London, Canada.
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21
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MacKay JW, Nezhad FS, Rifai T, Kaggie JD, Naish JH, Roberts C, Graves MJ, Waterton JC, Janiczek RL, Roberts AR, McCaskie A, Gilbert FJ, Parker GJM. Dynamic contrast-enhanced MRI of synovitis in knee osteoarthritis: repeatability, discrimination and sensitivity to change in a prospective experimental study. Eur Radiol 2021; 31:5746-5758. [PMID: 33591383 PMCID: PMC8270862 DOI: 10.1007/s00330-021-07698-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/07/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Evaluate test-retest repeatability, ability to discriminate between osteoarthritic and healthy participants, and sensitivity to change over 6 months, of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) biomarkers in knee OA. METHODS Fourteen individuals aged 40-60 with mild-moderate knee OA and 6 age-matched healthy volunteers (HV) underwent DCE-MRI at 3 T at baseline, 1 month and 6 months. Voxelwise pharmacokinetic modelling of dynamic data was used to calculate DCE-MRI biomarkers including Ktrans and IAUC60. Median DCE-MRI biomarker values were extracted for each participant at each study visit. Synovial segmentation was performed using both manual and semiautomatic methods with calculation of an additional biomarker, the volume of enhancing pannus (VEP). Test-retest repeatability was assessed using intraclass correlation coefficients (ICC). Smallest detectable differences (SDDs) were calculated from test-retest data. Discrimination between OA and HV was assessed via calculation of between-group standardised mean differences (SMD). Responsiveness was assessed via the number of OA participants with changes greater than the SDD at 6 months. RESULTS Ktrans demonstrated the best test-retest repeatability (Ktrans/IAUC60/VEP ICCs 0.90/0.84/0.40, SDDs as % of OA mean 33/71/76%), discrimination between OA and HV (SMDs 0.94/0.54/0.50) and responsiveness (5/1/1 out of 12 OA participants with 6-month change > SDD) when compared to IAUC60 and VEP. Biomarkers derived from semiautomatic segmentation outperformed those derived from manual segmentation across all domains. CONCLUSIONS Ktrans demonstrated the best repeatability, discrimination and sensitivity to change suggesting that it is the optimal DCE-MRI biomarker for use in experimental medicine studies. KEY POINTS • Dynamic contrast-enhanced MRI (DCE-MRI) provides quantitative measures of synovitis in knee osteoarthritis which may permit early assessment of efficacy in experimental medicine studies. • This prospective observational study compared DCE-MRI biomarkers across domains relevant to experimental medicine: test-retest repeatability, discriminative validity and sensitivity to change. • The DCE-MRI biomarker Ktrans demonstrated the best performance across all three domains, suggesting that it is the optimal biomarker for use in future interventional studies.
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Affiliation(s)
- James W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK. .,Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7UY, UK.
| | | | - Tamam Rifai
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | | | | | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - John C Waterton
- Bioxydyn Limited, Manchester, UK.,Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | | | - Alexandra R Roberts
- Clinical Imaging, GlaxoSmithKline, London, UK.,Antaros Medical, Uppsala, Sweden
| | - Andrew McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Geoff J M Parker
- Bioxydyn Limited, Manchester, UK.,Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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22
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van der Heijden RA, de Vries BA, Poot DHJ, van Middelkoop M, Bierma-Zeinstra SMA, Krestin GP, Oei EHG. Quantitative volume and dynamic contrast-enhanced MRI derived perfusion of the infrapatellar fat pad in patellofemoral pain. Quant Imaging Med Surg 2021; 11:133-142. [PMID: 33392017 DOI: 10.21037/qims-20-441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patellofemoral pain (PFP) is a common knee condition and possible precursor of knee osteoarthritis (OA). Inflammation, leading to an increased perfusion, or increased volume of the infrapatellar fat pad (IPFP) may induce knee pain. The aim of the study was to compare quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters, as imaging biomarkers of inflammation, and volume of the IPFP between patients with PFP and controls and between patients with and without IPFP edema or joint effusion. Methods Patients with PFP and healthy controls were included and underwent non-fat suppressed 3D fast-spoiled gradient-echo (FSPGR) and DCE-MRI. Image registration was applied to correct for motion. The IPFP was delineated on FSPGR using Horos software. Volume was calculated and quantitative perfusion parameters were extracted by fitting extended Tofts' pharmacokinetic model. Differences in volume and DCE-MRI parameters between patients and controls were tested by linear regression analyses. IPFP edema and effusion were analyzed identically. Results Forty-three controls and 35 PFP patients were included. Mean IPFP volume was 26.04 (4.18) mL in control subjects and 27.52 (5.37) mL in patients. Median Ktrans was 0.017 (0.016) min-1 in control subjects and 0.016 (0.020) min-1 in patients. None of the differences in volume and perfusion parameters were statistically significant. Knees with effusion showed a higher perfusion of the IPFP compared to knees without effusion in patients only. Conclusions The IPFP has been implicated as source of knee pain, but higher DCE-MR blood perfusion, an imaging biomarker of inflammation, and larger volume are not associated with PFP. Patient's knees with effusion showed a higher perfusion, pointing towards inflammation.
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Affiliation(s)
| | - Bas A de Vries
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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23
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Bandak E, Boesen M, Bliddal H, Daugaard C, Hangaard S, Bartholdy C, Damm Nybing J, Kubassova O, Henriksen M. The effect of exercise therapy on inflammatory activity assessed by MRI in knee osteoarthritis: Secondary outcomes from a randomized controlled trial. Knee 2021; 28:256-265. [PMID: 33453514 DOI: 10.1016/j.knee.2020.12.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 10/28/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study investigated the effect of exercise therapy on inflammatory activity in synovitis and bone marrow lesions (BMLs) assessed by magnetic resonance imaging (MRI) in patients with knee OA. METHODS 60 patients with knee OA were randomized 1:1 to 12 weeks of supervised exercise therapy 3 times/week (ET) or a no-attention control group (CG). Synovitis and BMLs were assessed with static MRI with and without contrast and with dynamic contrast enhanced MRI (DCE-MRI). DCE-MRI data was quantified using pixel-by-pixel methodology based on analysis of signal intensity curves. Pain was assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS). Analyses of covariance were used assessing group differences in changes from baseline to week 12. RESULTS 33 patients adhered to the protocol and had valid MRI and KOOS data (ET, n = 16, CG, n = 17). Statistically significant and clinically relevant group difference in favour of ET was seen in KOOS pain change (-11.7 points, 95%CI: -20.1 to -3.4). There were statistically significant group differences in DCE-MRI assessed synovitis in the anterior synovium with unchanged inflammatory activity in the ET group compared to the CG. There were no group differences in BMLs and static MRI. CONCLUSION Inflammatory activity was unchanged, and pain was reduced in patients with knee OA adhering to 12 weeks of exercise therapy compared to a no-attention control group. The reduction in pain was not explained by changes in inflammatory activity. Overall, the results suggest that exercise is not harmful in knee OA. ClinicalTrials.gov number: NCT01545258.
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Affiliation(s)
- Elisabeth Bandak
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark.
| | - Mikael Boesen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark; Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark.
| | - Cecilie Daugaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark.
| | - Stine Hangaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark.
| | - Cecilie Bartholdy
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark.
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
| | - Olga Kubassova
- Image Analysis Group, QABC Minster House, 272-274 Vauxhall Bridge Rd, Westminster, London SW1V 1BA, United Kingdom.
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000 Frederiksberg, Copenhagen, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.
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24
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Tryfonidou MA, de Vries G, Hennink WE, Creemers LB. "Old Drugs, New Tricks" - Local controlled drug release systems for treatment of degenerative joint disease. Adv Drug Deliv Rev 2020; 160:170-185. [PMID: 33122086 DOI: 10.1016/j.addr.2020.10.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) and chronic low back pain (CLBP) caused by intervertebral disc (IVD) degeneration are joint diseases that have become major causes for loss of quality of life worldwide. Despite the unmet need, effective treatments other than invasive, and often ineffective, surgery are lacking. Systemic administration of drugs entails suboptimal local drug exposure in the articular joint and IVD. This review provides an overview of the potency of biomaterial-based drug delivery systems as novel treatment modality, with a focus on the biological effects of drug release systems that have reached translation at the level of in vivo models and relevant ex vivo models. These studies have shown encouraging results of biomaterial-based local delivery of several types of drugs, mostly inhibitors of inflammatory cytokines or other degenerative factors. Prevention of inflammation and degeneration and pain relief was achieved, although mainly in small animal models, with interventions applied at an early disease stage. Less convincing data were obtained with the delivery of regenerative factors. Multidisciplinary efforts towards tackling the discord between in vitro and in vivo release, combined with adaptations in the regulatory landscape may be needed to enhance safe and expeditious introduction of more and more effective controlled release-based treatments with the OA and CLBP patients.
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25
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Daugaard CL, Henriksen M, Riis RGC, Bandak E, Nybing JD, Hangaard S, Bliddal H, Boesen M. The impact of a significant weight loss on inflammation assessed on DCE-MRI and static MRI in knee osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2020; 28:766-773. [PMID: 32165240 DOI: 10.1016/j.joca.2020.02.837] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/03/2020] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the impact of weight loss on inflammation in individuals with overweight and knee osteoarthritis (OA) using both static- and dynamic contrast-enhanced (DCE)-MRI and assess the association of these changes to pain. DESIGN Individuals with overweight (BMI > 27) and knee OA were examined before and after a >5% weight loss over 8 weeks (ClinicalTrials.gov NCT02905864). Using 3-T MRI, inflammation was quantified from non-contrast enhanced static-MRI according to MOAKS and contrast enhanced static MRI according to BLOKS and 11-point whole-knee synovitis score. DCE-MRI was used to assess the inflammation in the infra patellar fat pad (IPFP). Pain was assessed using KOOS. RESULTS Complete data were available in 117 participants with a mean age of 60 years, BMI of 35 kg/m2 and KOOS pain score of 64. Mean weight loss was 12 kg and KOOS pain was improved by 13 points at follow-up. Change in inflammation was not associated with weight loss in static MRI. None of the MRI variables correlated with the change in KOOS pain. CONCLUSION Weight loss did not induce a significant change in inflammation in individuals with overweight and OA. The significant clinical beneficial effect of weight loss on knee pain in individuals with overweight and knee OA seems uncoupled to changes in imaging markers of synovitis.
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Affiliation(s)
- C L Daugaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - R G C Riis
- Dept. of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - E Bandak
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - J D Nybing
- Dept. of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - S Hangaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - M Boesen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
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26
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de Vries BA, van der Heijden RA, Poot DHJ, van Middelkoop M, Meuffels DE, Krestin GP, Oei EHG. Quantitative DCE-MRI demonstrates increased blood perfusion in Hoffa's fat pad signal abnormalities in knee osteoarthritis, but not in patellofemoral pain. Eur Radiol 2020; 30:3401-3408. [PMID: 32064564 PMCID: PMC7248045 DOI: 10.1007/s00330-020-06671-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/19/2019] [Accepted: 01/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Infrapatellar fat pad (IPFP) fat-suppressed T2 (T2FS) hyperintense regions on MRI are an important imaging feature of knee osteoarthritis (OA) and are thought to represent inflammation. These regions are also common in non-OA subjects, and may not always be linked to inflammation. Our aim was to evaluate quantitative blood perfusion parameters, as surrogate measure of inflammation, within T2FS-hyperintense regions in patients with OA, with patellofemoral pain (PFP) (supposed OA precursor), and control subjects. METHODS Twenty-two knee OA patients, 35 PFP patients and 43 healthy controls were included and underwent MRI, comprising T2 and DCE-MRI sequences. T2FS-hyperintense IPFP regions were delineated and a reference region was drawn in adjacent IPFP tissue with normal signal intensity. After fitting the extended Tofts pharmacokinetic model, quantitative DCE-MRI perfusion parameters were compared between the two regions within subjects in each subgroup, using a paired Wilcoxon signed-rank test. RESULTS T2FS-hyperintense IPFP regions were present in 16 of 22 (73%) OA patients, 13 of 35 (37%) PFP patients, and 14 of 43 (33%) controls. DCE-MRI perfusion parameters were significantly different between regions with and without a T2FS-hyperintense signal in OA patients, demonstrating higher Ktrans compared to normal IFPF tissue (0.039 min-1 versus 0.025 min-1, p = 0.017) and higher Ve (0.157 versus 0.119, p = 0.010). For PFP patients and controls no significant differences were found. CONCLUSIONS IPFP T2FS-hyperintense regions are associated with higher perfusion in knee OA patients in contrast to identically appearing regions in PFP patients and controls, pointing towards an inflammatory pathogenesis in OA only. KEY POINTS • Morphologically identical appearing T2FS-hyperintense infrapatellar fat pad regions show different perfusion in healthy subjects, subjects with patellofemoral pain, and subjects with knee osteoarthritis. • Elevated DCE-MRI perfusion parameters within T2FS-hyperintense infrapatellar fat pad regions in patients with osteoarthritis suggest an inflammatory pathogenesis in osteoarthritis, but not in patellofemoral pain and healthy subjects.
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Affiliation(s)
- Bas A de Vries
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rianne A van der Heijden
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Department of Orthopedic Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
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27
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Daugaard CL, Riis RG, Bandak E, Gudbergsen H, Henriksen M, Bliddal H, Boesen M. Perfusion in bone marrow lesions assessed on DCE-MRI and its association with pain in knee osteoarthritis: a cross-sectional study. Skeletal Radiol 2020; 49:757-764. [PMID: 31820043 DOI: 10.1007/s00256-019-03336-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association between pain and perfusion in bone marrow lesions with and without cysts assessed dynamic contrast-enhanced (DCE)-MRI in patients with knee osteoarthritis. SUBJECTS AND METHODS In a cross-sectional setting, perfusion in bone marrow lesions was assessed using 3 Tesla MRI and correlated (Spearman's rank correlation) to pain using the knee injury and osteoarthritis outcome score (KOOS). Bone marrow lesions were assessed across the whole knee with DCE-MRI using heuristic variable and non-contrast-enhanced-MRI using MRI osteoarthritis knee score. RESULTS Data were available from 107 participants. The participants had a mean age of 60.8 years, mean BMI of 34.5 kg/m2, mean KOOS-pain of 63.7 (0-100 scale), and mean bone marrow lesion sum score of 6.5 (0-45 scale). The bivariate association between KOOS-pain and the heuristic perfusion variable time to peak in bone marrow lesions containing subchondral cysts showed a statistically significant correlation (r = 0.40; p = 0.002). The perfusion variables were not correlated with KOOS-pain in bone marrow lesions without cysts. CONCLUSION In this cross-sectional study, the rate of perfusion (TTP) in bone marrow lesions containing subchondral cysts was associated with pain in patients with knee OA. DCE-MRI has a potential to be used for separating subtypes of OA.
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Affiliation(s)
- Cecilie L Daugaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Robert Gc Riis
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth Bandak
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Mikael Boesen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark. .,Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
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28
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Yu MX, Ma XQ, Song X, Huang YM, Jiang HT, Wang J, Yang WH. Validation of the Key Active Ingredients and Anti-Inflammatory and Analgesic Effects of Shenjin Huoxue Mixture Against Osteoarthritis by Integrating Network Pharmacology Approach and Thin-Layer Chromatography Analysis. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:1145-1156. [PMID: 32214800 PMCID: PMC7083645 DOI: 10.2147/dddt.s243951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/25/2020] [Indexed: 12/11/2022]
Abstract
Background Shenjin Huoxue Mixture (SHM), a classic traditional herb mixture has shown significant clinical efficacy against osteoarthritis (OA). Our previous experimental study has confirmed its anti–inflammatory and analgesic effect on acute soft tissue injury in rats, with the compound of glycyrrhizinate in SHM identified and the content of paeoniflorin in SHM determined by high-performance liquid chromatography (HPLC). However, the components and its pharmacological mechanisms of SHM against OA have not been systematically elucidated yet. Thus this study aimed to predict the key active ingredients and potential pharmacological mechanisms of SHM in the treatment of OA by network pharmacology approach and thin-layer chromatography (TLC) validation. Methods The active ingredients of SHM and their targets, as well as OA-related targets, were identified from databases. The key active ingredients were defined and ranked by the number of articles retrieved in PubMed using the keyword “(the active ingredients [Title/Abstract]) AND Osteoarthritis[Title/Abstract] ”, and validated partially by TLC. The pharmacological mechanisms of SHM against OA were displayed by GO term and Reactome pathway enrichment analysis with Discovery Studio 3.0 software docking to testing the reliability. Results Finally, 16 key active ingredients were identified and ranked, including quercetin validated through TLC. Inflammatory response, IL-6 signaling pathway and toll-like receptor (TLR) cascades pathway were predicted as the main pharmacological mechanisms of SHM against OA. Especially, 12 out of 16 key active ingredients, including validated quercetin, were well docked to IL-6 proteins. Conclusion Our results confirmed the anti–inflammatory and analgesic effect of SHM against OA through multiple components, multiple targets and multiple pathways, which revealed the theoretical basis of SHM against OA and may provide a new drug option for treating OA.
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Affiliation(s)
- Mei-Xiang Yu
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Xiao-Qin Ma
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Xin Song
- South Campus, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201100, People's Republic of China
| | - Yong-Mei Huang
- Jinshan Hospital, Shanghai Fudan University School of Medicine, Shanghai 201508, People's Republic of China
| | - Hui-Ting Jiang
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Jing Wang
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China
| | - Wan-Hua Yang
- Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, People's Republic of China.,Department of Pharmacy, Ruijin Hospital North Affiliated to the Shanghai Jiao Tong University Medical School, Shanghai 201801, People's Republic of China
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29
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Conaghan PG, Cook AD, Hamilton JA, Tak PP. Therapeutic options for targeting inflammatory osteoarthritis pain. Nat Rev Rheumatol 2020; 15:355-363. [PMID: 31068673 DOI: 10.1038/s41584-019-0221-y] [Citation(s) in RCA: 264] [Impact Index Per Article: 52.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pain is the major symptom of osteoarthritis (OA) and is an important factor in strategies to manage this disease. However, the current standard of care does not provide satisfactory pain relief for many patients. The pathophysiology of OA is complex, and its presentation as a clinical syndrome is associated with pathologies of multiple joint tissues. Inflammation is associated with both OA pain and disease outcome and is therefore a major treatment target for OA and OA pain. Unlike TNF inhibitors and IL-1 inhibitors, established drugs such as glucocorticoids and methotrexate can reduce OA pain. Although central nociceptive pathways contribute to OA pain, crosstalk between the immune system and nociceptive neurons is central to inflammatory pain; therefore, new therapies might target this crosstalk. Newly identified drug targets, including neurotrophins and the granulocyte-macrophage colony-stimulating factor (GM-CSF)-CC-chemokine ligand 17 (CCL17) chemokine axis, offer the hope of better results but require clinical validation.
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Affiliation(s)
- Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute of Health Research Leeds Biomedical Research Centre, Leeds, UK
| | - Andrew D Cook
- The University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - John A Hamilton
- The University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Victoria, Australia
| | - Paul P Tak
- Department of Clinical Immunology & Rheumatology, Academic Medical Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands. .,Department of Rheumatology, Ghent University, Ghent, Belgium. .,Department of Medicine, Cambridge University, Cambridge, UK. .,Flagship Pioneering, Cambridge, MA, USA.
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30
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Bandak E, Boesen M, Bliddal H, Riis RGC, Nielsen SM, Klokker L, Bartholdy C, Nybing JD, Henriksen M. Exercise-induced pain changes associate with changes in muscle perfusion in knee osteoarthritis: exploratory outcome analyses of a randomised controlled trial. BMC Musculoskelet Disord 2019; 20:491. [PMID: 31656173 PMCID: PMC6815355 DOI: 10.1186/s12891-019-2858-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/30/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Exercise therapy is recommended for knee osteoarthritis (OA), but the underlying mechanisms of pain relief are not fully understood. The purpose of this study was to explore the effects of exercise on muscle perfusion assessed by dynamic contrast enhanced MRI (DCE-MRI) and its association with changes in pain in patients with knee OA. METHODS Exploratory outcome analyses of a randomised controlled study with per-protocol analyses ( ClinicalTrials.gov : NCT01545258) performed at an outpatient clinic at a public hospital in Denmark. We compared 12 weeks of supervised exercise therapy 3 times per week (ET) with a no attention control group (CG). Analyses of covariance (ANCOVA) were used to assess group mean differences in changes from baseline to week 12 in knee muscle perfusion quantified by DCE-MRI, patient-reported pain and function using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, knee extensor and flexor muscle strength tests, and the six-minute walking test (6MWT). Spearman's correlation coefficients were used to determine the correlation between changes in DCE-MRI variables, KOOS, muscle strength, and 6MWT. The potential effect mediation of the DCE-MRI perfusion variables was investigated in a post-hoc mediation analysis. RESULTS Of 60 participants randomised with knee osteoarthritis, 33 (ET, n = 16, CG, n = 17) adhered to the protocol and had complete DCE-MRI data. At follow-up, there were significant group differences in muscle perfusion changes and clinically relevant group differences in KOOS pain changes (10.7, 95% CI 3.3 to 18.1, P = 0.006) in favor of ET. There were no significant between-group differences on muscle strength and function. The changes in pain and muscle perfusion were significantly correlated (highest Spearman's rho = 0.42, P = 0.014). The mediation analyses were generally not statistically significant. CONCLUSION The pain-reducing effects of a 12-week exercise program are associated with changes in knee muscle perfusion quantified by DCE-MRI in individuals with knee OA, but whether the effects are mediated by muscle perfusion changes remains unclear. TRIAL REGISTRATION ClinicalTrials.gov: NCT01545258 , first posted March 6, 2012.
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Affiliation(s)
- Elisabeth Bandak
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
| | - Mikael Boesen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Robert G C Riis
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Sabrina Mai Nielsen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Louise Klokker
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Cecilie Bartholdy
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of physical and occupational therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.,Department of physical and occupational therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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31
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Inflammation and Hypervascularization in a Large Animal Model of Knee Osteoarthritis: Imaging with Pathohistologic Correlation. J Vasc Interv Radiol 2019; 30:1116-1127. [PMID: 30935868 DOI: 10.1016/j.jvir.2018.09.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/22/2018] [Accepted: 09/29/2018] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To evaluate if synovial inflammation and hypervascularization are present in a dog model of knee osteoarthritis and can be detected on conventional magnetic resonance imaging (MRI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), contrast-enhanced magnetic resonance imaging (CE-MRI), and quantitative digital subtraction angiography (Q-DSA) imaging. MATERIALS AND METHODS Six dogs underwent MRI and angiography of both knees before and 12 weeks after right knee anterior cruciate ligament injury. Synovial vascularity was evaluated on CE-MRI, DCE-MRI, and Q-DSA by 2 independent observers. Synovial inflammation and vascularity were histologically scored independently. Cartilage lesions and osteophytes were analyzed macroscopically, and cartilage volumetry was analyzed by MRI. Vascularity and osteoarthritis markers on imaging were compared before and after osteoarthritis generation, and between the osteoarthritis model and the control knee, using linear mixed models accounting for within-dog correlation. RESULTS In all knees, baseline imaging showed no abnormalities. Control knees did not develop significant osteoarthritis changes, synovial inflammation, or hypervascularization. In osteoarthritis knees, mean synovial enhancement score on CE-MR imaging increased by 13.1 ± 0.59 (P < .0001); mean synovial inflammation variable increased from 47.33 ± 18.61 to 407.97 ± 18.61 on DCE-MR imaging (P < .0001); and area under the curve on Q-DSA increased by 1058.58 ± 199.08 (P = .0043). Synovial inflammation, hypervascularization, and osteophyte formations were present in all osteoarthritis knees. Histology scores showed strong correlation with CE-MR imaging findings (Spearman correlation coefficient [SCC] = 0.742; P = .0002) and Q-DSA findings (SCC = 0.763; P < .0001) and weak correlation with DCE-MR imaging (SCC = -0.345; P = .329). Moderate correlation was found between CE-MR imaging and DSA findings (SCC = 0.536; P = .0004). CONCLUSIONS In this early-stage knee osteoarthritis dog model, synovial inflammation and hypervascularization were found on imaging and confirmed by histology.
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Osteoarthritis phenotypes and novel therapeutic targets. Biochem Pharmacol 2019; 165:41-48. [PMID: 30831073 DOI: 10.1016/j.bcp.2019.02.037] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/28/2019] [Indexed: 02/07/2023]
Abstract
The success of disease-modifying osteoarthritis drug (DMOAD) development is still elusive. While there have been successes in preclinical and early clinical studies, phase 3 clinical trials have failed so far and there is still no approved, widely available DMOAD on the market. The latest research suggests that, among other causes, poor trial outcomes might be explained by the fact that osteoarthritis (OA) is a heterogeneous disease with distinct phenotypes. OA trials might be more successful if they would address and target a specific phenotype. The increasing availability of advanced techniques to detect particular OA characteristics expands the possibilities to distinguish between such potential OA phenotypes. Magnetic resonance imaging is among the key imaging techniques to stratify and monitor patients with changes in bone, cartilage and inflammation. Biochemical markers have mainly used as secondary parameters and could further delineate phenotypes. Moreover, post-hoc analyses of trial data have suggested the existence of distinct pain phenotypes and their relevance in the design of clinical trials. Although ongoing work in the field supports the concept of OA heterogeneity, this has not yet resulted in more effective treatment options. This paper reviews the current knowledge about potential OA phenotypes and suggests that combining patient clinical data, quantitative imaging, biochemical markers and utilizing data-driven approaches in patient selection and efficacy assessment will allow for more successful development of effective DMOADs.
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Brown A, Leeds AR. Very low‐energy and low‐energy formula diets: Effects on weight loss, obesity co‐morbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice. NUTR BULL 2019. [DOI: 10.1111/nbu.12372] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- A. Brown
- Centre for Obesity Research University College London London UK
- National Institute of Health Research University College London Hospitals London UK
| | - A. R. Leeds
- Department of Nutrition, Exercise and Sports Faculty of Science University of Copenhagen Copenhagen Denmark
- Parker Institute Frederiksberg Hospital Copenhagen Denmark
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Burke CJ, Alizai H, Beltran LS, Regatte RR. MRI of synovitis and joint fluid. J Magn Reson Imaging 2019; 49:1512-1527. [PMID: 30618151 DOI: 10.1002/jmri.26618] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 12/20/2022] Open
Abstract
Synovitis and joint effusion are common manifestations of rheumatic disease and play an important role in the disease pathophysiology. Earlier detection and accurate assessment of synovial pathology, therefore, can facilitate appropriate clinical management and hence improve prognosis. Magnetic resonance imaging (MRI) allows unparalleled assessment of all joint structures and associated pathology. It has emerged as a powerful tool, which enables not only detection of synovitis and effusion, but also allows quantification, detailed characterization, and noninvasive monitoring of synovial processes. The purpose of this article is to summarize the pathophysiology of synovitis and to review the role of qualitative, semiquantitative, and quantitative MRI in the assessment of synovitis and joint fluid. We also discuss the utility of MRI as an outcome measure to assess treatment response, particularly with respect to osteoarthritis and rheumatoid arthritis. Emerging applications such as hybrid positron emission tomography / MRI and molecular imaging are also briefly discussed. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
| | - Hamza Alizai
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Luis S Beltran
- Department of Radiology, NYU Langone Health, New York, New York, USA
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Boesen M, Kubassova O, Sudoł-Szopińska I, Maas M, Hansen P, Nybing JD, Oei EH, Hemke R, Guermazi A. MR Imaging of Joint Infection and Inflammation with Emphasis on Dynamic Contrast-Enhanced MR Imaging. PET Clin 2018; 13:523-550. [PMID: 30219186 DOI: 10.1016/j.cpet.2018.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Contrast-enhanced MR imaging (CE-MR imaging) is recommended for diagnosis and monitoring of infectious and most inflammatory joint diseases. CE-MR imaging clearly differentiates soft and bony tissue from fluid collections and infectious debris. To improve imaging information, a dynamic CE-MR imaging sequence (DCE-MR imaging) sequence can be applied using fast T1-weighted sequential image acquisition during contrast injection. Use of DCE-MR imaging allows robust extraction of quantitative information regarding blood flow and capillary permeability, especially when dedicated analysis methods and software are used to analyze contrast kinetics. This article describes principles of DCE-MR imaging for the assessment of infectious and inflammatory joint diseases.
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Affiliation(s)
- Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen Nv, Denmark; Parker Institute, Bispebjerg and Frederiksberg Hospital, Nordrefasanvej 57, 2000 Copenhagen F, Denmark.
| | - Olga Kubassova
- Image Analysis Group (IAG), AQBC Minster House, 272-274 Vauxhall Bridge Road, SW1V 1BA, London, UK
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Diagnostic Imaging, Warsaw Medical University, Warsaw, Poland
| | - Mario Maas
- Department of Radiology, Faculty of Medicine, Academic Medical Center (AMC) Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Department of Nuclear Medicine, Faculty of Medicine, Academic Medical Center (AMC) Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Philip Hansen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen Nv, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen Nv, Denmark
| | - Edwin H Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert Hemke
- Department of Radiology, Faculty of Medicine, Academic Medical Center (AMC) Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Department of Nuclear Medicine, Faculty of Medicine, Academic Medical Center (AMC) Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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Bayer ML, Hoegberget-Kalisz M, Jensen MH, Olesen JL, Svensson RB, Couppé C, Boesen M, Nybing JD, Kurt EY, Magnusson SP, Kjaer M. Role of tissue perfusion, muscle strength recovery, and pain in rehabilitation after acute muscle strain injury: A randomized controlled trial comparing early and delayed rehabilitation. Scand J Med Sci Sports 2018; 28:2579-2591. [DOI: 10.1111/sms.13269] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/17/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Monika L. Bayer
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
| | - Maren Hoegberget-Kalisz
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
| | - Mikkel H. Jensen
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
| | - Jens L. Olesen
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Research Unit for General Practice in Aalborg; Department of Clinical Medicine; Aalborg University; Aalborg Denmark
| | - Rene B. Svensson
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
| | - Christian Couppé
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Department of Physical Therapy; Bispebjerg Hospital; Copenhagen Denmark
| | - Mikael Boesen
- Radiology; Bispebjerg Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Janus D. Nybing
- Radiology; Bispebjerg Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Engin Y. Kurt
- Radiology; Bispebjerg Frederiksberg Hospital; University of Copenhagen; Copenhagen Denmark
| | - S. Peter Magnusson
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
- Department of Physical Therapy; Bispebjerg Hospital; Copenhagen Denmark
| | - Michael Kjaer
- Department of Orthopedic Surgery M; Faculty of Health and Medical Sciences; Institute of Sports Medicine Copenhagen; Bispebjerg Hospital and Center for Healthy Aging; University of Copenhagen; Copenhagen Denmark
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Agten CA, Rosskopf AB, Jonczy M, Brunner F, Pfirrmann CWA, Buck FM. Frequency of inflammatory-like MR imaging findings in asymptomatic fingers of healthy volunteers. Skeletal Radiol 2018; 47:279-287. [PMID: 29110050 DOI: 10.1007/s00256-017-2808-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the frequency of inflammatory-like findings on MR imaging in asymptomatic volunteers and compare them with patients with known rheumatoid arthritis and psoriatic arthritis. MATERIALS AND METHODS MR images of fingers in 42 asymptomatic volunteers and 33 patients with rheumatoid/psoriatic arthritis were analyzed. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) Rheumatoid/Psoriatic Arthritis MRI Scoring System (RAMRIS/PsAMRIS) and tenosynovitis scoring system were used to assess: bone marrow edema (BME), erosions, tendon sheath fluid/tenosynovitis, joint effusion, and soft-tissue edema. Findings and scores were compared between volunteers and patients. Inter-reader agreement was calculated (intraclass correlation coefficients, ICC). RESULTS In volunteers, tendon sheath fluid was very common in at least one location (42/42 volunteers for reader 1, 34/42 volunteers for reader 2). BME, erosions, joint effusion, and soft-tissue edema were absent (except one BME in the 3rd proximal phalanx for reader 1). Tendon sheath fluid scores in volunteers and tenosynovitis scores in patients were high (reader 1, 7.17 and 5.39; reader 2, 2.31 and 5.45). Overall, inter-reader agreement was substantial (ICC = 0.696-0.844), except for tendon sheath fluid (ICC = 0.258). CONCLUSION Fluid in the finger flexor tendon sheaths may be a normal finding and without gadolinium administration should not be interpreted as tenosynovitis. Bone marrow edema, erosions, joint effusion, and soft-tissue edema in the fingers most likely reflect pathology if present.
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Affiliation(s)
- Christoph A Agten
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland. .,University of Zurich, Faculty of Medicine, Zurich, Switzerland.
| | - Andrea B Rosskopf
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Maciej Jonczy
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Florian Brunner
- University of Zurich, Faculty of Medicine, Zurich, Switzerland.,Department of Physical Medicine and Rheumatology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Florian M Buck
- Radiology, University Hospital Balgrist, Forchstrasse 340, 8008, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
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Bartels EM, Henrotin Y, Bliddal H, Centonze P, Henriksen M. Relationship between weight loss in obese knee osteoarthritis patients and serum biomarkers of cartilage breakdown: secondary analyses of a randomised trial. Osteoarthritis Cartilage 2017; 25:1641-1646. [PMID: 28689920 DOI: 10.1016/j.joca.2017.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/26/2017] [Accepted: 06/30/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore effects of weight loss and maintenance on serum cartilage biomarkers denaturation neoepitope for Collagen2 (Coll2-1) and Fibulin3 fragment (Fib3-2), as well as correlations between Coll2-1 and Fib3-2 and symptomatic improvement, in a knee osteoarthritis (KOA) population. DESIGN 192 obese KOA patients followed a 16 week weight loss intervention and 52 weeks weight maintenance (ClinicalTrials.gov identifier: NCT00655941). Assessments were at 0, 8, 16 and 68 weeks. Serum Coll2-1 and Fib3-2 were determined with ELISA, and symptoms by the Knee Osteoarthritis Outcome Score (KOOS) questionnaire. Changes from week 0 and association between changes from baseline in body weight and Coll2-1, Fib3-2, and the 5 KOOS domains were assessed at all time points. RESULTS Coll2-1 changes from baseline showed a decrease at week 8 (P = 0.0002), no change at week 16 (P = 0.49), and an increase at week 68 (P = 0.036). Fib3-2 showed an increase from baseline at week 8 (P = 0.0015) and 16 (P < 0.0001), but none at week 68 (P = 0.23). No statistically significant correlations were found between changes in body weight and Coll2-1 and Fib3-2 at any time point (r < 0.05; P > 0.49). At all time-points there were significant positive correlations between changes from baseline in Coll2-1 and in KOOSSports/Recreation (week 8, 16, 68: r = 0.17; P = 0.03; r = 0.16; P = 0.04; and r = 0.17; P = 0.04, respectively). CONCLUSION The clinical improvement after a substantial weight loss and weight maintenance in KOA patients was not associated with decrease in markers of cartilage breakdown Coll2-1 or Fib3-2, even with indications of a slightly negative effect.
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Affiliation(s)
- E M Bartels
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
| | - Y Henrotin
- Bone and Cartilage Research Unit, Arthropôle Liège, Institute of Pathology, Level 5, CHU Sart-Tilman, 4000 Liège, Belgium; Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Vivalia, Marche-en-Famenne, Belgium.
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Faculty of Health Science, University of Copenhagen, Denmark.
| | - P Centonze
- Bone and Cartilage Research Unit, Arthropôle Liège, Institute of Pathology, Level 5, CHU Sart-Tilman, 4000 Liège, Belgium.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
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Variance in infra-patellar fat pad volume: Does the body mass index matter?—Data from osteoarthritis initiative participants without symptoms or signs of knee disease. Ann Anat 2017; 213:19-24. [DOI: 10.1016/j.aanat.2017.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/05/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022]
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Sujlana P, Skrok J, Fayad LM. Review of dynamic contrast‐enhanced MRI: Technical aspects and applications in the musculoskeletal system. J Magn Reson Imaging 2017; 47:875-890. [DOI: 10.1002/jmri.25810] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/20/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Parvinder Sujlana
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
| | - Jan Skrok
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
| | - Laura M. Fayad
- The Russell H. Morgan Department of Radiology and Radiological ScienceBaltimore Maryland USA
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Abstract
PURPOSE OF REVIEW Inflammatory changes in joint tissues can be detected by modern imaging techniques in osteoarthritis patients, but may be clinically subtle compared with many other types of arthritis. These changes associate with disease progression and clinical severity, and many inflammatory mediators may have biomarker utility. Moreover, a number of inflammatory mechanisms play a role in animal models of disease, but it is still not clear which mechanisms predominate and might be therapeutically manipulated most effectively. This review highlights specific examples of recent advances published in the past 18 months that have advanced this field. RECENT FINDINGS Clinical investigators now show that synovial inflammation is associated with pain sensitization, and similar to knee osteoarthritis, is a common and important feature of hand osteoarthritis. In addition, recent advances in basic studies demonstrate inflammatory markers and mechanisms related to leukocyte activity, innate immune mechanisms, and the chondrocyte-intrinsic inflammatory response that might provide better opportunities for early detection, prognosis, or therapeutic intervention. SUMMARY Inflammation plays a central role in osteoarthritis pathogenesis, but additional translational work in this field is necessary, as are more clinical trials of anti-inflammatory approaches.
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Midterm Clinical Outcomes and MR Imaging Changes after Transcatheter Arterial Embolization as a Treatment for Mild to Moderate Radiographic Knee Osteoarthritis Resistant to Conservative Treatment. J Vasc Interv Radiol 2017; 28:995-1002. [DOI: 10.1016/j.jvir.2017.02.033] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/15/2017] [Accepted: 02/27/2017] [Indexed: 01/11/2023] Open
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Krasnokutsky S, Oshinsky C, Attur M, Ma S, Zhou H, Zheng F, Chen M, Patel J, Samuels J, Pike VC, Regatte R, Bencardino J, Rybak L, Abramson S, Pillinger MH. Serum Urate Levels Predict Joint Space Narrowing in Non-Gout Patients With Medial Knee Osteoarthritis. Arthritis Rheumatol 2017; 69:1213-1220. [PMID: 28217895 DOI: 10.1002/art.40069] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 02/07/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The pathogenesis of osteoarthritis (OA) includes both mechanical and inflammatory features. Studies have implicated synovial fluid uric acid (UA) as a potential OA biomarker, possibly reflecting chondrocyte damage. Whether serum UA levels reflect/contribute to OA is unknown. We investigated whether serum UA levels predict OA progression in a non-gout knee OA population. METHODS Eighty-eight patients with medial knee OA (body mass index [BMI] <33 kg/m2 ) but without gout were studied. Baseline serum UA levels were measured in previously banked serum samples. At 0 and 24 months, patients underwent standardized weight-bearing fixed-flexion posteroanterior knee radiography to determine joint space width (JSW) and Kellgren/Lawrence grades. Joint space narrowing (JSN) was calculated as the change in JSW from 0 to 24 months. Twenty-seven patients underwent baseline contrast-enhanced 3T knee magnetic resonance imaging for assessment of synovial volume. RESULTS Serum UA levels correlated with JSN values in both univariate (r = 0.40, P < 0.01) and multivariate (r = 0.28, P = 0.01) analyses. There was a significant difference in mean JSN after dichotomization at a serum UA cut point of 6.8 mg/dl, the solubility point for serum urate, even after adjustment (JSN of 0.90 mm for a serum UA ≥6.8 mg/dl and 0.31 mm for a serum UA <6.8 mg/dl; P < 0.01). Baseline serum UA levels distinguished progressors (JSN >0.2 mm) and fast progressors (JSN >0.5 mm) from nonprogressors (JSN ≤0.0 mm) in multivariate analyses (area under the receiver operating characteristic curve 0.63 [P = 0.03] and 0.62 [P = 0.05], respectively). Serum UA levels correlated with the synovial volume (r = 0.44, P < 0.01), a possible marker of JSN, although this correlation did not persist after controlling for age, sex, and BMI (r = 0.13, P = 0.56). CONCLUSION In non-gout patients with knee OA, the serum UA level predicted future JSN and may serve as a biomarker for OA progression.
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Affiliation(s)
| | | | - Mukundan Attur
- New York University School of Medicine, New York, New York
| | - Sisi Ma
- New York University School of Medicine, New York, New York
| | - Hua Zhou
- New York University School of Medicine, New York, New York
| | - Fangfei Zheng
- New York University School of Medicine, New York, New York
| | - Meng Chen
- New York University School of Medicine, New York, New York
| | - Jyoti Patel
- New York University School of Medicine, New York, New York
| | | | | | | | | | - Leon Rybak
- New York University School of Medicine, New York, New York
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Riis RGC, Henriksen M, Klokker L, Bartholdy C, Ellegaard K, Bandak E, Hansen BB, Bliddal H, Boesen M. The effects of intra-articular glucocorticoids and exercise on pain and synovitis assessed on static and dynamic magnetic resonance imaging in knee osteoarthritis: exploratory outcomes from a randomized controlled trial. Osteoarthritis Cartilage 2017; 25:481-491. [PMID: 27746377 DOI: 10.1016/j.joca.2016.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aims of the present knee osteoarthritis (KOA)-study were to: (1) describe and compare the changes in magnetic resonance imaging (MRI)-measures of synovitis following an exercise program preceded by an intra-articular injection of either corticosteroid or isotonic saline and (2) investigate if any of the changes in patient reported outcome measures (PROMs) were associated with changes in MRI-measures of synovitis. DESIGN We performed a randomized, double-blinded, placebo-controlled clinical trial evaluating the effects of intra-articular corticosteroid vs placebo injections given before exercise therapy in KOA-patients. PROMs were assessed using the KOOS (knee injury and osteoarthritis outcome score). Synovitis was assessed on conventional non-contrast-enhanced, conventional contrast-enhanced (CE) and dynamic contrast-enhanced (DCE) MRI. PROMs and MRIs were obtained prior to the intra-articular injection, after termination of the exercise program (week 14-primary time point) and week 26. RESULTS Of 100 randomized participants (50 in each allocation group), 91 had complete MRI-data at baseline (63% female, mean age: 62 years, median Kellgren-Lawrence-grade: 3). There were no statistically significant differences between the two interventions in regards of changes in MRI-measures of synovitis at any time-point. At week 14, we found no statistical significant MRI-explanatory variables of either of the PROMs. CONCLUSIONS The present study does not justify the use of intra-articular corticosteroids over intra-articular saline when combined with an exercise program for reduction of synovitis in KOA. The improvement in pain and function following the intervention with intra-articular corticosteroids/saline and exercise could not be explained by a decrease in synovitis on MRI indicating other pain causing/relieving mechanisms in KOA.
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Affiliation(s)
- R G C Riis
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Zealand University Hospital, Holbaek, Denmark.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Physical & Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - L Klokker
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - C Bartholdy
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Physical & Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - K Ellegaard
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - E Bandak
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - B B Hansen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
| | - M Boesen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark.
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Mathiessen A, Conaghan PG. Synovitis in osteoarthritis: current understanding with therapeutic implications. Arthritis Res Ther 2017; 19:18. [PMID: 28148295 PMCID: PMC5289060 DOI: 10.1186/s13075-017-1229-9] [Citation(s) in RCA: 664] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Modern concepts of osteoarthritis (OA) have been forever changed by modern imaging phenotypes demonstrating complex and multi-tissue pathologies involving cartilage, subchondral bone and (increasingly recognized) inflammation of the synovium. The synovium may show significant changes, even before visible cartilage degeneration has occurred, with infiltration of mononuclear cells, thickening of the synovial lining layer and production of inflammatory cytokines. The combination of sensitive imaging modalities and tissue examination has confirmed a high prevalence of synovial inflammation in all stages of OA, with a number of studies demonstrating that synovitis is related to pain, poor function and may even be an independent driver of radiographic OA onset and structural progression. Treating key aspects of synovial inflammation therefore holds great promise for analgesia and also for structure modification. This article will review current knowledge on the prevalence of synovitis in OA and its role in symptoms and structural progression, and explore lessons learnt from targeting synovitis therapeutically.
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Affiliation(s)
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,National Institute for Health Research Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Osteoarthritis year in review 2016: imaging. Osteoarthritis Cartilage 2017; 25:216-226. [PMID: 27965137 DOI: 10.1016/j.joca.2016.12.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/21/2016] [Accepted: 12/05/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The current narrative review covers original research related to imaging in osteoarthritis (OA) in humans published in English between April 1st 2015 and March 31st 2016, in peer reviewed journals available in Medline via PubMed (http://www.ncbi.nlm.nih.gov/pubmed/). METHODS Relevant studies in humans, subjectively decided by the authors, contributing significantly to the OA imaging field, were selected from an extensive Medline search using the terms "Osteoarthritis" in combination with "MRI", "Imaging", "Radiography", "X-rays", "Ultrasound", "Computed tomography", "Nuclear medicine", "PET-CT", "PET-MRI", "Scintigraphy", "SPECT". Publications were sorted according to relevance for the OA imaging research community with an emphasis on high impact special interest journals using the software for systematic reviews www.covidence.org. RESULTS An overview of newly published studies compared to studies reported previous years is presented, followed by a review of selected imaging studies of primarily knee, hip and hand OA focussing on (1) results for detection of OA and OA-related pathology (2) studies dealing with treatments and (3) studies focussing on prognosis of disease progression or joint replacement. A record high number of 1420 articles were published, among others, of new technologies and tools for improved morphological and pathophysiological understanding of OA-related changes in joints. Also, imaging data were presented of monitoring treatment effect and prognosis of OA progression, primarily using established radiographic, magnetic resonance imaging (MRI), and ultrasound (US) methods. CONCLUSION Imaging continues to play an important role in OA research, where several exciting new technologies and computer aided analysis methods are emerging to complement the conventional imaging approaches.
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Riis RGC, Gudbergsen H, Simonsen O, Henriksen M, Al-Mashkur N, Eld M, Petersen KK, Kubassova O, Bay Jensen AC, Damm J, Bliddal H, Arendt-Nielsen L, Boesen M. The association between histological, macroscopic and magnetic resonance imaging assessed synovitis in end-stage knee osteoarthritis: a cross-sectional study. Osteoarthritis Cartilage 2017; 25:272-280. [PMID: 27737813 DOI: 10.1016/j.joca.2016.10.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 08/31/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate the association between magnetic resonance imaging (MRI), macroscopic and histological assessments of synovitis in end-stage knee osteoarthritis (KOA). METHODS Synovitis of end-stage osteoarthritic knees was assessed using non-contrast-enhanced (CE), contrast-enhanced magnetic resonance imaging (CE-MRI) and dynamic contrast-enhanced (DCE)-MRI prior to (TKR) and correlated with microscopic and macroscopic assessments of synovitis obtained intraoperatively. Multiple bivariate correlations were used with a pre-specified threshold of 0.70 for significance. Also, multiple regression analyses with different subsets of MRI-variables as explanatory variables and the histology score as outcome variable were performed with the intention to find MRI-variables that best explain the variance in histological synovitis (i.e., highest R2). A stepped approach was taken starting with basic characteristics and non-CE MRI-variables (model 1), after which CE-MRI-variables were added (model 2) with the final model also including DCE-MRI-variables (model 3). RESULTS 39 patients (56.4% women, mean age 68 years, Kellgren-Lawrence (KL) grade 4) had complete MRI and histological data. Only the DCE-MRI variable MExNvoxel (surrogate of the volume and degree of synovitis) and the macroscopic score showed correlations above the pre-specified threshold for acceptance with histological inflammation. The maximum R2-value obtained in Model 1 was R2 = 0.39. In Model 2, where the CE-MRI-variables were added, the highest R2 = 0.52. In Model 3, a four-variable model consisting of the gender, one CE-MRI and two DCE-MRI-variables yielded a R2 = 0.71. CONCLUSION DCE-MRI is correlated with histological synovitis in end-stage KOA and the combination of CE and DCE-MRI may be a useful, non-invasive tool in characterising synovitis in KOA.
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Affiliation(s)
- R G C Riis
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Department of Radiology, Zealand University Hospital Holbaek, Denmark.
| | - H Gudbergsen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.
| | - O Simonsen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark.
| | - M Henriksen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.
| | - N Al-Mashkur
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark.
| | - M Eld
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark.
| | - K K Petersen
- Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
| | - O Kubassova
- Image Analysis Ltd., London, United Kingdom.
| | | | - J Damm
- Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.
| | - L Arendt-Nielsen
- Centre for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark.
| | - M Boesen
- The Parker Institute, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark.
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Nielsen FK, Egund N, Jørgensen A, Peters DA, Jurik AG. Assessment of subchondral bone marrow lesions in knee osteoarthritis by MRI: a comparison of fluid sensitive and contrast enhanced sequences. BMC Musculoskelet Disord 2016; 17:479. [PMID: 27852298 PMCID: PMC5112734 DOI: 10.1186/s12891-016-1336-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/09/2016] [Indexed: 01/29/2023] Open
Abstract
Background Bone marrow lesions (BMLs) in knee osteoarthritis (OA) can be assessed using fluid sensitive and contrast enhanced sequences. The association between BMLs and symptoms has been investigated in several studies but only using fluid sensitive sequences. Our aims were to assess BMLs by contrast enhanced MRI sequences in comparison with a fluid sensitive STIR sequence using two different segmentation methods and to analyze the association between the MR findings and disability and pain. Methods Twenty-two patients (mean age 61 years, range 41–79 years) with medial femoro-tibial knee OA obtained MRI and filled out a WOMAC questionnaire at baseline and follow-up (median interval of 334 days). STIR, dynamic contrast enhanced-MRI (DCE-MRI) and fat saturated T1 post-contrast (T1 CE FS) MRI sequences were obtained. All STIR and T1 CE FS sequences were assessed independently by two readers for STIR-BMLs and contrast enhancing areas of BMLs (CEA-BMLs) using manual segmentation and computer assisted segmentation, and the measurements were compared. DCE-MRIs were assessed for the relative distribution of voxels with an inflammatory enhancement pattern, Nvoxel, in the bone marrow. All findings were compared to WOMAC scores, including pain and overall symptoms, and changes from baseline to follow-up were analyzed. Results The average volume of CEA-BML was smaller than the STIR-BML volume by manual segmentation. The opposite was found for computer assisted segmentation where the average CEA-BML volume was larger than the STIR-BML volume. The contradictory finding by computer assisted segmentation was partly caused by a number of outliers with an apparent generally increased signal intensity in the anterior parts of the femoral condyle and tibial plateau causing an overestimation of the CEA-BML volume. Both CEA-BML, STIR-BML and Nvoxel were significantly correlated with symptoms and to a similar degree. A significant reduction in total WOMAC score was seen at follow-up, but no significant changes were observed for either CEA-BML, STIR-BML or Nvoxel. Conclusions Neither the degree nor the volume of contrast enhancement in BMLs seems to add any clinical information compared to BMLs visualized by fluid sensitive sequences. Manual segmentation may be needed to obtain valid CEA-BML measurements. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1336-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flemming K Nielsen
- Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus, Denmark.
| | - Niels Egund
- Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Anette Jørgensen
- Department of Rheumatology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus, Denmark
| | - David A Peters
- Department of Biomedical Engineering, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus, Denmark
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