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Synovitis detected on magnetic resonance imaging and its relation to pain and cartilage loss in knee osteoarthritis
  1. Catherine L Hill1,
  2. David J Hunter2,
  3. Jingbo Niu2,
  4. Margaret Clancy2,
  5. Ali Guermazi3,
  6. Harry Genant3,
  7. Daniel Gale4,
  8. Andrew Grainger5,
  9. Philip Conaghan5,
  10. David T Felson2,4
  1. 1
    Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, Australia
  2. 2
    Boston University Clinical Epidemiology Research and Training Unit, Boston, MA, USA
  3. 3
    Synarc, Inc, San Francisco, CA, USA and University of California San Francisco, San Francisco, CA, USA
  4. 4
    VA Boston Healthcare System, Boston, MA, USA
  5. 5
    Departments of Radiology and Rheumatology, Leeds Teaching Hospitals Trust & Leeds Primary Care Trust, Leeds, UK
  1. D T Felson, Boston University School of Medicine, A203, 80 E. Concord Street, Boston, MA 02118, USA; dfelson{at}


Objective: To examine the relationship between longitudinal fluctuations in synovitis with change in pain and cartilage in knee osteoarthritis.

Methods: Study subjects were patients 45 years of age and older with symptomatic knee osteoarthritis from the Boston Osteoarthritis of the Knee Study. Baseline and follow-up assessments at 15 and 30 months included knee magnetic resonance imaging (MRI), BMI and pain assessment (VAS) over the last week. Synovitis was scored at 3 locations (infrapatellar fat pad, suprapatellar and intercondylar regions) using a semiquantitative scale (0–3) at all 3 time points on MRI. Scores at each site were added to give a summary synovitis score (0–9).

Results: We assessed 270 subjects whose mean (SD) age was 66.7 (9.2) years, BMI 31.5 (5.7) kg/m2; 42% were female. There was no correlation of baseline synovitis with baseline pain score (r = 0.09, p = 0.17). The change in summary synovitis score was correlated with the change in pain (r = 0.21, p = 0.0003). An increase of one unit in summary synovitis score resulted in a 3.15-mm increase in VAS pain score (0–100 scale). Effusion change was not associated with pain change. Of the 3 locations for synovitis, changes in the infrapatellar fat pad were most strongly related to pain change. Despite cartilage loss occurring in over 50% of knees, synovitis was not associated with cartilage loss in either tibiofemoral or patellofemoral compartment.

Conclusions: Change in synovitis was correlated with change in knee pain, but not loss of cartilage. Treatment of pain in knee osteoarthritis (OA) needs to consider treatment of synovitis.

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  • Supported by NIH AR47785.

  • Competing interests: None declared.

  • Abbreviations:
    magnetic resonance imaging
    visual analogue scale
    whole-organ magnetic resonance imaging score