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Extended report
Association between MRI-detected knee joint regional effusion-synovitis and structural changes in older adults: a cohort study
  1. Xia Wang1,
  2. Leigh Blizzard1,
  3. Andrew Halliday2,
  4. Weiyu Han1,
  5. Xingzhong Jin1,
  6. Flavia Cicuttini3,
  7. Graeme Jones1,
  8. Changhai Ding1,3,4
  1. 1Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
  2. 2Department of Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
  3. 3Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
  1. Correspondence to Professor Changhai Ding, Menzies Institute for Medical Research, University of Tasmania; Private Bag 23, Hobart, Tasmania 7000, Australia; changhai.ding{at}


Objective To describe the cross-sectional and longitudinal associations between knee regional effusion-synovitis and structural changes in older adults.

Methods A total of 977 subjects were randomly selected from the local community (mean 62 years, 50% female) at baseline and 404 were followed up 2.6 years later. T2-weighted MRI was used to assess knee effusion-synovitis in four subregions: suprapatellar pouch, central portion, posterior femoral recess and subpopliteal recess. Knee cartilage defects, cartilage volume and bone marrow lesions (BMLs) were measured using MRI at baseline and follow-up.

Results Cross-sectionally, effusion-synovitis in most subregions was significantly associated with a higher risk of cartilage defects, BMLs and reduced cartilage volume. Longitudinally, suprapatellar pouch effusion-synovitis at baseline predicted an increase in cartilage defects (p<0.01), loss of cartilage volume (p=0.04) and an increase in BMLs (p=0.02) in multivariable analyses. The significant associations of effusion-synovitis with cartilage volume and BMLs disappeared after adjustment for cartilage defects. Effusion-synovitis in whole knee joint (p<0.01) and subpopliteal recess (p<0.05) was consistently associated with longitudinal changes in cartilage defects but not in cartilage volume and BMLs.

Conclusions There are independent associations between knee joint effusion-synovitis and knee cartilage defects in both cross-sectional and longitudinal analyses, suggesting a potential causal relationship. The associations of effusion-synovitis with BMLs and cartilage volume were largely dependent on cartilage defects, suggesting potential causal pathways.

  • Knee Osteoarthritis
  • Synovitis
  • Inflammation

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