Thresholds of ultrasound synovial abnormalities for knee osteoarthritis: a cross sectional study in the general population

Sarmanova, A.; Hall, M.; Fernandes, G.S.; Valdes, A.M.; Walsh, D.A.; Doherty, M.; Zhang, W.

Abstract

Objective

To establish “normal” ranges for synovial thickness and effusion detected by ultrasound (US) and to determine cut-offs associated with knee pain (KP) and radiographic knee osteoarthritis (RKOA) in the community.

Methods

147 women and 152 men ≥40 years old were randomly selected from the Nottingham KP and Related Health in the Community (KPIC) cohort (n = 9506). The “normal” range was established using the percentile method in 163 participants who had no KP and no RKOA. Optimal (maximum sensitivity and specificity) and high specificity (90%) cut-offs were established using receiver operating characteristic (ROC) curve analysis in a comparison between people with both KP and RKOA and normal controls.

Results

Effusion and synovial hypertrophy differed by gender but not by age or laterality, therefore gender-specific reference limits were estimated. However, the “normal” ranges between men and women were similar for effusion (0–10.3 mm vs 0–9.8 mm), but different for synovial hypertrophy (0–6.8 mm vs 0–5.4 mm). Power Doppler Signal (PDS) in the healthy controls was uncommon (1.2% in men and 0.0% in women). The optimal cut-off was 7.4 mm for men and 5.3 mm for women for effusion, and 3.7 and 1.6 for hypertrophy respectively. The high specificity cut-off was 8.9 for men and 7.8 for women for effusion, and 5.8 and 4.2 for hypertrophy respectively.

Conclusions

US effusion and synovial hypertrophy but not PDS are common, but differ by gender, in community-derived people without painful knee OA. Currently used cut-offs for abnormality need reappraisal.

Citation

Sarmanova, A., Hall, M., Fernandes, G., Valdes, A., Walsh, D., Doherty, M., & Zhang, W. (2019). Thresholds of ultrasound synovial abnormalities for knee osteoarthritis: a cross sectional study in the general population. Osteoarthritis and Cartilage, 27(3), 435-443. https://doi.org/10.1016/j.joca.2018.09.018

• Journal Article Type: Article
• Acceptance Date: Sep 18, 2018
• Online Publication Date: Nov 16, 2018
• Publication Date: Mar 1, 2019
• Deposit Date: Dec 3, 2018
• Publicly Available Date: Dec 4, 2018
• Journal: Osteoarthritis and Cartilage
• Print ISSN: 1063-4584
• Electronic ISSN: 1522-9653
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 27
• Issue: 3
• Pages: 435-443
• DOI: https://doi.org/10.1016/j.joca.2018.09.018
• Keywords: Ultrasound; Ultrasonography; Knee pain; Osteoarthritis; Synovitis
• Public URL: https://nottingham-repository.worktribe.com/output/1360620
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S106345841831522X?via%3Dihub
• Contract Date: Dec 3, 2018