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Association between ultrasound-detected synovitis and knee pain: a population-based case-control study with both cross-sectional and follow-up data

Sarmanova, Aliya; Hall, Michelle C.; Fernandes, Gwen Sascha; Bhattacharya, Archan; Valdes, Ana M.; Walsh, David A.; Doherty, Michael; Zhang, Weiya


Aliya Sarmanova

Michelle C. Hall

Gwen Sascha Fernandes

Archan Bhattacharya

Professor of Rheumatology

Michael Doherty


Background: Recently an important role for synovial pathology in the initiation and progression of knee osteoarthritis (OA) has been emphasised. This study aimed to examine whether ultrasonographydetected synovial changes (USSCs) associate with knee pain (KP) in a community population.

Methods: A case-control study was conducted to compare people with early KP (n=298), established KP (n=100) or no KP (n=94) at baseline. Multinomial logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (CI) between groups adjusted for radiographic osteoarthritis (ROA) severity and other confounding factors. After one year 255 participants with early and established KP completed the followup questionnaire for changes in KP. Logistic regression with adjustment was used to determine predictors of KP worsening.

Results: At baseline, effusion was associated with early (OR 2.64, 95%CI 1.57 to 4.45) and established KP (OR 5.07, 95%CI 2.74 to 9.38). Synovial hypertrophy was also associated with early (OR 5.43, 95%CI 2.12 to 13.92) and established KP (OR 13.27, 95%CI 4.97 to 35.43). The association with effusion diminished when adjusted for ROA. Power Doppler signal was uncommon (early KP 3%, established KP 2%, controls 0%). Baseline effusion predicted worsening of knee pain at one year (OR 1.95, 95% CI 1.05 to 3.64). However, after adjusting for ROA, the prediction was insignificant (aORs 0.95, 95%CI 0.44 to 2.02).

Conclusion: US effusion and synovial hypertrophy are associated with KP, but only effusion predicts KP worsening. However, the association/prediction are not independent from ROA. Power Doppler signal is uncommon in people with KP. Further study is needed to understand whether synovitis is directly involved in different types of KP.


Sarmanova, A., Hall, M. C., Fernandes, G. S., Bhattacharya, A., Valdes, A. M., Walsh, D. A., …Zhang, W. (in press). Association between ultrasound-detected synovitis and knee pain: a population-based case-control study with both cross-sectional and follow-up data. Arthritis Research and Therapy, 19(281),

Journal Article Type Article
Acceptance Date Nov 24, 2017
Online Publication Date Dec 19, 2017
Deposit Date Dec 12, 2017
Publicly Available Date Dec 19, 2017
Journal Arthritis Research & Therapy
Print ISSN 1478-6354
Electronic ISSN 1478-6362
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Issue 281
Keywords knee pain, synovial changes, synovitis, ultrasound, osteoarthritis, cohort study
Public URL
Publisher URL


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