Effusion-synovitis worsens cartilage damage in OA patients with meniscal tear

In patients with osteoarthritis and meniscal tear, the presence or persistence of effusion-synovitis appears to be associated with progression of cartilage damage, according to data presented at the American College of Rheumatology Annual Meeting.

“Inflammation manifesting as synovitis is a common feature in both knee osteoarthritis and meniscal tear,” Lindsay A. MacFarlane, MD, from the department of rheumatology at Brigham & Women’s Hospital, and a lead author of the study, said during a presentation. “Synovitis is associated with pain in both incidence and progression of knee OA. Intra-articular damage, including debris from cartilage damage and meniscal tear, may provoke synovitis. Synovitis, in turn, may lead to the release of cytokines and chemokines that negatively impact cartilage health.”

In the study, MacFarlane and colleagues evaluated data on 174 knees from the Meniscal Tear in Osteoporosis Research (MeTeOR) trial of arthroscopic partial meniscectomy (APM) vs. physiotherapy. They identified patients aged 45 years and older who had meniscal tear on MRI, OA on MRI or radiograph, and exhibited knee symptoms. The researchers excluded patients who crossed over between APM and physiotherapy treatment, or who lacked both baseline and 18-month MRI data. MacFarlane and colleagues used the MRI OA Knee Score (MOAKS) to view and interpret the MRI. Effusion-synovitis at baseline was classified as none/mild (0) or moderate/severe (1). Over 18 months, changes in effusion-synovitis were classified as never developed (0 at baseline and 18 months); intermittent (1 at only 1 time-point); or persistent (1 at baseline and at 18 months).

The researchers evaluated cartilage damage changes in 14 subregions over 18 months, based on the number of subregions with progression of cartilage damage and number of additional subregions affected. They used logistic regression to evaluate correlations between baseline effusion and change in effusion to both cartilage damage outcomes over an 18-month period. Four individual models were used and were adjusted for differences in treatment (APM vs. physiotherapy), sex, BMI and baseline cartilage damage.

They found that of 174 knees assessed (1 knee per patient), 102 underwent APM and 72 were treated with physiotherapy. At baseline, 48% of patients had moderate/severe effusion, while 29% had moderate/severe effusion at 18 months. In 56% of individuals, there were subregions with worsening cartilage damage, and 45% had additional affected subregions.

Between baseline and 18 months, 44% of patients never had effusion, 35% had intermittent effusion, and 21% had persistent effusion. Compared with individuals who never developed effusion, patients with intermittent effusion had 2.6 times (95% CI, 1.2-5.5) the likelihood of cartilage damage progression. Patients with persistent effusion had 4.5-fold (95% CI, 1.6-12.8) greater likelihood of damage progression. Analyses of baseline effusion and number of additional affected subregions yielded similar results.

“Our findings augment prior research demonstrating the negative impact of synovitis on cartilage in patients with OA. We identified a near 1.5-fold risk of cartilage damage progression in patients with greater effusion-synovitis at baseline,” MacFarlane said. “Over 18 months, intermittent and persistent effusion-synovitis increased the risk of cartilage damage progression up to twofold in comparison to those who never developed effusion-synovitis. Our work highlights the potential value of developing anti-inflammatory modalities that target synovitis.” – by Jennifer Byrne

Reference:

MacFarlane L., et al. Abstract # 2756. Presented at: American College of Rheumatology Annual Meeting; Nov. 4-8, 2017; San Diego.

Disclosures: Dr. Guermazi discloses relationships with BICL, LLC, MerckSerono, TissueGene, OrthoTrophix, AstraZeneca, and Gynzyme. Dr. Mandi discloses relationships with Boehringer Ingelheim, the American College of Physicians, and Up To Date.