Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population-the Xiangya Osteoarthritis Study

Ting Jiang; Tuo Yang; Weiya Zhang; Michael Doherty; Yuqing Zhang; Jie Wei; Aliya Sarmanova; Michelle Hall; Zidan Yang; Jiatian Li; Gwen S Fernandes; Abasiama D Obotiba; Sameer A Gohir; Philip Courtney; Chao Zeng; Guanghua Lei

doi:10.1186/s13075-021-02539-2

Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population-the Xiangya Osteoarthritis Study

Arthritis Res Ther. 2021 Jun 2;23(1):156. doi: 10.1186/s13075-021-02539-2.

Authors

Ting Jiang^#^{1

2

3

4}, Tuo Yang^#^{3

4

5}, Weiya Zhang^{3

4}, Michael Doherty^{3

4}, Yuqing Zhang^{6

7}, Jie Wei^{5

8}, Aliya Sarmanova⁹, Michelle Hall^{4

10

11}, Zidan Yang⁸, Jiatian Li¹, Gwen S Fernandes¹², Abasiama D Obotiba^{3

4}, Sameer A Gohir¹¹, Philip Courtney¹³, Chao Zeng^{14

15

16}, Guanghua Lei^{17

18

19}

Affiliations

¹ Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
² Department of Ultrasonography, Xiangya Hospital, Central South University, Changsha, China.
³ Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
⁴ Pain Centre Versus Arthritis UK, Nottingham, UK.
⁵ Health Management Center, Xiangya Hospital, Central South University, Changsha, China.
⁶ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
⁷ The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
⁸ Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China.
⁹ Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.
¹⁰ School of Health Sciences, University of Nottingham, Nottingham, UK.
¹¹ NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.
¹² Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
¹³ Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
¹⁴ Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. [email protected].
¹⁵ Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China. [email protected].
¹⁶ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. [email protected].
¹⁷ Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. [email protected].
¹⁸ Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China. [email protected].
¹⁹ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. [email protected].

^# Contributed equally.

Abstract

Background: There is paucity of data on the prevalence of ultrasound-detected synovial abnormalities in the general population, and the relationship between synovial changes and knee pain remains unclear. We examined the prevalence of synovial abnormalities on ultrasound and the relationship of these features with knee pain and radiographic osteoarthritis (ROA) in a community sample.

Methods: Participants aged 50 years or over were from the Xiangya Osteoarthritis Study, a community-based cohort study. Participants were questioned about chronic knee pain and underwent (1) ultrasonography of both knees to determine presence of synovial hypertrophy (≥ 4 mm), effusion (≥ 4 mm), and Power Doppler signal [PDS; yes/no]; and (2) standard radiographs of both knees (tibiofemoral and patellofemoral views) to determine ROA.

Results: There were 3755 participants (mean age 64.4 years; women 57.4%). The prevalence of synovial hypertrophy, effusion, and PDS were 18.1% (men 20.2%; women 16.5%), 46.6% (men 49.9%; women 44.2%), and 4.9% (men 4.9%; women 5.0%), respectively, and increased with age (P for trend < 0.05). Synovial abnormalities were associated with knee pain, with adjusted odds ratios (aORs) of 2.39 (95% confidence interval [CI] 2.00-2.86) for synovial hypertrophy, 1.58 (95%CI 1.39-1.80) for effusion, and 4.36 (95%CI 3.09-6.17) for PDS. Similar associations with ROA were observed, the corresponding aORs being 4.03 (95%CI 3.38-4.82), 2.01 (95%CI 1.76-2.29), and 6.49 (95%CI 4.51-9.35), respectively. The associations between synovial hypertrophy and effusion with knee pain were more pronounced among knees with ROA than those without ROA, and the corresponding P for interaction were 0.004 and 0.067, respectively.

Conclusions: Knee synovial hypertrophy and effusion are more common and increase with age, affecting men more than women. All three ultrasound-detected synovial abnormalities associate both with knee pain and ROA, and knee synovial hypertrophy or effusion and ROA may interact to increase the risk of knee pain.

Keywords: General population; Knee; Synovial abnormalities; Ultrasonography.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cohort Studies
Female
Humans
Knee Joint / diagnostic imaging
Male
Middle Aged
Osteoarthritis, Knee*
Prevalence
Ultrasonography