EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: Prevalence of inflammation in osteoarthritis

M. A. D'Agostino, Maria Antonietta D'Agostino, P. Conaghan, M. Le Bars, G. Baron, W. Grassi, E. Martin-Mola, R. Wakefield, J. L. Brasseur, A. So, M. Backhaus, M. Malaise, G. Burmester, N. Schmidely, P. Ravaud, M. Dougados, P. Emery

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Objectives: To assess the prevalence of inflammation in subjects with chronic painful knee osteoarthritis (OA), as determined by the presence of synovitis or joint effusion at ultrasonography (US); and to evaluate the correlation between synovitis, effusion, and clinical parameters. Methods: A cross sectional, multicentre, European study was conducted under the umbrella of EULAR-ESCISIT. Subjects had primary chronic knee OA (ACR criteria) with pain during physical activity ≥30 mm for at least 48 hours. Clinical parameters were collected by a rheumatologist and an US examination of the painful knee was performed by a radiologist or rheumatologist within 72 hours of the clinical examination. Ultrasonographic synovitis was defined as synovial thickness ≥4 mm and diffuse or nodular appearance, and a joint effusion was defined as effusion depth ≥4 mm. Results: 600 patients with painful knee OA were analysed. At US 16 (2.7%) had synovitis alone, 85 (14.2%) had both synovitis and effusion, 177 (29.5%) had joint effusion alone, and 322 (53.7%) had no inflammation according to the definitions employed. Multivariate analysis showed that inflammation seen by US correlated statistically with advanced radiographic disease (Kellgren-Lawrence grade ≥3; odds ratio (OR) = 2.20 and 1.91 for synovitis and joint effusion, respectively), and with clinical signs and symptoms suggestive of an inflammatory "flare", such as joint effusion on clinical examination (OR = 1.97 and 2.70 for synovitis and joint effusion, respectively) or sudden aggravation of knee pain (OR = 1.77 for joint effusion). Conclusion: US can detect synovial inflammation and effusion in painful knee OA, which correlate significantly with knee synovitis, effusion, and clinical parameters suggestive of an inflammatory "flare".
Original languageEnglish
Pages (from-to)1703-1709
Number of pages7
JournalAnnals of the Rheumatic Diseases
Publication statusPublished - 2005


  • Aged
  • Cross-Sectional Studies
  • Europe
  • Exudates and Transudates
  • Female
  • Humans
  • Knee Joint
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Osteoarthritis, Knee
  • Pain Measurement
  • Prevalence
  • Severity of Illness Index
  • Synovitis
  • Ultrasonography


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