Comparison of Synovitis on MRI and Pain in Knee Osteoarthritis Patients with and without Chondrocalcinosis: Data from the Osteoarthritis Initiative (OAI)

Bobby Kwanghoon Han¹, Woojin Kim², Jingbo Niu³, Shristi Basnyat¹, Veniamin Barshay⁴, Charlene Williams⁵, Sharon L. Kolasinski⁶ and David T. Felson³, ¹Division of Rheumatology, Cooper Medical School of Rowan University, Voorhees, NJ, ²Division of Musculoskeletal Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, ³Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, ⁴Department of Radiology, Cooper Medical School of Rowan University, Camden, NJ, ⁵Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ, ⁶Division of Rheumatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Chondrocalcinosis and osteoarthritis

Session Information

Date: Tuesday, November 10, 2015

Title: Osteoarthritis - Clinical Aspects Poster II: Biomarkers, Biomechanics and Health Services Research

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: CPPD crystals are frequently
deposited in the fibrocartilage of the meniscus and detected radiographically
as linear calcification, termed chondrocalcinosis (CC). Several studies have
found an association between CC and the severity of OA. However, CC has not been
associated with worsening of OA, and its role in the pathogenesis of OA is not
well understood. In this study, we explored whether CC was associated with
synovitis on MRI or pain in patients with knee OA by examining data from the Osteoarthritis
Initiative (OAI).

Methods: The study rationale and inclusion
criteria for the OAI (men and women ages 45–79 with symptoms of and/or knee
radiographic OA or risk factors for developing knee OA) have been described
previously (http://oai.epi-ucsf.org/datarelease/). We included subjects who were 60
years and older and had Kellgren-Lawrence (KL) grade 0, 1, or 2 on baseline radiograph.
We conducted a matched cohort study by selecting subjects with CC on baseline knee
radiograph and age, gender, and KL grade-matched controls with no CC. We
assessed each subject for synovitis by MRI Osteoarthritis Knee Score (MOAKS) on
4-year MRI. MOAKS synovitis score includes the Hoffa synovitis and effusion
synovitis score. If the person had the same KL grade in both knees, we assessed
one knee (left knee) per person. Wilcoxon two sample test was performed to
compare MOAKS synovitis scores. Then we conducted a cohort study to assess the
association between baseline CC and the Intermittent and Constant
Osteoarthritis Pain (ICOAP) score at 4 years. ICOAP is a questionnaire to
assess intermittent and constant pain for the past 7-day period with score ranging
from 0 to 100. Linear regression was performed and the data were adjusted for
age, gender, BMI, and KL grade. The correlation between two knees in a subject
was controlled using generalized estimating equation.

Results: We assessed MRI of 191 knees (97 CC,
94 control) from the OAI data base. There was no difference in Hoffa synovitis score
(0.9 [0.8,1.0] vs 0.9 [0.8,1.0], p=0.81) and effusion synovitis score (3.7 [3.2,4.2]
vs 3.8 [3.3,4.3], p=0.60) at 4 years between the CC group and the control group.
We also compared subjects within each KL grade and found there was no
association with synovitis. However, there was an association between CC and ICOAP
score. Knees with CC (n=138) had significantly higher intermittent pain score
at 4 years compared to knees without CC (n=1760) (Table 1).

Conclusion:
Knees with CC did not
have higher MOAKS synovitis scores on MRI compared to knees without CC but CC was
associated with significantly higher ICOAP intermittent pain scores. These
results suggest that CC is associated with increased intermittent knee pain but
that this pain may not be explained by an increase in synovitis.

Table 1. Chondroclacinosis (CC) and Intermittent
and Constant Osteoarthritis Pain (ICOAP) at year 4

	Crude model		Adjusted model ^[1]		Adjusted model ^[2]
CC at BL	mean [95% CI]	p-value	adjusted mean [95% CI]	p-value	adjusted mean [95% CI]	p-value
ICOAP knee Intermittent Pain Score at year 4 (0-100)
CC-(N=1760)	9.2 [8.3,10.0]	0.052	8.9 [8.1,9.7]	0.013	8.2 [7.4,9.1]	0.021
CC+ (N=138)	12.0 [9.2,14.9]	0.052	12.6 [9.7,15.4]	0.013	11.7 [8.7,14.6]	0.021
ICOAP knee Constant Pain Score at year 4 (0-100)
CC- (N=1760)	1.9 [1.4,2.4]	0.198	1.9 [1.4,2.4]	0.125	1.9 [1.4,2.4]	0.124
CC+ (N=138)	3.2 [1.2,5.2]	0.198	3.5 [1.5,5.5]	0.125	3.5 [1.4,5.5]	0.124
ICOAP knee Intermittent and Constant Pain Total Score at year 4 (0-100)
CC- (N=1759)	5.8 [5.3,6.4]	0.031	5.7 [5.1,6.3]	0.007	5.3 [4.8,5.9]	0.011
CC+ (N=138)	8.1 [6.1,10.1]	0.031	8.5 [6.5,10.5]	0.007	8.0 [6.0,10.1]	0.011

^[1]Adjusting for age, gender, BMI at
baseline

^[2]Adjusting for age, gender, BMI, and KL
grade at baseline

Disclosure: B. K. Han, None; W. Kim, None; J. Niu, None; S. Basnyat, None; V. Barshay, None; C. Williams, None; S. L. Kolasinski, None; D. T. Felson, None.

To cite this abstract in AMA style:

Han BK, Kim W, Niu J, Basnyat S, Barshay V, Williams C, Kolasinski SL, Felson DT. Comparison of Synovitis on MRI and Pain in Knee Osteoarthritis Patients with and without Chondrocalcinosis: Data from the Osteoarthritis Initiative (OAI) [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/comparison-of-synovitis-on-mri-and-pain-in-knee-osteoarthritis-patients-with-and-without-chondrocalcinosis-data-from-the-osteoarthritis-initiative-oai/. Accessed .

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