Session Type: Poster Session A
Session Time: 8:30AM-10:30AM
Background/Purpose: Intra-articular corticosteroids (IACS) are commonly used for symptom management in knee osteoarthritis (KOA) patients, despite the fact that many patients do not respond to this treatment. Knee inflammation (synovitis) is increasingly appreciated as an important factor in OA disease progression and pain, yet studies have failed to find any features of inflammation measured by ultrasound (US) that are associated with pain/function response. Our objective is to test whether nuanced features of sonographically-detected inflammation including synovial tissue quality and synovial vascularity are associated with response after IACS.
Methods: KOA patients presenting to a rheumatology center for regular follow up and steroid injection were administered a standardized US and completed patient surveys prior to injection. Using random-effects linear and logistic models, baseline US features were tested for association with improvement in pain, function, patient-reported global assessment (PGA) of disease activity, and OARSI-OMERACT-defined responder status 18-28 days after IACS injection.
Results: Individuals with echogenic synovium and positive Power Doppler (PD) signal have an improved response to pain (β= 14.500 & 7.655, respectively) and function (β= 11.677 & β= 7.650, respectively) after IACS. Patients with metabolic syndrome have as much as a 30% reduced response to IACS as measured by PGA of disease activity. Only baseline pain (OR= 1.042) and radiographic severity (OR= 5.282) were associated with OARSI-OMERACT-defined response.
Conclusion: Inflammation is not homogeneous across KOA patients, and response to IACS injections depends on baseline symptoms, the phenotype of synovitis, the presence of blood flow within synovium, and baseline radiographic severity.
To cite this abstract in AMA style:Dima R, Birmingham T, Pinto R, Philpott H, Carter M, Appleton T. Echogenic and Hypervascular Synovium Detected on Ultrasound Are Predictive of a Favorable Response After Intra-articular Corticosteroid Injection in Patients with Knee Osteoarthritis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10). https://acrabstracts.org/abstract/echogenic-and-hypervascular-synovium-detected-on-ultrasound-are-predictive-of-a-favorable-response-after-intra-articular-corticosteroid-injection-in-patients-with-knee-osteoarthritis/. Accessed December 3, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/echogenic-and-hypervascular-synovium-detected-on-ultrasound-are-predictive-of-a-favorable-response-after-intra-articular-corticosteroid-injection-in-patients-with-knee-osteoarthritis/