ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 443

Impact of Intra-Articular Steroid Injection on Bone Marrow Lesions in Osteoarthritis of the Hip: An Assessment Using the Outcome Measures in Rheumatology Hip MRI Inflammation Scoring System

Walter P. Maksymowych1,2, Robert G. Lambert3, Marcus Pianta4, Zeid Al-Ani5, Duncan Lindsay5, Ulrich Weber6, Susanne J Pedersen7, Stephanie Wichuk8, Kieran Steer9, Geoffrey Bostick10, Joel Paschke1 and Jacob L. Jaremko11, 1CaRE Arthritis, Edmonton, AB, Canada, 2Medicine, Medicine, University of Alberta, Edmonton, AB, Canada, 3Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada, 4Rheumatology, St. Vincent's Hospital, Melbourne, Australia, 5Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada, 6Department of Research, King Christian 10th Hospital for Rheumatic Diseases, Graasten, Denmark, 7Rheumatology, Gentofte Hospital, Copenhagen, Denmark, 8University of Alberta, Edmonton, AB, Canada, 9Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada, 10Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada, 11Radiology, University of Alberta, Edmonton, AB, Canada

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Date: Sunday, October 21, 2018

Title: Osteoarthritis – Clinical Poster I

Session Type: ACR Poster Session A

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

Background/Purpose:

Intra-articular (I/A) steroid injection is an effective treatment for alleviating symptoms in osteoarthritis (OA) of the hip but the impact of this treatment on imaging findings relevant to prognosis, such as bone marrow lesions (BML) on MRI, has not been reported. The OMERACT Hip MRI Inflammation Scoring System (HIMRISS) is a validated method for semi-quantitative assessment of BML in hip OA1. We aimed to assess the impact of I/A steroid on BML in a multireader exercise of MRI scans from a prospective cohort.


Methods:

We assessed MRI scans from both hips of 90 patients at baseline and 8 weeks after I/A steroid injection. In HIMRISS, BML is scored as 0/1 (absent/present) in 100 regions on a web-based grid overlay slice-by-slice on coronal hip MRI. T1/STIR sequences were read blinded to time point by 8 readers (2 radiology fellows, 3 rheumatologists, 3 MSK radiologists) after review of validated HIMRISS methodology and calibration tools and attaining pre-specified scoring proficiency for assessment of status and change scores (intra-class correlation coefficient (ICC)>0.80) versus expert reader consensus scores. Readers each scored HIMRISS BML in all 360 hips.


Results:

Subjects were 56% male, age 59±13 (mean±SD) years, symptom duration 4.4±4.5 years, K-L OA grade 1/2/3/4 in 20%/28%/34%/18%, 24% taking NSAID. Although mean change in femoral BML was small (potential range 0-100), a significant increase was noted after injection. Moreover, change in BML greater than smallest detectable change (SDC) was noted in 30-40% of cases amongst readers with worsening score being more frequent (mean 22.2%) than improvement (10.0%) ((Figure). In univariate analysis, worsening of femoral BML by >SDC was associated with NSAID use (OR=3.78 (1.37 to 10.45), P=0.01) and this remained significant in multivariate analysis adjusted for age, gender, BMI, baseline femoral BML score (OR=4.25(1.31 to 13.83), P=0.02).


Conclusion:

Following I/A steroid injection for hip OA, extent of BML is more likely to deteriorate than improve and deterioration may be associated with concomitant NSAID use.

1. Maksymowych WP, et al. J Rheumatol 42: 370-8, 2014

Table. OMERACT HIMRISS BML scores (mean(SD)) in femoral head and the entire hip joint at baseline and 8 weeks after I/A steroid injection.

SRM: standardized response mean

SDC: smallest detectable change

 

Baseline

8 weeks

Change

P value

SRM

% change > SDC

All readers

Fem BML

18.9(17.4)

21.1(18.7)

2.2 (9.2)

0.02

0.24

44.4%

Fem BML

Central slices

14.2 (13.0)

15.5 (13.6)

1.3 (6.5)

0.06

0.20

41.1%

Fem BML

Ant-Post slices

4.8 (4.7)

5.7 (5.4)

0.9 (3.1)

0.01

0.30

33.3%

Total HIMRISS

29.1(23.1)

31.2(24.8)

2.1 (10.0)

0.05

0.21

35.6%

Expert readers

Femoral BML

16.1 (16.7)

19.2 (18.5)

3.0 (9.9)

<0.001

0.31

32.2%

Fem BML

Central slices

11.8 (12.4)

13.7 (13.2)

1.9 (7.0)

0.01

0.27

32.2%

Fem BML

Ant-Post slices

4.4 (4.8)

5.5 (5.6)

1.1 (3.4)

<0.001

0.33

25.6%

Total HIMRISS

26.3 (22.6)

29.0 (24.6)

2.7 (11.0)

0.02

0.25

33.3%

Figure. Cumulative probability plot of change in femoral BML scores at 8 weeks after I/A steroid injection in 90 patients with hip OA.

 

Disclosure: W. P. Maksymowych, CaRE rthritis, 9; R. G. Lambert, None; M. Pianta, None; Z. Al-Ani, None; D. Lindsay, None; U. Weber, None; S. J. Pedersen, None; S. Wichuk, None; K. Steer, None; G. Bostick, None; J. Paschke, None; J. L. Jaremko, None.

To cite this abstract in AMA style:

Maksymowych WP, Lambert RG, Pianta M, Al-Ani Z, Lindsay D, Weber U, Pedersen SJ, Wichuk S, Steer K, Bostick G, Paschke J, Jaremko JL. Impact of Intra-Articular Steroid Injection on Bone Marrow Lesions in Osteoarthritis of the Hip: An Assessment Using the Outcome Measures in Rheumatology Hip MRI Inflammation Scoring System [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/impact-of-intra-articular-steroid-injection-on-bone-marrow-lesions-in-osteoarthritis-of-the-hip-an-assessment-using-the-outcome-measures-in-rheumatology-hip-mri-inflammation-scoring-system/. Accessed .

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-intra-articular-steroid-injection-on-bone-marrow-lesions-in-osteoarthritis-of-the-hip-an-assessment-using-the-outcome-measures-in-rheumatology-hip-mri-inflammation-scoring-system/