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Imaging in osteoarthritis

Issue 33 Synovium (Summer 2011)

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It is well known that changes on plain x-rays of joints with osteoarthritis (OA) correlate poorly with symptoms and are accordingly of relatively little use in the clinical assessment of patients with knee or hip pain and therefore in planning treatments. A recent systematic review1 examined the evidence for the utility of magnetic resonance imaging (MRI) and ultrasound scanning in OA. The review found that synovitis was commonly demonstrated in both early and advanced OA and may be associated with the presence of pain. Ultrasound scanning was effective in demonstrating synovitis. Plain MRI (without contrast) was not, but contrast enhancement was comparable with ultrasound. Since ultrasound scanning is much more readily available perhaps this should be part of the assessment of pain in OA knee.

Other features that have been demonstrated on imaging to correlate well with joint pain include effusions, subchondral bone marrow lesions and articular cartilage loss that exposes the bone surface. These features often coexist and an Arthritis Research UK-supported study has shown that their fluctuation correlates well with the experience of joint pain.2 All this opens the possibility of more specific, targeted treatments for joint pain in OA.

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