Abstract :
[en] BACKGROUND: Synovial inflammation (as defined by hypertrophy and effusion) is
common in osteoarthritis (OA) and may be important in both pain and structural
progression. OBJECTIVE: To determine if decision rules can be devised from
clinical findings and ultrasonography (US) to allow recognition of synovial
inflammation in patients with painful knee OA. METHODS: A EULAR-ESCISIT cross
sectional, multicentre study enrolled subjects with painful OA knee who had
clinical, radiographic, and US evaluations. A classification and regression tree
(CART) analysis was performed to find combinations of predictor variables that
would provide high sensitivity and specificity for clinically detecting synovitis
and effusion in individual subjects. A range of definitions for the two key US
variables, synovitis and effusion (using different combinations of synovial
thickness, depth, and appearance), were also included in exploratory analyses.
RESULTS: 600 patients with knee OA were included in the analysis. For both knee
synovitis and joint effusion, the sensitivity and specificity were poor, yielding
unsatisfactory likelihood ratios (75% sensitivity, 45% specificity, and positive
LR of 1.36 for knee synovitis; 71.6% sensitivity, 43.2% specificity, and positive
LR of 1.26 for joint effusion). The exploratory analyses did not improve the
sensitivity and specificity (demonstrating positive LRs of between 1.26 and
1.57). CONCLUSION: Although it is possible to determine clinical and radiological
predictors of OA inflammation in populations, CART analysis could not be used to
devise useful clinical decision rules for an individual subject. Thus sensitive
imaging techniques such as US remain the most useful tool for demonstrating
synovial inflammation of the knee at the individual level.
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