Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Association of Contrast Enhanced MRI Demonstrated Synovitis in Knee Osteoarthritis with Clinical Signs

Thomas1,  Matthew, Kiran2,  Amit, Roemer3,  Frank W., Guermazi3,  Ali, Javaid2,  M. Kassim, King1,  Leonard, Sampson4,  Madeleine

Southampton University, Southampton, United Kingdom
Oxford University, Oxford, United Kingdom
BUSM, Boston, MA
Southampton University Hospital, Southampton, United Kingdom
University College London, United Kingdom
UCSF, San Francisco, CA


Osteoarthritis (OA) is the most prevalent form of arthritis, a major cause of morbidity worldwide. Synovitis is common in OA and thought to be a secondary phenomenon related to structural changes. Its presence has been documented in early phases of OA. Only contrast (C) enhanced (E) T1 weighted images are proven to correlate with histologically proven synovitis. Few studies have been performed assessing the link between active synovitus and clinical signs of inflammation. The aim of our study was to describe the link between synovitus measured by contrast enhanced MRI and these signs of inflammation.


Participants of the VIDEO study of knee OA were included. MRI was performed at baseline using axial proton density (PD) weighted fat suppressed (FS), axial T1 weighted FSCE and sagittal T1 weighted FSCE sequences. Synovitis enhanced was scored semi-quantitively from 0–3: 0= no synovial thickening, 1 = <2mm (equivocal synovial thickening), 2 = 2–4 mm (moderate synovitis) and 3 =>= 4mm (severe synovitis). 11 regions were assessed in this fashion (suprapatellar, infrapatellar, medial parapatellar, lateral parapatellar, intercondylar, ACL, posterior to PCL, medial perimeniscal, lateral perimeniscal, Baker's cyst and around loose bodies). A cumulative grade was obtained from summation of these individual scores to provide an estimate of the volume of synovitis, subsequently divided into quartiles for secondary analysis. Effusion was scored from 0–3 on PD FS and T1 FS CE sequences according to the amount of capsular distension. All participants were examined by a trained research nurse for effusion, joint line tenderness (JLT) and warmth. We describe the association of vol of synovitis with joint effusion, warmth and JLT. We also explored the association of perimeniscal and peripatellar synovitis with JLT. Correlation of clinical versus radiological grading of effusion is determined.


111 subjects were included. Age: mean=64.4, median(IQR) = 64 (58,70), range =51,81. Gender: m = 36.04% (40/111), f= 63.96% (71/111). BMI: mean = 29.3, median(IQR) = 28.2 (26.0,32.0), range =21.3,42.7. cumulative synovitis mean=8, median(IQR)=9(7,10), range=2,11

Table 1. association of clinical variable with cumulative synovitis MRI score.

Explanatory VariableOutcome VariableOR (CI)
cumulative synovitis scoreAny clinical effusion1.66 (1.32,2.09)
cumulative synovitis scoreSevere clinical effusion1.65 (1.24, 2.18)

There was no significant association of synovitis with warmth or JLT. There was no significant association of radiological effusion and clinical effusion.


We have demonstrated a strong association of cumulative synovitis score with radiological effusion but surprisingly no association with warmth or of JLT.

To cite this abstract, please use the following information:
Thomas, Matthew, Kiran, Amit, Roemer, Frank W., Guermazi, Ali, Javaid, M. Kassim, King, Leonard, et al; Association of Contrast Enhanced MRI Demonstrated Synovitis in Knee Osteoarthritis with Clinical Signs [abstract]. Arthritis Rheum 2009;60 Suppl 10 :201
DOI: 10.1002/art.25284

Abstract Supplement

Meeting Menu