Effusion and synovial hyperplasia: Distinct constructs in early and late-stage knee OA.

Robert Dima, Trevor Birmingham, Holly Philpott, Dianne Bryant, Aaron Fenster, C Thomas Appleton

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In one paragraph

Article in Osteoarthritis imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Robert DimaFaculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6A 5B5; Lawson Health Sciences Centre, St. Joseph's Healthcare London, London, Ontario, Canada N6G 1H1. Electronic address: robertdima@hotmail.com.

Trevor BirminghamFaculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6A 5B5.

Holly PhilpottFaculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6A 5B5.

Dianne BryantFaculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6A 5B5.

Aaron FensterDepartment of Medical Biophysics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada N6A 5C1; Centre for Medical Imaging, Robarts Research Institute, London, Ontario, Canada N6A 5K8.

C Thomas AppletonFaculty of Health Sciences, University of Western Ontario, London, Ontario, Canada N6A 5B5; Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada N6A 5C1; Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada N6A 5C1.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveUltrasound (US) permits the assessment of synovial effusion and synovial thickening (hyperplasia) in knee osteoarthritis (OA). We aimed to measure the associations of these features with radiographic OA severity and patient-reported knee-specific pain using a quantitative US image analysis approach.

methodsPatients with symptomatic knee OA were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale, Kellgren-Lawrence (KL) grade, and lateral suprapatellar recess B-mode images were acquired for Outcome Measures in Rheumatology (OMERACT) measurement and grading. US images of effusion-synovitis were manually segmented to calculate effusion and hyperplasia area. Correlation was assessed, and associations with KL grade/KOOS pain were modelled using multivariable linear and quadratic regression with and without adjustment for age, sex, and body mass index (BMI).

resultsQuantitative measures of effusion and hyperplasia area correlated strongly (ρ 0.83 to 0.86) with OMERACT grades and effusion-synovitis depth. Adjusting for age, sex, and BMI, synovial effusion and hyperplasia area are non-linearly related to radiographic severity, a pattern also observed in models of OMERACT global synovitis and effusion-synovitis depth. KOOS pain was associated with effusion-synovitis depth (β=-0.53) and borderline associated with OMERACT hyperplasia (β=-5.55), but not with OMERACT global synovitis, effusion, nor any quantitative effusion-synovitis area measures.

conclusionMinimal US effusion-synovitis among knee OA patients with late-stage disease may indicate maladaptive remodeling of the synovium instead of reduced inflammation. Discriminating between patients with and without maladaptive synovial remodeling in early and late-stage disease should be a priority, as it may improve our ability to predict joint failure.

Indexed as

KneeOsteoarthritisRegression analysisSynovitisUltrasonography

Identifiers

PMID42635962

DOI10.1016/j.ostima.2026.100468

PMCPMC13590911

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.