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Background Knee pain is highly prevalent in elderly and influences quality of life. Pathogenesis of knee pain in such population is commonly related to osteoarthritis (OA). It is yet unclear however, which pathological lesions in the knee contribute most to symptomatic disease. Objectives To define the articular and enthesal inflammatory and structural lesions that contribute to knee pain in an elderly healthy population using Power Doppler ultrasound (PDUS). Methods All subjects (≥65 years) were part of the prospective long-term population-based Bruneck Study (1) and received a clinical and ultrasound investigation of both knees. Ultrasound was performed by an independent investigator unaware of clinical symptoms. Knee entheses (quadriceps insertion, proximal and distal patella insertion) and joint cavity were assessed. Demographic variables were recorded in all individuals. Pain sensation during knee palpation was collected and participants were asked to complete a standardized pain questionnaire for knee joints (Knee injury and osteoarthritis outcome score [KOOS], question P1-P9) (2). Joint changes (synovial hypertrophy, power doppler (PD) signal, joint effusion, baker cysts, osteophytes) were assessed using a GE Logic E device. Enthesial changes such as positive PD, calcification, enthesiophytes as well as hypoechogenecity were also recorded. All ultrasound abnormalities were scored using validated OMERACT scores. The prevalence of observed changes was compared between subjects without palpation pain and participants with pain. By summing up the articular and entheseal changes a total score was calculated and correlated with the KOOS pain values. Results A total of 303 (Male 154; Female 149) aged participants (age: 75.3±6.9 years) underwent ultrasound examination of both knees. Knee tenderness was found by 30/149 (20.1%) women and 15/154 (9.7%) men. Ultrasound effusion (p=0.010), synovial hypertrophy (p=0.001), PD synovial activity (p=0.003) and osteophytes (p=0.001) were more prevalent in women with knee tenderness than without. In men, knee tenderness was associated PD synovial activity (p=0.0014), and entheseal calcification (p=0.020). Presence of more than 1 ultrasound pathology was associated with lower KOOS pain values, indicating higher impact on symptoms. This was observed in both women (r=-0.285, p=0.021) and men (r=-0.298, p=0.008). Conclusion In an elderly healthy population, knee pain is associated with the presence of joint and entheseal inflammatory lesions. References [1] D’Agostino MA, Iagnocco A, Aegerter P, Kleyer A, Zwerina J, Perricone C, Lorenzini R, Aschenbrenner F, Willeit J, Kiechl S, Schett G. Does subclinical inflammation contribute to impairment of function of knee joints in aged individuals? High prevalence of ultrasound inflammatory findings. Rheumatology (Oxford). 2015Sep;54(9):1622-9. [2] Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther1998;28:88-96. Disclosure of Interests David Simon Grant/research support from: Novartis, Consultant for: Lilly, Speakers bureau: Janssen, Arnd Kleyer Grant/research support from: Lilly, Consultant for: Lilly, Speakers bureau: Abbvie, Antonella Adinolfi: None declared, Johann Willeit: None declared, Stefan Kiechl: None declared, Nina Gasperi: None declared, Georg Schett: None declared, Christian Dejaco Speakers bureau: MSD, Pfizer, UCB, AbbVie, Roche, Novartis, Lilly, Celgene, Merck, Sandoz, Annamaria Iagnocco: None declared, Maria-Antonietta d’Agostino: None declared |
