J. Gratacós

Differential involvement of synovial adipokines in pain and physical function in female patients with knee osteoarthritis. A cross-sectional study

OBJECTIVEnAdipokines have been reported to play a role in the development, progression and severity of knee osteoarthritis but the influence of the different adipokines are not well known. The aim of this study was to evaluate the association between different synovial fluid adipokines with pain and disability knee osteoarthritis patients.nnnMETHODSnCross-sectional study with systematic inclusion of 115 symptomatic primary knee osteoarthritis female patients with ultrasound-confirmed joint effusion. Age, physical exercise, symptoms duration and different anthropometric measurements were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales and Knee injury and Osteoarthritis Outcome Score (KOOS) pain and function scales. Seven adipokines and three inflammatory markers were measured by ELISA in synovial fluid. Partial Correlation Coefficient (PCC) and corresponding 95% confidence interval were used as a measure of association.nnnRESULTSnLeptin, osteopontin and inflammatory factors, especially TNF-alpha, were associated to pain and function. After adjustment for potential confounders including inflammatory factors and all adipokines, an association was found for adiponectin with pain (PCC 0.240 [0.012, 0.444]) and for resistin and visfatin with function (PCC 0.336 [0.117, 0.524] andxa0-0.262 [-0.463,xa0-0.036]). No other adipokines or inflammatory markers were statistically and independently associated. An association between physical exercise and pain and disability remained after adjustment, whereas an attenuation of the influence of anthropometric measurements was observed.nnnCONCLUSIONSnDifferent patterns of association between synovial fluid adipokines were observed regarding pain and disability in knee osteoarthritis patients. Specifically, adiponectin was associated to pain while resistin and visfatin were mainly related to function.

More prominent inflammatory features in knee osteoarthritis in the presence of concomitant hand osteoarthritis

s / Osteoarthritis and Cartilage 21 (2013) S63–S312 S142 infection within 2years of their surgery, but did not differ in terms of risk for DVT/PE, early revision, infection, peri-prosthetic fracture or death following TKA. To our knowledge, this is the first study that has utilized a validated algorithm to identify TKA recipients with RA, thereby increasing the validity of our findings, and aiding patientphysician decision-making around joint replacement in patients with RA. Further research is required to elucidate potential explanations for the higher rates of infection in RA versus OA, including the use of biologic agents. 261 MORE PROMINENT INFLAMMATORY FEATURES IN KNEE OSTEOARTHRITIS IN THE PRESENCE OF CONCOMITANT HAND OSTEOARTHRITIS C. Orellana, N. Navarro, J. Calvet, M. Garcia-Manrique, J. Gratacos, M. Larrosa. CSiU Parc Tauli. Hosp. de Sabadell, Sabadell, Spain Background: In recent years it has been recognized the existence of a link between hand osteoarthritis and systemic inflammation. On the other hand, a significant proportion of patients with knee osteoarthritis show local clinically evident inflammatory features such as synovial effusion and synovial hypertrophy. Purpose: To evaluate if patients with knee osteoarthritis show more inflammatory signs as measured by ultrasound when hand osteoarthritis is concomitantly present. Methods: Patients aged 50 years or more with symptomatic osteoarthritis of the knee and joint effusion, Kellgren-Lawrence II-III. Demographics, BMI, disease duration, pain assessed by VAS (0-100 mm) and algofuncional Lequesne index were assessed. Knee ultrasound was performed evaluating and measuring the presence of effusion and synovial hypertrophy (defined as > 4 mm synovial thickening) at the suprapatellar midline. Results: In a cross-sectional study we analyzed 50 patients, F/M 39/11, age 61.8 10.1 years, disease duration 50.8 6.3 months, BMI 28 1.4 kg/cm2. Ten patients (20%) had concomitant hand osteoarthritis. There were no significant differences in age, disease duration, BMI or radiological grade between patients with knee and hand osteoarthritis compared with those with only knee osteoarthritis. On ultrasound examination patients with concomitant hand osteoarthritis showed a clear trend to have a more prominent joint effusion (7.39 3 vs. 6.7 2.8 mm) and synovial hypertrophy (3.6 2.6 vs. 2.7 1.8 mm), although not statistically differences were found. Patients with concomitant hand osteoarthritis also had a non-significant trend to experience greater knee pain (VAS 70.3 12.5 vs. 61 18.5 mm) and Lesquesne index scores (11.4 3.3 vs. 9.8 2.9). Conclusions: Although results were not statistically significant probably in relation to small size sample, in this study the presence of hand osteoarthritis appeared to be associated with greater inflammatory features in patients with symptomatic knee osteoarthritis. 262 NETWORKING TO CAPTURE PATIENT-REPORTED OUTCOMES DURING ROUTINE ORTHOPAEDIC CARE ACROSS TWO DISTINCT INSTITUTIONS R. Karia y, J. Slover y, C. Hauer z, Z. Gelber y, P. Band y, J. Graham z. yNew York Univ. Sch. of Med., NY, USA; zGeisinger Med. Systems, Danville, PA,

305 INCREASED SEVERITY OF SYNOVIAL HYPERTROPHY BY ULTRASOUND IN KNEE OSTEOARTHRITIS OF SHORTER DISEASE DURATION

Purpose: To analyze whether the existence or severity of inflammatory changes as detected by ultrasound (synovial effusion and /or hypertrophy) are related to disease duration in patients with knee osteoarthritis. Methods: Patients aged 50 y or more with symptomatic osteoarthritis of the knee and joint effusion, Kellgren-Lawrence II-III. Demographics, BMI, duration from onset of symptoms, pain assessed by VAS (0–10 cm) and the Lequesne index algofuncional were analyzed in a cross-sectional study. Knee ultrasound was performed evaluating and measuring the presence of effusion and synovial hypertrophy at the suprapatellar midline. Two groups were established depending on whether the evolution time from the onset of symptoms was less than or equal to or greater than 2 years. Results: Thirty patients were analyzed, F/M 29/6, age 61.7±9.6 y, disease duration 46.1±43 months, BMI 30.6±4.9 kg/cm2. Disease duration was ≤ 2 years in 19 patients (54.3%). There were no differences according to disease duration with regard to age, BMI or radiological grade. Patients with osteoarthritis of the knee with less evolution time showed a moderate tendency to have a greater joint effusion (7±3.1 vs. 6.6±2.6mm, ns). Synovial hypertrophy was significantly greater in the shorter duration group (6.9±2.1 vs. 4.1±2.1mm, P< 0.005) and also showed a tendency to have higher pain by VAS (6.5±1.5 vs. 5.9±2.6, ns). On the other hand, patients with a longer history of knee OA showed significantly higher scores on the Lequesne index (11.3±4 vs. 8.4±2.6, p < 0.05). Conclusions: In this sample of patients with symptomatic knee OA, synovial hypertrophy had a greater thickness in patients with shorter disease duration. This finding could be related to the existence of pain in the early stages of the disease.

318 FUNCTIONAL IMPAIRMENT IN PATIENTS WITH FEMOROACETABULAR IMPINGEMENTWITHOUT RADIOGRAPHIC OSTEOARTHRITIS

who do not speak the Dutch language; those with previous ACL injury or meniscus or cartilage damage (diagnosed by an orthopaedic surgeon or sports physician); those with previous surgery of the involved knee; those with disabling co-morbidity; and those with already osteoarthritic changes on X-ray (Kellgren & Lawrence > 0) will be excluded. As control group (n=80) the healthy knee of the patients will be used (with similar exclusion criteria). Patients will be recruited at the outpatient clinic of the department of orthopaedics of Erasmus Medical Center (Rotterdam) and the department of orthopaedics or sports medicine of Medical Center Haaglanden (The Hague). The expected recruitment period was 1 year. Unfortunately this period needed to be extended. We started with inclusions in February 2009 and the current expectation is to obtain the inclusion of 160 patients in September 2010. There were several reasons for this delay, of which two in particular. First, a lot of patients were excluded because of their age (> 45 years or 0). In addition, the X-ray and DEXA scan measurements are used for evaluating the bone shape and bone density changes over time (active shape modelling). To identify early degenerative changes on MRI, we will use the Knee Osteoarthristis Scoring System (KOSS), a semi quantitative, multi-feature scoring method, reported by Kornaat et al. Serum and urine are collected for assessment of biomarkers. At the end of the study a combination of biomarkers will be determined. Results: At this moment the recruitment period is still ongoing. At the 30th of April 2010 109 patients were included, of which 66% is male. The median age of the included patients is 25 years (range, 18 to 45 years) and the median Tegner activity scale, before trauma, is 9 (range 3 to 10).

300 HIGH PREVALENCE OF VENOUS INSUFFICIENCY IN PATIENTS WITH KNEE OSTEOARTHRITIS

limitation and 17% reported improvement on the transition question at 3 years. Changes in AUSCAN scores in the hand OA group were 0.0 (3.8) for Pain, 0.1 (1.0) for Stiffness and -0.6 (6.1) for Functional limitation with 14% reporting improvement on the transition question at 3 years. Baseline and 3-year AUSCAN scores were consistently higher in the hand OA group compared with the no OA group. Conclusions: Hand OA is thought to have a good prognosis. This study shows high levels of disabling pain at baseline, which do not improve over three years. Only a minority of participants with hand OA report improvement in the medium term. Longer-term follow up can help to determine the burden of hand OA and to assess the impact of this on pain and functional limitation.