Currently Viewing:
Currently Reading
What We're Reading: High Court Lets Abortion Cases Stand; NIH and Fetal Tissue; Dsuvia Examined
December 11, 2018 – AJMC Staff
Rate of Uninsured Increased in 2017 for the First Time Since 2014
December 11, 2018 – Allison Inserro
More Than 300 Groups Seek Halt to CMS' Plans for Global Drug Pricing Index
December 10, 2018 – Allison Inserro
Study Confirms Safe Use of Opioids for Pain Control in Sickle Cell Disease
December 10, 2018 – Jackie Syrop
Premature Birth May Induce Variability in the Mother's Systolic Blood Pressure
December 10, 2018 – AJMC Staff
Coalition Agrees on Need to Protect Patients From Surprise Medical Bills
December 10, 2018 – Allison Inserro
What We're Reading: Democrats Split Over Single Payer; Generic Drug Probe; Virginia Work Requirements
December 10, 2018 – AJMC Staff
What Might Come After the Oncology Care Model
December 10, 2018 – Laura Joszt
Some Lifestyle Factors Positively Impact Depression in People With Multiple Sclerosis
December 09, 2018 – Laura Joszt

EULAR Recommendations for Abnormalities in Knee Osteoarthritis Need an Update

David Bai, PharmD
A new study has recommended updated cutoffs for synovial effusion and hypertrophy to help screen for patients with symptomatic radiographic knee osteoarthritis.
The EULAR thresholds of an ultrasound for knee osteoarthritis (OA) were found to have high misclassification rates with poor sensitivity for both synovial effusion and hypertrophy. These were the findings of a new study that has recommended updated cutoffs for synovial effusion and hypertrophy to help screen for patients with symptomatic radiographic knee osteoarthritis (RKOA).

Knee OA is a joint disorder that can be detected through ultrasound. Even though ultrasound is more sensitive than clinical examination at detecting synovial effusion and hypertrophy in knees, values for effusion and hypertrophy are rather limited. Current EULAR cutoff thresholds are not sensitive, leading to patients being misclassified. In the current study, investigators established optimal cutoffs for symptomatic knee OA and analyzed the normal ranges of ultrasound synovial changes in healthy patients, stratified by age, gender, and laterality.

Of the total 299 patients, both male and female, 163 were categorized as healthy controls that had no knee pain or RKOA and 44 patients had symptomatic RKOA. Power doppler signaling was 0.65% in healthy patients and 7% in symptomatic RKOA (P = .0083). Because the frequency was very close to 0 in healthy patients, normal ranges and cutoffs were not needed.

For healthy individuals, age and laterality did not affect synovial effusion and hypertrophy, but gender did. On average, men had greater synovial effusion and hypertrophy than women (median synovial effusion, 4.7 mm versus 3.4 mm, P = .0035; median synovial hypertrophy 2.0 mm vs 0 mm, P = .0012). Synovial hypertrophy differences in gender were still significant after adjusting for height (P = .019); however, effusion was not (P >.05). In most healthy patients, the normal ranges for effusion were 0 mm-10.3 mm in men and 0 mm-9.8 mm in women; the normal ranges for hypertrophy were 0 mm-6.8 mm in men and 0 mm-5.4 mm in women.

After finding the maximum sensitivity and specificity possible, investigators determined that the optimal threshold for effusion in men and women were 7.4 mm and 5.3 mm, respectively, and for synovial hypertrophy, 3.7 mm for men and 1.6 mm for women. Therefore, optimal cutoffs to screen for people with abnormal synovial effusion changes in symptomatic RKOA would be approximately 7 mm in men and 5 mm in women, while abnormal synovial hypertrophy would be 4 mm in men and 2 mm in women. Investigators also determined a threshold for high specificity that would be useful if a more stringent cutoff is required such as in randomized clinical trials. Thresholds with a specificity of 90% was defined as 8.9 mm (~9 mm) in men and 7.8 mm (~8 mm) in women for synovial effusion and 5.8 mm (~6 mm) in men and 4.2 mm (~4 mm) in women for synovial hypertrophy.

The increased use of ultrasound for knee OA requires more specific classifications for categorizing patients that are healthy and patients that have symptomatic RKOA. The authors recommend that the different thresholds found for both synovial effusion and hypertrophy can be used to revise previous EULAR guidelines for ultrasound abnormalities in knee OA.


Sarmanova A, Hall M, Fernandes GS, et al. Thresholds of ultrasound synovial abnormalities for knee osteoarthritis – a cross sectional study in the general population [published online November 16, 2018]. Osteoarthritis Cartilage. doi: 10.1016/j.joca.2018.09.018.

Related Articles

Inefficiencies in Osteoarthritis and Chronic Low Back Pain Management
Hydroxychloroquine Ineffective in Treating Hand Osteoarthritis Compared With Placebo
AJMC® Pharmacy Benefits Special Issue Features Long-Acting Insulins, Switching Rheumatoid Arthritis Drugs, Adherence in ADHD and More
EULAR Asserts Physical Activity Integral to Care Plan in RA
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up

Sign In

Not a member? Sign up now!