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.
Reference
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.
The Pivotal Role of Payers in Improving Health Equity, Maternal Health Care in the US
March 26th 2024A presentation at the Greater Philadelphia Business Coalition on Health's 2024 Women’s Health Summit discussed how payers, including employers and public entities, can strategically influence health care purchasing to prioritize maternal health and equity.
Read More
Addressing Maternal Mortality in Medicaid by Focusing on Mental Health
February 15th 2023On this episode of Managed Care Cast, we speak with Inland Empire Health Plan, a managed care plan serving more than 1.4 million residents on Medi-Cal in California, about a new maternal mental health program aimed at supporting new mothers, both before they give birth and afterward.
Listen
For National Women’s Health Week, One Company Emphasizes Cardiovascular Risk Management
May 10th 2022On this episode of Managed Care Cast, we speak with Joanne Armstrong, MD, MPH, vice president and chief medical officer for Women’s Health and Genomics at CVS Health, on the distinct pathophysiology of cardiovascular disease in women and how her own health experiences have influenced her perspective on cardiovascular disease management.
Listen
What We’re Reading: Historic Low of Uninsured; Youth Gender Treatments; Birth Control Recall
August 4th 2023A record low of 7.7% of Americans had no health insurance at the start of 2023; the American Academy of Pediatrics renewed its backing of gender care for children while requesting a research review; 2 lots of an oral contraceptive were recalled for possible reduction in effectiveness.
Read More
Lawyers were questioned in a federal lawsuit intending to overturn approval of a drug used for medication abortion; during the COVID-19 pandemic in 2021, US maternal mortality increased for the third year in a row; the Alzheimer’s Association is lobbying Congress to push for Medicare coverage of new Alzheimer drugs under early access.
Read More