title: Are ultrasonographic signs of inflammation predictors for response to intra-articular glucocorticoids in knee osteoarthritis?
abstract: OBJECTIVE
  To investigate the predictive value of ultrasound (US) characteristics for the effect of intra-articular glucocorticoids in knee osteoarthritis (OA).
  
  
  METHODS
  In this prospective cohort study, 62 patients with symptomatic knee OA (clinical knee OA criteria, pain>4 on a Numerical Rating Scale (NRS; 0-10)) received an intra-articular glucocorticoid injection (40 mg triamcinolone acetonide). Patients with NRS pain ≤4 at 4 weeks were defined as responders. On inclusion, demographics, clinical data (body mass index, local swelling) knee x-rays and knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire were collected. Six US features were assessed including: effusion, synovial hypertrophy, Baker's cyst, infrapatellar bursitis, meniscal protrusion and cartilage thickness. Stepwise multiple logistic regression analyses with forward selection were conducted to identify possible predictors.
  
  
  RESULTS
  At 4 weeks, 42% of the study participants reached a NRS ≤4; an effect comparable to existing literature. Regression analyses showed that patients who used analgesics at baseline were less likely to have a good response. The small proportion of patients with infrapatellar bursitis was more likely to respond to the injection.
  
  
  CONCLUSIONS
  No patient, disease or US characteristic of inflammation, turned out to be a reliable and clinically meaningful predictor for the effect of intra-articular glucocorticoids after four weeks in knee OA.
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands. k.bevers@maartenskliniek.nl.
authors.forename: Karen
authors.initials: K
authors.lastname: Bevers
authors.forename: Manon C
authors.initials: MC
authors.lastname: Zweers
authors.forename: Joke E
authors.initials: JE
authors.lastname: Vriezekolk
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
authors.forename: Alfons A
authors.initials: AA
authors.lastname: den Broeder
mesh_terms: D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007269:Injections, Intra-Arterial; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D014463:Ultrasonography
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide