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Observational Study
. 2019 Jan;27(1):80-89.
doi: 10.1016/j.joca.2018.09.004. Epub 2018 Sep 20.

Diagnostic Performance of Knee Physical Exam and Participant-Reported Symptoms for MRI-detected Effusion-Synovitis Among Participants With Early or Late Stage Knee Osteoarthritis: Data From the Osteoarthritis Initiative

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Observational Study

Diagnostic Performance of Knee Physical Exam and Participant-Reported Symptoms for MRI-detected Effusion-Synovitis Among Participants With Early or Late Stage Knee Osteoarthritis: Data From the Osteoarthritis Initiative

A Berlinberg et al. Osteoarthritis Cartilage. .
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Abstract

Objective: Evaluate the diagnostic performance of knee physical exam findings and participant-reported symptoms for MRI-detected effusion-synovitis (ES) among knees with early and late-stage osteoarthritis (OA).

Design: The Osteoarthritis Initiative (OAI) is a longitudinal study of participants with or at risk for knee OA. Two samples with MRI readings were available: 344 knees with early OA (312 participants) and 216 with late-stage OA (186 participants). Trained examiners performed bulge sign (BS) and patellar tap (PT) exams, and participants reported on knee swelling and pain with leg straightening. Effusion-synovitis on 3T non-contrast MRI was scored using the MRI Osteoarthritis Knee Score (MOAKS). Diagnostic performance of physical exam findings and symptoms was estimated with bootstrapped confidence intervals.

Results: For the early OA sample, the highest sensitivity for medium/large effusion-synovitis was achieved with a positive finding for any of the physical exam maneuvers and/or participant-reported symptoms (81.0 [95% CI: 70.0, 91.3]). Both knee symptoms in combination had a prevalence of 11.7% and yielded the highest estimated positive predictive value (PPV) (50.0 [95% CI: 34.2, 66.7]) and likelihood ratio positive (LR+) (5.2 [95% CI: 2.9, 9.7]). In late-stage OA knees, exam findings and symptoms provided minimal information beyond the prevalence.

Conclusion: Patient report of both symptoms, or at least one positive exam finding and at least one symptom, could be used to identify knees at increased risk of effusion-synovitis in knees with early stage OA, either for screening purposes in clinical evaluation, or for study sample enrichment with an inflammatory phenotype; diagnostic performance was not sufficiently high for clinical diagnostic purposes.

Keywords: Diagnostic accuracy; Effusion-synovitis; Knee osteoarthritis.

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