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The value of different involvement patterns of the knee “synovio-entheseal complex” in the differential diagnosis of spondyloarthritis, rheumatoid arthritis, and osteoarthritis: an MRI-based study

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To explore the different involvement patterns of the knee “synovio-entheseal complex (SEC)” on MRI in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA).

Methods

This study retrospectively included 120 patients (male:female, 55:65) with a mean age of 39.20 years diagnosed with SPA (n = 40), RA (n = 40), and OA (n = 40) at the First Central Hospital of Tianjin between January 2020 and May 2022. Six knee entheses were assessed by two musculoskeletal radiologists according to the SEC definition. Bone marrow lesions associated with entheses include bone marrow edema (BME) and bone erosion (BE), which were classified as entheseal or peri-entheseal based on their relationship to the entheses. Three groups (OA, RA, and SPA) were established to characterize the location of enthesitis and the different SEC involvement patterns. Inter-group and intra-group differences were analyzed using the ANOVA or chi-square tests, and the inter-class correlation coefficient (ICC) test was used to determine inter-reader agreement.

Results

The study contained a total of 720 entheses. The SEC-based analysis revealed different involvement patterns in three groups. The OA group had the most abnormal signals in tendons/ligaments (p = 0.002). The RA group had considerably greater synovitis (p = 0.002). The majority of peri-entheseal BE was identified in the OA and RA groups (p = 0.003). Furthermore, entheseal BME in the SPA group was significantly different from those in the other two groups (p < 0.001).

Conclusions

SEC involvement patterns differed in SPA, RA, and OA, which is important for differential diagnosis. SEC should be used as a whole evaluation method in clinical practice.

Key Points

• The “synovio-entheseal complex (SEC)” explained differences and characteristic alterations in the knee joint in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA).

• The various SEC involvement patterns are crucial for differentiating SPA, RA, and OA.

• When “knee pain” is the only symptom, a detailed identification of characteristic alterations in the knee joint of SPA patients may help timely treatment and delay the structural damage.

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Abbreviations

ASAS:

Assessment of Spondyloarthritis international Society

BE:

Bone erosion

BME:

Bone marrow edema

BML:

Bone marrow lesions

CL:

Collateral ligament

ESSG:

European Spondyloarthropathy Study Group

GTi:

Gastrocnemius tendon insertion

HIS:

Hospital information system

HLA-B27:

Human leukocyte antigen B27

ICC:

Inter-class correlation coefficient

LCL-PT:

Lateral collateral ligament + popliteal tendon (femoral attachment)

MCP:

Metacarpophalangeal

OA:

Osteoarthritis

PCL:

Posterior cruciate ligament (tibial attachment)

PDW-SPAIR:

Proton density–weighted-spectral attenuated inversion recovery

PsA:

Psoriatic arthritis

PTi:

Patellar tendon insertion

PTo:

Patellar tendon origin

QTi:

Quadriceps tendon insertion

RA:

Rheumatoid arthritis

SEC:

Synovio-entheseal complex

SPA:

Spondyloarthritis

T1W-TSE:

T1-weighted turbo spin echo

T2W-FFE:

T2-weighted fast field echo

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Acknowledgements

Thanks to all colleagues in the radiology department of Tianjin First Central Hospital for their support. In addition, we thank Dr. Huang Shan (Philips Healthcare, Shanghai) for her linguistic assistance in this study.

Funding

Funded by Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-041A).

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Author notes

  1. Boya Li contributed to the manuscript as the first author.

Authors and Affiliations

  1. First Central Clinical College, Tianjin Medical University, Tianjin, China

    Boya Li & Zikang Guo

  2. Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China

    Jin Qu, Ying Zhan & Xinwei Lei

  3. Clinical Science, Philips Healthcare, Beijing, China

    Zhiwei Shen

  4. Department of radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, NO. 24 Fukang Road, Nankai District, Tianjin, 300192, China

    Xinwei Lei

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Correspondence to Xinwei Lei.

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The scientific guarantor of this publication is Xinwei Lei.

Conflict of interest

One of the authors (Zhiwei Shen) is an employee of Philips Healthcare. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was omitted by the Institutional Review Board of Tianjin First Central Hospital Medical Ethics Committee because the study was performed in a retrospective manner.

Ethical approval

This study was approved by the Institutional Review Board of Tianjin First Central Hospital Medical Ethics Committee (No.2022N143KY).

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• cross-sectional study

• performed at one institution

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Li, B., Guo, Z., Qu, J. et al. The value of different involvement patterns of the knee “synovio-entheseal complex” in the differential diagnosis of spondyloarthritis, rheumatoid arthritis, and osteoarthritis: an MRI-based study. Eur Radiol 33, 3178–3187 (2023). https://doi.org/10.1007/s00330-023-09485-4

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  • DOI: https://doi.org/10.1007/s00330-023-09485-4

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