Nicolas Deseyne1, Thierry Conrozier2, Henri Lellouche3, Bernard Maillet4, Ulrich Weber5, Jacob L Jaremko6, Joel Paschke7, Jonathan Epstein8, Walter P Maksymowych9, Damien Loeuille10. 1. Department of Rheumatology, CHRU de Nancy, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France. Electronic address: nico.deseyne@gmail.com. 2. Department of Rheumatology, North Hospital Franche-Comté, 25200 Montbéliard, France. 3. Department of Rheumatology, Lariboisière Hospital, 75475 Paris cedex 10, France. 4. Department of Rheumatology, Clinique Saint-Odilon, 03000 Moulins, France. 5. King Christian 10th Hospital for Rheumatic Diseases, Gråsten, Denmark; Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark. 6. Department of Radiology and Diagnostic Imaging, University of Alberta, Alberta AB T6G 2R3, Edmonton, Canada. 7. CaRE Arthritis, Alberta T6W 2Z8, Edmonton, Canada. 8. CEC-Inserm CIE6, epidemiology and clinical evaluations department, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France. 9. Department of Medicine, University of Alberta, Alberta AB T6G 2R3, Edmonton, Canada. 10. Department of Rheumatology, CHRU de Nancy, 5, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
Abstract
OBJECTIVE: To assess predictors of response, according to hip MRI inflammatory scoring system (HIMRISS), in a sample of patients with hip osteoarthritis (OA) treated by hyaluronic acid (HA) injection. METHOD: Sixty patients with hip OA were included. Clinical outcomes were assessed at baseline and three months after HA injection by WOMAC. On hip MRI performed before HA injection, bone marrow lesion (BML) and synovitis were assessed by HIMRISS by four readers. The inter-reader reliability of HIMRISS was for HIMRISS total, acetabular BML, femoral BML and synovitis-effusion respectively 0.86, 0.64, 0.83 and 0.78. Associations between MRI features and clinical data were assessed. Logistic regression (univariate and multivariate) was used to explore associations between MRI features and response to HA injection, according to WOMAC50 response at three months. RESULTS: In total, 45.5% of patients met WOMAC50 response. Five adverse events were reported. At baseline, WOMAC function correlated significantly to HIMRISS synovitis-effusion (r=0.27, P=0.03). In univariate analysis, BML femoral according to binary assessment (P=0.025), HIMRISS BML femoral (P=0.0038), HIMRISS BML acetabular (P=0.042), HIMRISS total (P=0.0092) were associated negatively with WOMAC50 response. In multivariate analysis, adjusted for age and BMI, HIMRISS femoral BML (P=0.02) and HIMRISS total (P=0.016) were negatively associated with response. At a HIMRISS threshold of<15, 82% of patients were responders, with specificity SP=0.97, sensitivity SN=0.39, and positive and negative predictive values of 0.91 and 0.64, respectively. CONCLUSION: HIMRISS is reliable for total scores and sub-domains. It permits identification of responders to HA injection in hip OA patients.
OBJECTIVE: To assess predictors of response, according to hip MRI inflammatory scoring system (HIMRISS), in a sample of patients with hip osteoarthritis (OA) treated by hyaluronic acid (HA) injection. METHOD: Sixty patients with hip OA were included. Clinical outcomes were assessed at baseline and three months after HA injection by WOMAC. On hip MRI performed before HA injection, bone marrow lesion (BML) and synovitis were assessed by HIMRISS by four readers. The inter-reader reliability of HIMRISS was for HIMRISS total, acetabular BML, femoral BML and synovitis-effusion respectively 0.86, 0.64, 0.83 and 0.78. Associations between MRI features and clinical data were assessed. Logistic regression (univariate and multivariate) was used to explore associations between MRI features and response to HA injection, according to WOMAC50 response at three months. RESULTS: In total, 45.5% of patients met WOMAC50 response. Five adverse events were reported. At baseline, WOMAC function correlated significantly to HIMRISS synovitis-effusion (r=0.27, P=0.03). In univariate analysis, BML femoral according to binary assessment (P=0.025), HIMRISS BML femoral (P=0.0038), HIMRISS BML acetabular (P=0.042), HIMRISS total (P=0.0092) were associated negatively with WOMAC50 response. In multivariate analysis, adjusted for age and BMI, HIMRISS femoral BML (P=0.02) and HIMRISS total (P=0.016) were negatively associated with response. At a HIMRISS threshold of<15, 82% of patients were responders, with specificity SP=0.97, sensitivity SN=0.39, and positive and negative predictive values of 0.91 and 0.64, respectively. CONCLUSION: HIMRISS is reliable for total scores and sub-domains. It permits identification of responders to HA injection in hip OA patients.