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Knee effusion-synovitis volume measurement and effects of vitamin D supplementation in patients with knee osteoarthritis

journal contribution
posted on 2023-05-19, 12:23 authored by Wang, X, Cicuttini, F, Jin, X, Wluka, AE, Han, W, Zhu, Z, Christopher BlizzardChristopher Blizzard, Benny Eathakkattu AntonyBenny Eathakkattu Antony, Tania WinzenbergTania Winzenberg, Graeme JonesGraeme Jones, Chang-Hai DingChang-Hai Ding
Objective: To develop a measure of knee joint effusion-synovitis volume and to examine the effect of vitamin D supplementation on effusion-synovitis in people with knee osteoarthritis (OA) and low vitamin D levels over 24 months.

Method: Symptomatic knee OA patients with low 25-(OH)D levels (12.5-60 nmol/l) were recruited for a multi-centre, randomised, placebo-controlled and double-blind trial. Participants (age 63 ± 7 years, 208 females) were allocated to either 50,000 IU monthly vitamin D3 (n = 209) or placebo (n = 204) for 24 months. Knee effusion-synovitis volume in suprapatellar and other regions was measured on magnetic resonance imaging (MRI) using OsiriX software. The intra-class correlation coefficients (ICCs) were used to test inter- and intra-rater reliabilities. The least significant change criterion was used to define the increase/decrease in effusion-synovitis volume.

Result: The reproducibilities of effusion-synovitis volume measurement were high with ICCs ranging from 0.93 to 0.99. Over 24 months, effusion-synovitis volume remained stable in the vitamin D group but increased in placebos with a significant between-group difference (-1.94 ml, 95% confidence interval (CI): -3.54, -0.33). This effect was evident in those with baseline effusion-synovitis and with suprapatellar effusion-synovitis. The proportion with an increase in effusion-synovitis volume was lower in the vitamin D group than placebo (risk ratio (RR): 0.87, 95% CI: 0.77, 0.97).

Conclusion: This highly reproducible effusion-synovitis volume measurement could be a promising outcome measure in OA trials. Vitamin D supplementation could retard the progression of effusion-synovitis which can potentially benefit people with an inflammatory OA phenotype.


Publication title

Osteoarthritis and Cartilage










Menzies Institute for Medical Research


W B Saunders Co Ltd

Place of publication

United Kingdom

Rights statement

© 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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Socio-economic Objectives

Clinical health not elsewhere classified

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