Bidirectional association identified between synovitis and knee and hand osteoarthritis: a general population-based study

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-08-12 DOI:10.1016/j.lanwpc.2024.101169
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Abstract

Background

Synovitis has long been considered a common and modifiable inflammatory feature of osteoarthritis (OA), but current disease-modifying anti-inflammatory treatments appear ineffective in OA clinical trials. Elucidating the temporal relationship between synovitis and OA could provide insight into the role of synovitis in OA.

Methods

We conducted a prospective cohort study based on the baseline and three-year follow-up data from the Xiangya Osteoarthritis (XO) Study. We assessed bidirectional associations between ultrasound-detected synovitis and radiographic and symptomatic OA at knee and hand sites using generalized estimating equations. Additionally, we performed bidirectional Mendelian randomization (MR) analyses to test these hypotheses utilising whole-genome sequencing data in the XO population. Age, sex, body mass index, smoking, alcohol consumption, educational level, physical activity, and joint injury history were adjusted for these analyses.

Findings

A total of 2211, 2420, 2280, and 2600 participants were enrolled for analyses of radiographic knee OA (RKOA), symptomatic knee OA (SKOA), radiographic hand OA (RHOA) and symptomatic hand OA (SHOA), respectively. The baseline synovitis (i.e., with synovitis vs. without synovitis) was associated with the incident RKOA (76/277 vs. 557/3674 knees), SKOA (49/387 vs. 287/4213 knees), RHOA (171/358 vs. 686/3664 hands) and SHOA (35/689 vs. 76/4327 hands), with adjusted odds ratio (aORs) of 2.2 (95% CI 1.7–3.1), 2.0 (1.3–2.9), 3.4 (2.7–4.4), and 2.4 (1.5–3.8), respectively. The baseline RKOA (with OA vs. without OA: 409/1246 vs. 481/3758 knees), SKOA (200/576 vs. 675/4356 knees), RHOA (192/778 vs. 410/3723 hands), and SHOA (41/162 vs. 548/4285 hands) were also associated with the incident synovitis, with aORs of 3.4 (95% CI 2.9–4.1), 2.7 (2.1–3.4), 2.3 (1.8–2.9) and 1.9 (1.2–2.8), respectively. These bidirectional associations were stronger when more active synovitis was compared with the reference group (all P < 0.05). MR analyses further supported bidirectional associations that synovitis significantly increased the odds of incident OA at both sites and vice versa (all ORs ranged from 1.2–1.7).

Interpretation

Our population-based cohort study found novel evidence of a bidirectional association between synovitis and OA, which was further validated through MR analysis and suggested that the bidirectional association is likely causal. Our findings indicated that synovitis is both a risk factor and a consequence of the OA rather than solely a risk factor.

Funding

The National Key Research and Development Plan, the National Natural Science Foundation of China, the Key Research and Development Program of Hunan Province, the Natural Science Foundation of Hunan Province, the Central South University Innovation-Driven Research Programme, and the Fundamental Research Funds for the Central Universities of Central South University.

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滑膜炎与膝关节和手部骨关节炎之间的双向关联:一项基于普通人群的研究
背景长期以来,滑膜炎一直被认为是骨关节炎(OA)的一种常见且可改变的炎症特征,但目前的疾病改变抗炎治疗在 OA 临床试验中似乎效果不佳。方法我们根据湘雅骨关节炎(XO)研究的基线和三年随访数据开展了一项前瞻性队列研究。我们使用广义估计方程评估了超声检测到的滑膜炎与膝关节和手部的影像学和症状性 OA 之间的双向关联。此外,我们还利用XO人群的全基因组测序数据进行了双向孟德尔随机化(MR)分析,以检验这些假设。这些分析对年龄、性别、体重指数、吸烟、饮酒、受教育程度、体力活动和关节损伤史进行了调整。研究结果 共有 2211 人、2420 人、2280 人和 2600 人分别参加了膝关节放射性 OA(RKOA)、症状性膝关节 OA(SKOA)、手部放射性 OA(RHOA)和症状性手部 OA(SHOA)的分析。滑膜炎基线(即与RKOA(76/277 对 557/3674 膝)、SKOA(49/387 对 287/4213 膝)、RHOA(171/358 对 686/3664 手)和无症状手部 OA(SHOA)相关。调整后的几率(aORs)分别为 2.2(95% CI 1.7-3.1)、2.0(1.3-2.9)、3.4(2.7-4.4)和 2.4(1.5-3.8)。基线 RKOA(有 OA 对无 OA:409/1246 对 481/3758 膝)、SKOA(200/576 对 675/4356 膝)、RHOA(192/778 对 410/3723 手)和 SHOA(41/162 对 548/4285 手)分别为:1.0(1.3-2.9)、2.0(1.3-2.9)、3.4(2.7-4.4)和 2.4(1.5-3.8)。RHOA(192/778 对 410/3723 双手)和 SHOA(41/162 对 548/4285 双手)也与滑膜炎的发生有关,其 aOR 分别为 3.4(95% CI 2.9-4.1)、2.7(2.1-3.4)、2.3(1.8-2.9)和 1.9(1.2-2.8)。当活动性滑膜炎与参照组相比时,这些双向关联性更强(所有 P 均为 0.05)。我们基于人群的队列研究发现了滑膜炎与 OA 之间存在双向关联的新证据,并通过 MR 分析进一步验证了这一证据,表明这种双向关联很可能是因果关系。我们的研究结果表明,滑膜炎既是OA的危险因素,也是OA的后果,而不仅仅是危险因素。基金项目国家重点研发计划、国家自然科学基金、湖南省重点研发计划、湖南省自然科学基金、中南大学创新驱动研究计划、中南大学中央高校基础研究基金。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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