Objective

To systematically review the literature on the relationship between markers of inflammation and pain in patients with knee osteoarthritis (OA).

Methods

We searched MEDLINE, Web of Science and EMBASE databases from inception until June 2021. Eligible articles had to report on the association between inflammation (as measured by effusion, synovitis, baker's cysts, cytokines and C-reactive protein) and pain in patients with radiographic knee OA. Two reviewers independently performed a screening on title and abstracts, data extraction and risk of bias assessment using the Newcastle–Ottawa Scale (NOS). A best evidence synthesis was conducted for each inflammatory sign included in this review.

Results

37 studies were included. Articles reported on the following measures: effusion or synovitis assessed via ultrasound (n = 9) or magnetic resonance imaging (MRI) (n = 17); baker's cyst (n = 3); cytokine concentrations (n = 11); and C-reactive protein levels (n = 4). The strength of the association between inflammation and pain does not exceed the moderate level (i.e., correlation coefficient values ranging from 0.19 to 0.61). Moderate levels of evidence were found for the association between synovitis (measured with ultrasound or contrast enhanced MRI) and pain. The levels of evidence between effusion (assessed via ultrasound), effusion/synovitis (assessed via non-contrast enhanced MRI), Baker's cyst, cytokines, C-reactive protein and pain were conflicting.

Conclusions

Different inflammatory markers are associated with pain but the correlation ranges from weak to moderate, and the quality of evidence from conflicting to moderate. Further research is needed to strengthen the level of evidence and to establish mechanisms.

中文翻译：

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膝骨关节炎患者膝关节炎症与膝关节疼痛的关系：系统评价

客观的

系统回顾膝骨关节炎（OA）患者炎症标志物与疼痛之间关系的文献。

方法

我们检索了 MEDLINE、Web of Science 和 EMBASE 数据库从开始到 2021 年 6 月。符合条件的文章必须报告炎症（通过积液、滑膜炎、贝克囊肿、细胞因子和 C 反应蛋白测量）与放射学患者疼痛之间的关联膝关节OA。两名评审员使用纽卡斯尔-渥太华量表 (NOS) 独立地对标题和摘要、数据提取和偏倚风险评估进行了筛选。对本综述中包含的每个炎症体征进行了最佳证据综合。

结果

纳入了 37 项研究。文章报道了以下措施：通过超声（n  = 9）或磁共振成像（MRI）（n  = 17）评​​估积液或滑膜炎；贝克氏囊肿（n  = 3）；细胞因子浓度（n  = 11）；和 C 反应蛋白水平 ( n = 4)。炎症和疼痛之间的关联强度不超过中等水平（即相关系数值范围从 0.19 到 0.61）。对于滑膜炎（通过超声或对比增强 MRI 测量）与疼痛之间的关联，发现了中等水平的证据。积液（通过超声评估）、积液/滑膜炎（通过非对比增强 MRI 评估）、贝克氏囊肿、细胞因子、C 反应蛋白和疼痛之间的证据水平相互矛盾。

结论

不同的炎症标志物与疼痛相关，但相关性范围从弱到中，证据质量从矛盾到中等。需要进一步研究以加强证据水平并建立机制。