Early-stage knee osteoarthritis: assessment of structural changes using imaging methods

Objective. To identify magnetic resonance imaging (MRI) features of structural changes in patients with early-stage knee osteoarthritis (OA) using the Whole-Organ Magnetic Resonance Imaging Score (WORMS).
Material and methods. The study included 78 women aged 35–68 years with knee pain lasting no longer than 1 year and minimal radiographic changes according to Kellgren–Lawrence grade 0–II (without joint space narrowing). A standardized individual record was completed for each patient, including anthropometric data (body mass index, BMI), disease history, results of clinical examination, assessment of knee pain by visual analogue scale, global health assessment by the patient, WOMAC index, KOOS scale, DN4 questionnaire, and information on comorbidities. All patients underwent standard radiography, ultrasound, knee MRI, and laboratory testing. MRI images were assessed using WORMS.
Results and discussion. At the early stage of OA, the most common MRI findings were synovitis (96.2%), cartilage changes (93.6%), and degenerative meniscal lesions (up to 89.7%). Osteophytes, mostly of small size, were detected in 38.5% of patients; osteitis and subchondral cysts were relatively rare (<15%). Correlation analysis showed no associations between synovitis, cartilage defects, and clinical/anthropometric parameters. Moderate but significant associations were observed between osteophytes, osteitis, meniscal lesions and patients’ age, BMI, metabolic syndrome (MS), and knee pain intensity. Comparative analysis of imaging modalities (MRI, ultrasound, and radiography) showed that the frequency of osteophyte detection by MRI (38.5%) was comparable to radiography (34.6%), while ultrasound detected significantly fewer cases (16.6%). MRI demonstrated the highest diagnostic yield for synovitis (96.2%), surpassing ultrasound (84.6%) and clinical examination (23%) (p<0.05).
Conclusion. MRI is a valuable tool for visualizing structural changes in early OA. In patients with such clinical risk factors as older age, increased BMI, MS, pain, and clinically detected synovitis, MRI can be considered a justified method for verifying early OA signs. Significant correlations between MRI changes and clinical parameters provide prospects for improving early OA diagnosis.

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