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ReplyLetter

Dr. Elsaman, et al reply

AHMED ELSAMAN, AHMED RADWAN, WALAA MOHAMMED and SARAH OHRNDORF
The Journal of Rheumatology December 2016, 43 (12) 2199; DOI: https://doi.org/10.3899/jrheum.161169
AHMED ELSAMAN
Consultant and lecturer in rheumatology and rehabilitation, Sohag University;
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AHMED RADWAN
Consultant and lecturer in rheumatology and rehabilitation, Sohag University;
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WALAA MOHAMMED
Consultant and lecturer in pharmacology, Sohag University, Sohag, Egypt;
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SARAH OHRNDORF
Specialist in Internal Medicine/Rheumatology, Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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  • For correspondence: sarah.ohrndorf@charite.de
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To the Editor:

The theory that pain in osteoarthritis (OA) is due to effusion is not answered in our study1. All the patients included in our study initially had effusion on clinical and ultrasound examination1. To prove the theory that pain in OA had been due to effusion, we would have had to include patients with painful osteoarthritic knee and examine all of them by ultrasound to detect the cause of pain.

The ratio of painful osteoarthritic knee effusion ranges from 44% to 79%2,3. However, 16% of osteoarthritic knee effusion is painless4. It can be stated that many painful osteoarthritic knees had effusion, but others may have had bursitis or associated activity of crystal-induced arthritis or severe thinning of the knee cartilage or more rarely, degenerative meniscal tear.

According to the results of our study we can say that most of the effusion is painful, but we cannot confirm that every painful osteoarthritic knee is due to effusion. Pain in OA is multifactorial, and effusion plays a crucial role.

The theory that effusion is due to mechanical and not inflammatory cause in OA has been supported in our study because reduction of effusion thickness using spironolactone was maintained after stoppage of treatment for 2 weeks. Further, the addition of power Doppler examination to the painful osteoarthritic knee could clarify more the inflammatory or mechanical nature of effusion. If the cause of effusion is inflammatory, we expect marked power Doppler activity.

REFERENCES

  1. 1.↵
    1. Elsaman AM,
    2. Radwan AR,
    3. Mohammed WI,
    4. Ohrndorf S
    . Low-dose spironolactone: treatment for osteoarthritis-related knee effusion. A prospective clinical and sonographic-based study. J Rheumatol 2016;43:1114–20.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. D’Agostino MA,
    2. Conaghan P,
    3. Le Bars M,
    4. Baron G,
    5. Grassi W,
    6. Martin-Mola E,
    7. et al.
    EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: prevalence of inflammation in osteoarthritis. Ann Rheum Dis 2005;64:1703–9.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. de Miguel Mendieta E,
    2. Ibanez TC,
    3. Jaeger JU,
    4. Hernán GB,
    5. Mola EM
    . Clinical and ultrasonographic findings related to knee pain in osteoarthritis. Osteoarthritis Cartilage 2006;14:540–4.
    OpenUrlCrossRefPubMed
  4. 4.↵
    1. Hill CL,
    2. Gale DG,
    3. Chaisson CE,
    4. Skinner K,
    5. Kazis L,
    6. Gale ME,
    7. et al.
    Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol 2001;28:1330–7.
    OpenUrlAbstract/FREE Full Text
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The Journal of Rheumatology
Vol. 43, Issue 12
1 Dec 2016
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Dr. Elsaman, et al reply
AHMED ELSAMAN, AHMED RADWAN, WALAA MOHAMMED, SARAH OHRNDORF
The Journal of Rheumatology Dec 2016, 43 (12) 2199; DOI: 10.3899/jrheum.161169

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Dr. Elsaman, et al reply
AHMED ELSAMAN, AHMED RADWAN, WALAA MOHAMMED, SARAH OHRNDORF
The Journal of Rheumatology Dec 2016, 43 (12) 2199; DOI: 10.3899/jrheum.161169
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