Journal of Medical Ultrasonics

, Volume 46, Issue 1, pp 137–146 | Cite as

Subclinical crystal arthropathy: a silent contributor to inflammation and functional disability in knees with osteoarthritis—an ultrasound study

  • Reem Hamdy A. MohammedEmail author
  • Hanan Kotb
  • Marian Amir
  • Andrea Di Matteo
Original Article



This study aimed at investigating the prevalence of crystal deposits with knee osteoarthritis (OA) by ultrasonography and measure the inflammatory burden associated with crystal deposits in OA using WOMAC score.


Adult patients with primary knee OA diagnosed according to the American College of Rheumatology criteria were included. Participants were subjected to history taking, clinical examination, knee US, and plain radiography. The EULAR and the OMERACT ultrasonography definitions and scanning protocols were used.


Fifty-three patients (44 females, 9 males) were enrolled. Mean values were 53.5 years ± 8.3 SD for age and 42.5 months ± 49.5 SD for disease duration. Crystals were detected by US in 73/106 knees (68.9%). Plain radiography revealed chondrocalcinosis in three patients. Mean values for WOMAC pain, stiffness, and disability scores were 14.38 ± 3.99, 4.93 ± 2.06, and 49.61 ± 13.06, respectively, with insignificant differences relative to presence of crystals (P > 0.05). Regression analysis revealed a 4.1-fold increase in the incidence of sonographic crystals with bursitis (OR = 4.13, CI = 1.5–11.2, p = 0.01) and a 3.2-fold increase in the incidence of sonographic crystals with synovial effusion (OR = 3.16, CI = 1.34–7.44, p = 0.01).


Subclinical crystals were detected in a considerable number of patients with primary knee OA. The incidence of crystal deposits was significantly higher in patients with bursitis and knee effusion.


Osteoarthritis Subclinical crystal deposition disease Chondrocalcinosis Clinical predictors 


Author contributions

Dr. RM was involved in the hypothesis and study design, performed ultrasound examinations of the patients, and was involved in statistical analysis of and interpretation of preliminary as well as final data, clinical assessment confirmation following ultrasound examination, review of plain radiography with a radiologist, and manuscript writing and revisions. Dr. ADM was involved in manuscript writing, interpretation of statistical data, and peer review for the manuscript. Dr. HK was involved as senior supervisor in the hypothesis, study design, and supervision and review of data collection and interpretation. Dr. AM was involved in patient recruitment, clinical assessment, and recording clinical data during the preliminary study.

Compliance with ethical standards

Conflict of interest

There are no financial or other relations that could lead to a conflict of interest. Forms were submitted for all authors.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2018

Authors and Affiliations

  1. 1.Department of Rheumatology and Rehabilitation, School of MedicineCairo University HospitalsCairoEgypt
  2. 2.Rheumatology DepartmentUniversità Politecnica delle Marche, “Carlo Urbani” HospitalIesiItaly

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