| Summary: | Osteoarthritis (OA) is the most common type of arthritis worldwide and a significant cause of pain and disability. Modem imaging, in particular magnetic resonance imaging (MRI), has revolutionized the understanding of this disease and it is now known that OA affects the whole joint in a dynamic, remodelling process. Current treatments for OA, such as anti-inflammatory drugs, analgesics or corticosteroid injections only have, at best, a moderate effect size and their use may be limited by side-effects. Recent modem imaging studies have identified the synovium as a target for treatment as inflammation in the synovium has been associated with pain. This thesis assessed whether targeting the synovium with anti-synovial agents would improve clinical symptoms in OA and whether differing imaging modalities would improve the synovitis- symptom relationship. An open label study of methotrexate demonstrated analgesic efficacy in OA of the knee and a randomised controlled trial is suggested. All participants had ultrasound- detected synovitis at baseline but there was no association between imaging and clinical features. A randomised controlled trial of low dose oral prednisolone for treating painful hand OA did not demonstrate any benefit above placebo. Extremity MRI found no clear associations between baseline imaging and clinical symptoms, although a finger joint that had definite synovitis or effusion on imaging was more likely to be painful, or swollen, or tender. Lastly, MRI was used to assess changes in the synovium after intra-articular corticosteroid. A reduction in synovitis was demonstrated using both synovial volumetric analysis and a semi- quantitative score. Dynamic MRI was able to demonstrate changes in the early enhancement rate, late static enhancement and a statistically significant reduction in the novel variable total synovial enhancement. Synovial volumetric analysis and some dynamic variables were associated with pain scores at baseline. Dynamic MRI shows potential as a more sensitive outcome measure in OA clinical studies, which may improve the synovium-syrnptorn relationship.
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