Viscosupplementation and osteoarthritis: -Viscosupplementation with hyaluronic acid injections (HA) symptomatic treatment early stage knee osteoarthritis (OA) -Significant good clinical results vs placebo 5 - 14 weeks after treatment (Bellamy 2006) -Possibility of disease modifying effects of viscosupplementation -Positive effect HA on sulphated glycosaminoglycans (sGAG) content of articular cartilage (Goldberg 2005, Moreland 2003) dGEMRIC: -Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) -Most sensitive indirect measure cartilage sGAG content (Bashir 1997, 1999) -Inverse relation sGAG and i.v. gadolinium -High T1 represents high sGAG content (Figure 1) -Highly reproducible...

Patient population: -20 early stage knee OA patients -Included via the outpatient clinic of the Department of Orthopedic Surgery of the Erasmus MC, Rotterdam, The Netherlands -Inclusion criteria: -Knee complaints: > 3 months -Kellgren & Lawrence grade I or II on radiography -Exclusion criteria: -Contra-indications to undergo MRI -Knee surgery schduled within the coming 6 months -Viscosupplementation during the last year Study measurements and intervention: -Basline measurements consisted of: -3D dGEMRIC (see Van Tiel, et al. Eur Radiol. 2013 Feb;23(2):496- 504 for MR and protocol)...

dGEMRIC: -dGEMRIC median T1 values and hence sGAG content of the cartilage did not improve significantly at 14 weeks follow-up (Figure 4) -In addition, the differences in T1 values did not reach an earlier established threshold for improvement in cartilage quality if measmured with dGEMRIC (VanTiel, et al. Eur Radiol. 2013 Feb;23(2):496-504.) (Figure 5) -The differences in T1 values for each individual participant (data not shown) only reached this threshold in a single ROI at a different location in the knee joint in only 7...

-Viscosupplementation with HA provides improvement in clinical complaints persistent up to 14 weeks after treatment -dGEMRIC does not measure improvement in sGAG content and hence cartilage quality 14 weeks after HA injections -Symptomatic efficacy of viscosupplementation cannot be explained by a detectable improvement of articular cartilage quality

References are included in the presentation

I am working as a PhD student in the Musculoskeletal Imaging Research Group. Our research group emphasizes on improving radiological imaging of cartilage, in particular using quantitative MRI and CT techniques. In addition, we participate in multiple clinical trials and observational studies focusing on osteoarthritis and osteoporosis, including the Rotterdam Study. My PhD project focusses on validation, translation and implementation of quantitative radiological techniques to measure knee cartilage quality. The techniques I use are dGEMRIC (T1-mapping), T1rho-mapping, T2-mapping and CT arthrography. These techniques, if properly...