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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Bone Research
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1477384
This article is part of the Research Topic Metabolic disorders as risk factors for osteoarthritis and targeted therapies for this pathology View all 6 articles

Enhanced joint pain in diabetic patients with knee osteoarthritis is associated with increased synovitis, synovial immune cell infiltration, and erythrocyte extravasation

Provisionally accepted
Annett Eitner Annett Eitner 1*Veronika Rutte Veronika Rutte 1,2Ivan Marintschev Ivan Marintschev 1Gunther O. Hofmann Gunther O. Hofmann 1Hans-Georg Schaible Hans-Georg Schaible 3
  • 1 Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Thuringia, Germany
  • 2 Cantonal Hospital St.Gallen, St. Gallen, St. Gallen, Switzerland
  • 3 Institute of Physiology 1, University Hospital Jena, Jena, Thuringia, Germany

The final, formatted version of the article will be published soon.

    Objective: Diabetes mellitus (DM) is an important risk factor for the development of osteoarthritis (OA), increasing OA progression and OA pain. To gain insight into the underlying mechanisms of how DM exacerbates OA processes and OA pain, this study analyzed histological differences of synovial tissues from non-DM and DM patients with OA and correlated these differences with knee pain severity. Materials and methods: Synovial tissue was obtained from 12 non-DM and 10 DM patients with advanced knee OA who underwent total knee arthroplasty. Synovial inflammation was assessed using the Synovitis score developed by Krenn. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to assess knee pain intensity and disability in OA patients. The number of mast cells, macrophages, nerve fibers, capillaries, larger vessels and erythrocyte extravasation were analyzed microscopically in histological and immunostained synovial sections from non-DM and DM patients. Association analyses were performed to determine associations between OA knee pain and synovial changes affected by DM. Results: Synovial tissue from OA patients with DM had a higher synovitis score, more erythrocyte extravasation, and contained higher numbers of mast cells and macrophages compared to non-DM patients. The number of capillaries and vessels in the lining/sublining layer of the synovial tissue was reduced in DM patients. OA patients with DM had more severe knee pain compared to non-DM patients. The KOOS pain score was associated with the synovitis score, the number of tissue macrophages, and the number of mast cells in the synovial tissue (adjusted for age, sex, and BMI). In addition, the erythrocyte extravasation score was associated with the KOOS pain score and with the synovitis score.The study suggests that increased OA progression and pain severity in patients with DM result from more pronounced synovitis and synovial vascular leakage and increased infiltration of macrophages and mast cells.

    Keywords: Osteoarthritis, Diabetes Mellitus, synovial tissue, Inflammation, Erythrocyte extravasation, Macrophages, Mast Cells, Pain

    Received: 07 Aug 2024; Accepted: 30 Sep 2024.

    Copyright: © 2024 Eitner, Rutte, Marintschev, Hofmann and Schaible. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Annett Eitner, Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, 07747, Thuringia, Germany

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.