Bone marrow abnormalities on magnetic resonance imaging are associated with type II collagen degradation in knee osteoarthritis - A three-month longitudinal study
Bone marrow abnormalities on magnetic resonance imaging are associated with type II collagen degradation in knee osteoarthritis - A three-month longitudinal study
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DOI：
10.1002/art.21366
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发表时间：
2005-09-01
影响因子：
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通讯作者：
Schoenharting, M
中科院分区：
文献类型：
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作者：
Garnero, P;Peterfy, C;Schoenharting, M
目标。使用放射摄影术来评估骨关节炎(OA)药物对关节结构的疗效是具有挑战性的。核磁共振成像(MRI)确定的软骨下骨髓异常和尿II型胶原C端交联末端肽(CTX-II)的排泄最近被证明是膝关节骨性关节炎患者放射学进展的预测因素，提示这些可能是有价值的生物标记物，与放射学结果相比敏感性更高。本研究的目的是分析膝骨性关节炎患者在3个月内这两个骨性关节炎生物标志物的值是否会发生变化，并调查骨髓异常与CTX-II的关系。对377例膝骨性关节炎疼痛患者(76%为女性，平均年龄63岁，平均病程6.6年)在基线和3个月进行了膝关节MRI扫描。将股骨髁、胫骨髁、髌骨分为8个部位，进行骨髓异常评分。骨髓异常定义为软骨下骨T2加权像上信号增强的区域。所有扫描都由一名训练有素的放射科医生使用有效的4分计分方法进行集中审查和评分。分别于基线、1个月、2个月、3个月采集空腹尿和血清标本，检测尿CTX-II和骨吸收生化标志物CTX-I水平。基线时，82%的患者有骨髓异常的MRI证据。骨髓异常积分与CTX-II水平显著相关(P<；0.0001)。3个月内骨髓异常积分下降37例(9.8%)，升高71例(18.8%)，多数患者无变化(71.4%)。在调整了年龄、性别和体重指数后，基线尿CTX-II水平位于最高三分位数的患者在3个月后发生骨髓异常恶化的相对风险为2.4(95%可信区间1.1-5.0)。3个月后骨髓异常积分下降的患者尿CTX-II水平显著降低(平均-75 ng/毫米尔肌酐)，而骨髓异常积分升高的患者尿CTX-II水平升高(平均+23 ng/毫摩尔肌酐)(P=0.01)。未观察到骨髓异常与血清CTX-I显著相关。在膝骨性关节炎疼痛的患者中，类似于30%的患者，MRI上的骨髓异常可以在3个月内发生变化。骨髓异常程度的减少与软骨退化的减少有关。
Objective. Using radiography to assess the efficacy of a disease-modifying osteoarthritis (OA) drug on joint structure is challenging. Subchondral bone marrow abnormalities determined by magnetic resonance imaging (MRI) and urinary excretion of C-terminal crosslinking telopeptide of type II collagen (CTX-II) have recently been shown to be predictors of radiographic progression in patients with knee OA, suggesting that these may represent valuable biomarkers with increased sensitivity compared with findings on radiography. The aims of this investigation were to analyze, in patients with knee OA, whether the values associated with these 2 OA biomarkers can change within 3 months, and to investigate the relationships between bone marrow abnormalities and CTX-II.Methods. Knee MRI scans were obtained in 377 patients with painful knee OA (76% women, mean age 63 years, mean disease duration 6.6 years) at both baseline and 3 months. The femoral and tibial condyles and the patella were divided into 8 sites for the scoring of bone marrow abnormalities. A bone marrow abnormality was defined as an area of increased signal on T2-weighted images of the subchondral bone. All scans were reviewed centrally and scored by a single trained radiologist using a validated 4-point scoring method. Fasting urine and serum samples were also collected from all patients at baseline, month 1, month 2, and month 3, in order to measure the levels of urinary CTX-II and serum CTX-I, a biochemical marker of bone resorption.Results. At baseline, 82% of patients had MRI evidence of bone marrow abnormalities. Bone marrow abnormality scores correlated significantly with CTX-II levels (P < 0.0001). Within 3 months, the bone marrow abnormality score decreased in 37 patients (9.8%), increased in 71 patients (18.8%), and did not change in the majority of patients (71.4%). Patients with baseline urinary CTX-II levels in the highest tertile had a relative risk of 2.4 (95% confidence interval 1.1-5.0) of worsening bone marrow abnormalities at 3 months compared with patients with levels in the lowest tertile, after adjustment for age, sex, and body mass index. In patients who showed a decrease in the bone marrow abnormality score at 3 months, urinary CTX-II levels decreased significantly (mean -75 ng/mmole creatinine), whereas levels increased (mean +23 ng/mmole creatinine) in patients showing an increase in the bone marrow abnormality score (P = 0.01 between the 2 groups). No significant association between bone marrow abnormalities and serum CTX-I was observed.Conclusion. In patients with painful knee OA, bone marrow abnormalities on MRI can change within only 3 months in similar to 30% of patients. Reduction in the extent of bone marrow abnormalities is associated with a decrease in cartilage degradation.