The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis
The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis
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DOI：
10.1016/j.joca.2006.03.015
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发表时间：
2006-10-01
影响因子：
7
通讯作者：
Sharma, L.
中科院分区：
文献类型：
--
作者：
Torres, L.;Dunlop, D. D.;Sharma, L.
引言：疼痛是膝关节骨关节炎（OA）最常见的症状，是慢性残疾的主要原因，也是一般OA所致残疾的主要来源。膝关节OA的疼痛严重程度不一，从几乎难以察觉至使人无法活动。导致疼痛严重程度的膝关节病变很少受到关注。
目的：研究特定膝关节组织（即软骨、骨（磨损、囊肿、骨髓病变和骨赘）、半月板（撕裂和半脱位）、韧带和滑膜（滑膜炎/积液））的更严重病理是否与更严重的膝关节疼痛相关。
方法：从社区招募了143名原发性（特发性）膝关节OA患者，至少一侧膝关节有明确的胫股骨赘，且在需要膝关节参与的活动中至少存在一些困难。使用冠状面T1加权自旋回波（SE）、矢状面脂肪抑制双回波快速自旋回波以及轴面和冠状面脂肪抑制、T1加权3D - 快速小角度激发（FLASH）序列获取膝关节磁共振（MR）图像。采用全器官磁共振成像（MRI）评分（WORMS）方法对膝关节组织状态进行评分。由于对整个关节（包括无病变区域）的组织评分求和可能会削弱检测该组织与疼痛严重程度之间真实关系的能力，我们将最差间室（即软骨形态最差的间室）的评分作为主要方法。使用针对膝关节的100毫米视觉模拟量表测量膝关节疼痛严重程度。在分析评估膝关节疼痛严重程度与病变评分之间的关系时，采用中位数分位数回归，并对年龄和体重指数（BMI）进行调整，其中95%置信区间不包括0则具有显著性。
结果：在对年龄和BMI进行调整后，通过中位数分位数回归得出的疼痛中位数增加情况在骨磨损（1.91，95%置信区间（CI）0.68，3.13）、骨髓病变（3.72，95%CI 1.76，5.68）、半月板撕裂（1.99，95%CI 0.60，3.38）以及2级或3级滑膜炎/积液与0级相比（9.82，95%CI 0.38，19.27）时具有显著性。骨赘和软骨形态与疼痛严重程度的关系具有临界显著性，而骨囊肿或半月板半脱位与疼痛严重程度的关系不显著。韧带撕裂发生频率过低，无法进行有意义的分析。当将骨磨损和骨髓病变评分均较高的膝关节疼痛严重程度（疼痛严重程度中位数为40毫米）与仅骨磨损评分高的膝关节（30毫米）相比时，差异不显著，但骨髓病变评分高而骨磨损评分不高的膝关节（15毫米）疼痛明显较轻。
结论：在膝关节OA患者中，膝关节疼痛严重程度与关节下骨磨损、骨髓病变、滑膜炎/积液和半月板撕裂相关。骨髓病变对疼痛严重程度的影响似乎需要骨磨损的存在。（C）2006国际骨关节炎研究协会。由爱思唯尔有限公司出版。保留所有权利。
Introduction: Pain is the most common symptom in knee osteoarthritis (OA), a leading cause of chronic disability, and a major source of the disability attributable to OA in general. Pain severity in knee OA is variable, ranging from barely perceptible to immobilizing. The knee lesions that contribute to pain severity have received little attention.Objective: To examine whether worse pathology of specific knee tissues - i.e. cartilage, bone (attrition, cysts, bone marrow lesions, and osteophytes), menisci (tears and subluxation), ligaments, and synovium (synovitis/effusion) - is associated with more severe knee pain.Methods: One hundred and forty-three individuals were recruited from the community with primary (idiopathic) knee OA, with definite tibiofemoral osteophytes in at least one knee, and at least some difficulty with knee-requiring activity. Knee magnetic resonance (MR) images were acquired using coronal T1-weighted spin-echo (SE), sagittal fat-suppressed dual-echo turbo SE, and axial and coronal fat-suppressed, T1-weighted 3D-fast low angle shot (FLASH) sequences. The whole-organ magnetic resonance imaging (MRI) scoring (WORMS) method was used to score knee tissue status. Since summing tissue scores across the entire joint, including regions free of disease, may dilute the ability to detect a true relationship between that tissue and pain severity, we used the score from the worst compartment (i.e. with the poorest cartilage morphology) as our primary approach. Knee pain severity was measured using knee-specific, 100 mm visual analogue scales. In analyses to evaluate the relationship between knee pain severity and lesion score, median quantile regression was used, adjusting for age and body mass index (BMI), in which a 95% CI excluding 0 is significant.Results: The increase in median pain from median quantile regression, adjusting for age and BMI, was significant for bone attrition (1.91, 95% confidence interval (CI) 0.68, 3.13), bone marrow lesions (3.72, 95% CI 1.76, 5.68), meniscal tears (1.99, 95% CI 0.60, 3.38), and grade 2 or 3 synovitis/effusion vs grade 0 (9.82, 95% CI 0.38, 19.27). The relationship with pain severity was of borderline significance for osteophytes and cartilage morphology and was not significant for bone cysts or meniscal subluxation. Ligament tears were too infrequent for meaningful analysis. When compared to the pain severity in knees with high scores for both bone attrition and bone marrow lesions (median pain severity 40 mm), knees with high attrition alone (30 mm) were not significantly different, but knees with high bone marrow lesion without high attrition scores (15 mm) were significantly less painful.Conclusion: In persons with knee OA, knee pain severity was associated with subarticular bone attrition, bone marrow lesions, synovitis/effusion, and meniscal tears. The contribution of bone marrow lesions to pain severity appeared to require the presence of bone attrition. (C) 2006 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.