Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging
Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging
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DOI：
10.1002/art.22851
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发表时间：
2007-09-01
影响因子：
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通讯作者：
Aliabadi, Piran
中科院分区：
文献类型：
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作者：
Felson, David T.;Niu, Jingbo;Aliabadi, Piran
目的。横断面研究结果表明，磁共振成像（MRI）显示的骨髓病变（BMLs）与膝关节疼痛有关，但尚未进行纵向研究。本研究旨在确定骨髓病变增大是否与新发膝关节疼痛有关。
方法。选取50 - 79岁患有膝关节骨关节炎（OA）或膝关节OA高风险的受试者，在基线时两次询问其大多数日子是否存在膝关节疼痛、酸痛或僵硬（归类为频繁膝关节疼痛）；无膝关节疼痛是基线入选标准。在15个月的随访中，再次两次询问受试者是否存在频繁膝关节疼痛。病例膝关节定义为基线时无膝关节疼痛，但随访时两次均存在膝关节疼痛。从基线时无疼痛的膝关节中随机选择对照。对所有MRI图像的内侧、外侧和髌股关节间室的骨髓病变体积进行评分。我们重点关注从基线到15个月膝关节各间室骨髓病变评分的最大变化。采用多因素逻辑回归，并对人口统计学和临床变量进行调整，以评估骨髓病变评分增加是否可预测膝关节疼痛的发生。
结果。在病例膝关节中，110例中有54例（49.1%）在一个间室内骨髓病变评分增加，而220例对照膝关节中只有59例（26.8%）增加（卡方检验P < 0.001）。骨髓病变评分至少增加2个单位在病例膝关节中比对照膝关节更为常见（27.5%对8.6%；调整后的优势比为3.2，95%置信区间为1.5 - 6.8）。在骨髓病变增加的病例膝关节中，大多数在基线时已有骨髓病变，随访时病变增大，但在基线时无骨髓病变的膝关节亚组中，病例膝关节出现新骨髓病变比对照膝关节更常见（34例中有11例[32.4%]）比对照膝关节（83例中有9例[10.8%]）。
结论。膝关节疼痛的发生与MRI显示的骨髓病变增加有关。
Objective. Results of cross-sectional studies have suggested that bone marrow lesions (BMLs) visualized on magnetic resonance imaging (MRI) are related to knee pain, but no longitudinal studies have been done. This study was undertaken to determine whether enlarging BMLs are associated with new knee pain.Methods. Subjects ages 50-79 years with knee osteoarthritis (OA) or at high risk of knee OA were asked twice at baseline about the presence of knee pain, aching, or stiffness (classified as frequent knee pain) on most days; absence. of knee pain was the baseline eligibility criterion. At 15 months' followup, subjects were again queried twice about frequent knee pain. A case knee was defined as absence of knee pain at baseline but presence of knee pain both times at followup. Controls were selected randomly from among knees with absence of pain at baseline. All MR images were scored for volume of BMLs in the medial, lateral, and patellofemoral compartments. We focused on the maximal change in BML score among the knee compartments from baseline to 15 months. Multiple logistic regression, with adjustments for demographic and clinical variables, was used to assess whether an increased BML score is predictive of the development of knee pain.Results. Among case knees, 54 of 110 (49.1%) showed an increase in BML score within a compartment, whereas only 59 of 220 control knees (26.8%) showed an increase (P < 0.001 by chi-square test). A BML score increase of at least 2 units was much more common in case knees than in control knees (27.5% versus 8.6%; adjusted odds ratio 3.2, 95% confidence interval 1.5-6.8). Among case knees with increased BMLs, most already had BMLs at baseline, with enlarging BMLs at followup, but among the subset of knees with no BMLs at baseline, new BMLs were more common in case knees (11 [32.4%] of 34) than in control knees (9 [10.8%] of 83).Conclusion. Development of knee pain is associated with an increase in BMLs as revealed on MRI.