Changes in bone marrow lesions in response to weight-loss in obese knee osteoarthritis patients: a prospective cohort study
Changes in bone marrow lesions in response to weight-loss in obese knee osteoarthritis patients: a prospective cohort study
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DOI：
10.1186/1471-2474-14-106
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发表时间：
2013-03-22
影响因子：
2.3
通讯作者：
Bliddal, Henning
中科院分区：
文献类型：
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作者：
Gudbergsen, Henrik;Boesen, Mikael;Bliddal, Henning
背景：随着年龄的增长和肥胖的增加，患者易患膝骨关节炎（KOA），预计KOA将在未来成为主要的致残疾病。KOA在磁共振成像（MRI）上的一个重要特征是软骨下骨、骨髓病变（BMLs）的改变，这与膝关节未来的退变以及常见的临床症状有关。本研究旨在探讨患有KOA的肥胖受试者在减肥16周后骨密度的变化，以及骨密度变化与减肥对临床症状的影响之间的关系。方法：本前瞻性队列研究纳入了体重指数>= 30 kg/m(2)，年龄>= 50岁，原发KOA的患者。患者接受了为期16周的监督饮食计划，其中包括配方产品和饮食咨询（ClinicalTrials.gov: NCT00655941）。采用Boston-Leeds骨关节炎膝关节评分，在减肥前后通过MRI评估胫骨和股骨的骨损伤。BML评分对体重减轻的反应分为BML评分下降的患者（应答者）和没有应答的患者（无应答者）。通过logistic回归和相关分析评估bmi与减肥的关系。结果：39例患者（23%）在所有BML大小评分的总和中被归类为应答者，而130例患者（77%）恶化或保持稳定，被归类为无应答者。Logistic回归分析显示，体重减轻<或>= 10%与受影响最严重的间室的bls反应没有关联（or 1.86 [CI 0.66至5.26,p=0.24]）。体重减轻与最大BML评分之间无相关性（OR 1.13 [CI 0.39 ~ 3.28, p=0.81]）。BML变化与临床症状之间的关系表明，BML应答者和无应答者中有同等比例的患者出现了OMERACT-OARSI应答（69%对71%，p=0.86）。结论：体重减轻并没有改善胫骨股骨BML大小评分总和或胫骨股骨BML最大评分，这表明BML对体重的迅速下降没有反应。临床症状与脑损伤之间的缺失关系有待进一步研究。
Background: Patients are susceptible for knee osteoarthritis (KOA) with increasing age and obesity and KOA is expected to become a major disabling disease in the future. An important feature of KOA on magnetic resonance imaging (MRI) is changes in the subchondral bone, bone marrow lesions (BMLs), which are related to the future degeneration of the knee joint as well as prevalent clinical symptoms. The aim of this study was to investigate the changes in BMLs after a 16-week weight-loss period in obese subjects with KOA and relate changes in BMLs to the effects of weight-loss on clinical symptoms.Methods: This prospective cohort study included patients with a body mass index >= 30 kg/m(2), an age >= 50 years and primary KOA. Patients underwent a 16 weeks supervised diet program which included formula products and dietetic counselling (ClinicalTrials.gov: NCT00655941). BMLs in tibia and femur were assessed on MRI before and after the weight-loss using the Boston-Leeds Osteoarthritis Knee Score. Response to weight-loss in BML scores was dichotomised to patients experiencing a decrease in BML scores (responders) and patients who did not (non-responders). The association of BMLs to weight-loss was assessed by logistic regressions and correlation analyses.Results: 39 patients (23%) were classified as responders in the sum of all BML size scores whereas 130 patients (77%) deteriorated or remained stable and were categorized as non-responders. Logistic regression analyses revealed no association between weight-loss < or >= 10% and response in BMLs in the most affected compartment (OR 1.86 [CI 0.66 to 5.26, p=0.24]). There was no association between weight-loss and response in maximum BML score (OR 1.13 [CI 0.39 to 3.28, p=0.81]). The relationship between changes in BMLs and clinical symptoms revealed that an equal proportion of patients classified as BML responders and non-responders experienced an OMERACT-OARSI response (69 vs. 71%, p=0.86).Conclusions: Weight-loss did not improve the sum of tibiofemoral BML size scores or the maximum tibiofemoral BML score, suggesting that BMLs do not respond to a rapidly decreased body weight. The missing relationship between clinical symptoms and BMLs calls for further investigation.