Structural Correlates of Knee Pain

描述（由申请人提供）：膝关节疼痛非常普遍，一个月的大部分时间疼痛影响大约25%的55岁及以上的成年人。在大多数研究中，经常膝关节疼痛的人中有一半没有X线OA。膝关节疼痛是残疾的主要原因，即使在没有症状性骨关节炎的患者中也是如此（Guccione et al，1990）。事实上，膝关节疼痛但无X线OA的患者发生活动性残疾的风险高于X线OA但无疼痛的患者（Guccione et al，1990）。我们已经证明，某些MRI特征与骨关节炎患者膝关节疼痛的存在相关。这些发现来自对膝关节OA患者的研究，这些膝关节中存在多种共存的结构变化，因此很难分离出可能的疼痛来源。此外，疼痛的膝关节在MRI上几乎都有滑膜增生，但目前还不清楚这种滑膜增生的范围有多大，以及它是否也经常发生在非疼痛的膝关节上。在社区中所有膝关节疼痛的患者中，我们不知道有多少人患有关节周围与关节内病变，以及哪些关节病变最可能与疼痛相关。使用MOST研究中收集的数据，一项对社区中膝关节疼痛高风险患者或既存症状性OA患者的纵向研究，我们将解决一系列有关膝关节疼痛结构相关性的问题：1.社区中有多少膝关节疼痛患者的疼痛源自膝关节？2.使用钆注射来全面评估滑膜增生，并关注疼痛但X线片显示OA很少的膝关节，最可能与膝关节内疼痛相关的结构性发现是什么？3.膝关节滑膜的体积是否与膝关节疼痛的严重程度相关？4.是否有与休息时疼痛相关的特定MRI结果？和5.随着时间的推移，我们能否通过确定膝关节疼痛的发展或消退是否与结构性病变的发展或消退相对应来确定疼痛的来源？解决这些问题将帮助我们更好地了解膝盖疼痛的来源，从而有助于其预防和治疗。

DESCRIPTION (provided by applicant): Knee pain is remarkably prevalent, with pain on most days of a month affecting roughly 25% of adults age 55 and over. In most studies, half of the persons with frequent knee pain do not have x-ray OA. Knee pain is a major cause of disability, even in persons without symptomatic osteoarthritis (Guccione et al, 1990). In fact, there is a higher risk of mobility disability in those with knee pain who do not have x-ray OA than among those with x-ray OA who have no pain (Guccione et al, 1990). We have shown that certain MRI features are correlated with the presence of knee pain in knees with osteoarthritis. These findings emanated from studies of those with knee OA, and multiple coexistent structural changes exist in these knees, making it hard to isolate the likely source of pain. Also, knees with pain almost all have synovial proliferation on MRI, but it is unclear how extensive this synovial proliferation is and whether it also occurs frequently in nonpainful knees. Of all persons with knee pain in the community, we do not know how many have periarticular vs. intraarticular pathology and which articular pathologies are most likely associated with pain. Using data being collected in the MOST Study, a longitudinal study of persons from the community with knee pain at high risk of developing OA or with preexisting symptomatic OA, we will address a series of questions about the structural correlates of knee pain: 1.How many persons in the community with knee pain have pain emanating from the knee joint? 2. Using gadolinium injections to allow comprehensive assessment of synovial proliferation and focusing on knees with pain but little x-ray OA, what are the structural findings most likely to be associated with intraarticular knee pain? 3. Is the volume of synovium in the knee associated with the severity of knee pain? 4. Are there specific MRI findings associated with pain at rest? and 5. Following subjects over time, can we identify sources of pain by identifying whether the development or resolution of knee pain corresponds with development or resolution of a structural lesion? Addressing these questions will help us better understand the sources of knee pain and will therefore aid in its prevention and treatment.