Dr. Eckstein has received consulting fees, speaking fees, and/or honoraria from Wyeth, Novo Nordisk, Novartis, and Biosyntech (less than $10,000 each) and from Pfizer, Merck Serono, and Medtronic (more than $10,000 each), and owns stock or stock options in Chondrometrics, Germany.
Denuded subchondral bone and knee pain in persons with knee osteoarthritis
Article first published online: 30 NOV 2009
Copyright © 2009 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 60, Issue 12, pages 3703–3710, December 2009
How to Cite
Moisio, K., Eckstein, F., Chmiel, J. S., Guermazi, A., Prasad, P., Almagor, O., Song, J., Dunlop, D., Hudelmaier, M., Kothari, A. and Sharma, L. (2009), Denuded subchondral bone and knee pain in persons with knee osteoarthritis. Arthritis & Rheumatism, 60: 3703–3710. doi: 10.1002/art.25014
- Issue published online: 30 NOV 2009
- Article first published online: 30 NOV 2009
- Manuscript Accepted: 31 AUG 2009
- Manuscript Received: 20 MAR 2009
- NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Numbers: R01-AR-48216, R01-AR-48748, P60-AR-48098
It is unclear how articular cartilage loss contributes to pain in patients with knee osteoarthritis (OA). Full-thickness cartilage defects expose the subchondral bone plate. The relationship between denuded bone and pain has not been examined. The aim of this study was to investigate whether the percent of denuded bone is associated with moderate-to-severe knee pain or frequent knee pain and longitudinally with frequent knee pain 2 years after the baseline evaluation.
We studied 182 persons with knee OA (305 knees). Applying specialized magnetic resonance imaging techniques, manual segmentation was used to compute cartilage-covered and denuded bone areas for each surface. Moderate-to-severe knee pain was defined as a score of ≥40 mm on a knee-specific 100-mm visual analog scale, and frequent knee pain was defined as pain on most days during the past month. Logistic regression and generalized estimating equations were used in analyses, adjusting for age, sex, body mass index, and bone marrow lesions.
Cross-sectional analyses revealed that moderate-to-severe knee pain was associated with percent denuded bone in the medial compartment (adjusted odds ratio [OR] 3.90, 95% confidence interval [95% CI] 1.33–11.47), in the medial and patellar surfaces together, and in the lateral and patellar surfaces. Frequent knee pain was associated with percent denuded bone in the patellar surface (adjusted OR 3.11, 95% CI 1.24–7.81), in the medial and patellar surfaces, and in the lateral and patellar surfaces. Longitudinal analyses (in 168 knees without frequent knee pain at baseline) revealed that percent denuded bone in the medial and patellar surfaces was associated with frequent incident knee pain (adjusted OR 4.19, 95% CI 1.56–11.22).
These results support a relationship between subchondral bone plate exposure and prevalent and incident knee pain in patients with knee OA.