Dr. Guermazi has received consulting fees, speaking fees, and/or honoraria from Merck Serono, Facet Solutions, and Genzyme (less than $10,000 each) and from Stryker and Novartis (more than $10,000 each); he owns stock or stock options in Synarc and is president of Boston Imaging Core Lab (BiCL), LLC.
Fluctuation of knee pain and changes in bone marrow lesions, effusions, and synovitis on magnetic resonance imaging
Article first published online: 25 FEB 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 63, Issue 3, pages 691–699, March 2011
How to Cite
Zhang, Y., Nevitt, M., Niu, J., Lewis, C., Torner, J., Guermazi, A., Roemer, F., McCulloch, C. and Felson, D. T. (2011), Fluctuation of knee pain and changes in bone marrow lesions, effusions, and synovitis on magnetic resonance imaging. Arthritis & Rheumatism, 63: 691–699. doi: 10.1002/art.30148
- Issue published online: 3 FEB 2011
- Article first published online: 25 FEB 2011
- Accepted manuscript online: 15 NOV 2010 12:00PM EST
- Manuscript Accepted: 4 NOV 2010
- Manuscript Received: 14 APR 2010
- NIH. Grant Number: AR-47785
- National Institute on Aging. Grant Numbers: 1-U01-AG-19069, 1-U01-AG-18947, 1-U01-AG-18832, 1-U01-AG-18820
Fluctuations in pain in patients with knee osteoarthritis (OA) are common, but risk factors for pain fluctuation are poorly understood. To best identify the structural causes of fluctuations, multiple assessments of pain status and structural lesions are needed. This study was undertaken to determine whether pain resolution is accompanied by diminution of lesions in patients with knee OA.
Subjects in the Multicenter Osteoarthritis Study were queried about their knee pain by interview, and knees were assessed by magnetic resonance imaging at the baseline and 15-month and 30-month clinic visits. For those knees in which pain fluctuation was identified over 3 clinic visits, the relationship of bone marrow lesions (BMLs), synovitis, and effusion to frequent knee pain and severity of knee pain was examined using conditional logistic regression analyses.
Included in the analysis were 570 subjects with knee OA (651 knees). When the BML score changed from 0 to 1, 2, 3, 4, 5–6, and 7–18 over 2 consecutive clinic visits, the odds ratios (ORs) for frequent knee pain were 1.2, 1.2, 1.5, 2.2, 2.4, and 2.5, respectively (P for trend = 0.006). The corresponding ORs were 1.5, 1.5, and 2.4 when the synovitis score changed from 0 to 1, 2, and 3–6, respectively (P for trend = 0.045). No significant association was found between the effusion score and frequent knee pain. Diminishing size of BMLs was associated with resolution of knee pain (P for trend = 0.007). Similar associations were also observed between these structural lesions and the severity of knee pain.
Changes in BMLs and synovitis are associated with fluctuations in knee pain in patients with knee OA. Pain resolution occurs more frequently when BMLs become smaller.