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A longitudinal study of the relationship between the status of bone marrow abnormalities and progression of knee osteoarthritis

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Bone marrow abnormalities (BMAs) detected on magnetic resonance imaging (MRI) are suggested to be involved in the pathogenesis of osteoarthritis (OA), and the size of the BMAs is associated with the progression of OA. However, it still remains unclear as to whether the associations of BMA size and OA severity are observed equally or whether they differ from early to advanced stages of OA. In the present study we examined whether BMA enlargement and OA progression differed according to the severity of OA.

Methods

One hundred and eighty patients with knee OA were enrolled in the present study, and 122 of these patients completed this study. Radiography and knee MRI were done two times in all patients, at the baseline and 6 months or later at the time of patient follow-up. The severity of OA was evaluated by radiography using the Kellgren-Lawrence (K-L) grade. The patients who showed a deterioration in the K-L grade during the follow-up examination (59/122) were defined as the deterioration group. T2-weighted fat-suppressed MR images were used to score the size of the BMAs according to the whole-organ magnetic resonance imaging score (WORMS). A new scoring system, the spacial BMA score (s-score) was defined to assess the size of the BMAs three-dimensionally.

Results

In patients with K-L grade 2, the s-score changes during the follow-up period in the deterioration group were significantly increased in comparison to those in the no-change group (P = 0.04), and no significant s-score changes were observed in patients with either K-L grade 1 or 3 (P = 0.07 and 0.57) between the deterioration group and the no-change group during the follow-up examination. In patients with K-L grade 3, the s-score at the baseline in the deterioration group was higher than that in the no-change group (P = 0.05).

Conclusions

The relationship between the size and enlargement of BMAs and the progression of OA changed depending upon the severity of OA.

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References

  1. Kijowski R, Stanton P, Fine J, De Smet A. Subchondral bone marrow edema in patients with degeneration of the articular cartilage of the knee joint. Radiology 2006;238:943–949. Epub 2006 Jan 19.

    Article  PubMed  Google Scholar 

  2. Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N, Majumdar S. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 2003;226:373–381.

    Article  PubMed  Google Scholar 

  3. Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med 2001;134:541–549.

    CAS  PubMed  Google Scholar 

  4. Kornaat PR, Ceulemans RY, Kroon HM, Riyazi N, Kloppenburg M, Carter WO, et al. MRI assessment of knee osteoarthritis: Knee Osteoarthritis Scoring System (KOSS)-inter-observer and intra-observer reproducibility of a compartment-based scoring system. Skeletal Radiol 2005;34:95–102. Epub 2004 Oct 8.

    Article  PubMed  Google Scholar 

  5. Pessis E, Drape JL, Ravaud P, Chevrot A, Dougados M, Ayral X. Assessment of progression in knee osteoarthritis: results of a 1 year study comparing arthroscopy and MRI. Osteoarthritis Cartilage 2003;11:361–369.

    Article  CAS  PubMed  Google Scholar 

  6. Peterfy CG, Guermazi A, Zaim S, Tirman PF, Miaux Y, White D, et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004;12:177–190.

    Article  CAS  PubMed  Google Scholar 

  7. Kubota M, Ikeda H, Takazawa Y, Kawasaki T, Ishijima M, Kurosawa H. Subchondral bone marrow abnormality on magnetic resonance imaging in osteoarthritic knees. Bessatsu Seikeigeka 2008;53:71–75. in Japanese.

    Google Scholar 

  8. Felson DT, McLaughlin S, Goggins J, LaValley MP, Gale ME, Totterman S, et al. Bone marrow edema and its relation to progression of knee osteoarthritis. Ann Intern Med 2003;139:330–336.

    PubMed  Google Scholar 

  9. Hunter DJ, Zhang Y, Niu J, Goggins J, Amin S, Lavalley M, et al. Increase in bone marrow lesions associated with cartilage loss. Arthritis Rheum 2006;54:1529–1535.

    Article  PubMed  Google Scholar 

  10. Brem MH, Schlechtweg PM, Bhagwat J, Genovese M, Dillingham MF, Yoshioka H, et al. Longitudinal evaluation of the occurrence of MRI-detectable bone marrow edema in osteoarthritis of the knee. Acta Radiol 2008;21:1–7.

    Google Scholar 

  11. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986;29:1039–1049.

    Article  CAS  PubMed  Google Scholar 

  12. Kubota M, Kurosawa H, Ikeda H, Takazawa Y, Kawasaki T, Ishijima M, et al. Bone marrow abnormality associated with painful osteoarthritis of the knee: a cross-sectional study of magnetic resonance imaging findings with the radiographic stage and clinical findings. Juntendo Medical Journal 2009;45–53.

  13. Ravaud P, Auleley GR, Chastang C, Rousselin B, Paolozzi L, Amor B, et al. Knee joint space width measurement: an experimental study of the influence of radiographic procedure and joint positioning. Br J Rheumatol 1996;35:761–766.

    Article  CAS  PubMed  Google Scholar 

  14. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957;16:494–502.

    Article  CAS  PubMed  Google Scholar 

  15. Kornaat PR, Kloppenburg M, Sharma R, Botha-Scheepers SA, Le Graverand MP, Coene LN, et al. Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features. Eur Radiol 2007;17:3073–3078. Epub 2007 Sep 7.

    Article  PubMed  Google Scholar 

  16. Bruyere O, Genant H, Kothari M, Zaim S, White D, Peterfy C, et al. Longitudinal study of magnetic resonance imaging and standard X-rays to assess disease progression in osteoarthritis. Osteoarthritis Cartilage 2007;15:98–103. Epub 2006 Aug 4.

    Article  CAS  PubMed  Google Scholar 

  17. Hunter DJ, Conaghan PG, Peterfy CG, Bloch D, Guermazi A, Woodworth T, et al. Responsiveness, effect size, and smallest detectable difference of magnetic resonance imaging in knee osteoarthritis. Osteoarthritis Cartilage 2006;14:A112–A115. Epub 2006 May 5.

    Article  PubMed  Google Scholar 

  18. Wluka AE, Hanna FS, Davies-Tuck M, Wang Y, Bell RJ, Davis SR, et al. Bone marrow lesions predict increase in knee cartilage defects and loss of cartilage volume in middle-aged women without knee pain over 2 years. Ann Rheum Dis 2008;14:14.

    Google Scholar 

  19. Hayes CW, Conway WF, Daniel WW. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics 1993;13:1001–1011; discussion 12.

    CAS  PubMed  Google Scholar 

  20. Nikolaou VS, Pilichou A, Korres D, Efstathopoulos N. Transient osteoporosis of the knee. Orthopedics 2008;31:502.

    PubMed  Google Scholar 

  21. Carrino JA, Blum J, Parellada JA, Schweitzer ME, Morrison WB. MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. Osteoarthritis Cartilage 2006;14:1081–1085. Epub 2006 Jun 27.

    Article  CAS  PubMed  Google Scholar 

  22. Milgram JW. Morphologic alterations of the subchondral bone in advanced degenerative arthritis. Clin Orthop Relat Res 1983;293–312.

  23. Oda H, Igarashi M, Sase H, Sase T, Yamamoto S. Bone bruise in magnetic resonance imaging strongly correlates with the production of joint effusion and with knee osteoarthritis. J Orthop Sci 2008;13:7–15. Epub 2008 Feb 16.

    Article  PubMed  Google Scholar 

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Kubota, M., Ishijima, M., Kurosawa, H. et al. A longitudinal study of the relationship between the status of bone marrow abnormalities and progression of knee osteoarthritis. J Orthop Sci 15, 641–646 (2010). https://doi.org/10.1007/s00776-010-1512-y

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  • DOI: https://doi.org/10.1007/s00776-010-1512-y

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