The clinical significance, natural history and predictors of bone marrow lesion change over eight years

Abstract

IntroductionThere is increasing evidence to suggest that bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA). However, there is a lack of long term data. The aim of this study was to describe the natural history of knee BMLs, their association with knee pain and examine predictors of BML change over eight years.MethodsA total of 198 subjects (109 adult offspring of subjects who had a knee replacement and 89 community-based controls) were studied. Knee pain and BML size were assessed at two and ten year visits.ResultsAt the two year visit, 64% of participants (n = 127) had 229 BMLs (34% patella, 26% femoral and 40% tibial). Over eight years, 24% (55/229) increased in size, 55% (125/229) remained stable and 21% (49/229) decreased in size or resolved completely. Of the participants without BMLs at baseline, 52% (37/71) developed incident BMLs.After adjusting for confounders, eight year change in total BML size was associated with change in knee pain in offspring (β = 2.50, 95% confidence interval (CI) 0.96 to 4.05) but not controls. This association was stronger in males. Incident BMLs were associated with increase in pain (β = 3.60, 95% CI 1.14 to 6.05). Body mass index (BMI) and strenuous activity (but not radiographic osteoarthritis or smoking) were associated with an increase in BML size.ConclusionIn this midlife cohort, the proportion of BMLs increasing in size was similar to those decreasing in size with the majority remaining stable. Change in BMLs was predicted by BMI and strenuous activity. An increase in BML size or a new BML resulted in an increase in pain especially in males and those with a family history of OA.

Patellofemoral Bone Marrow Lesions: Natural History and Associations With Pain and Structure

“…In a younger cohort, Foong. et al followed 198 patients over eight years and found that knee BML size remained stable in over half of the participants (14). However, both of these studies reported BMLs in the tibiofemoral compartment or total knee BMLs, and did not report patellar BMLs.…”

Successful hypnosis for obesity

“…1,2 Magnetic resonance imaging (MRI) has revolutionised our understanding of knee pathology, with early detection of knee abnormalities that eventually lead to significant disability. 3 This is the first study to determine the prevalence of MRI assessed knee abnormalities in ARF players and describe their associations with function, pain, past and incident injury and surgery history.…”

“…2 Focus group participants were also given the option to draw pictures on paper during the focus group in order to divert focus to a mutual activity. 3,4 Transcripts are analysed using NVivo10 qualitative software and coded using inductive and deductive coding with grounded theory.…”

Preliminary validation of the Knee Inflammation MRI Scoring System (KIMRISS) for grading bone marrow lesions in osteoarthritis of the knee: data from the Osteoarthritis Initiative

“…BML are associated with increased risk for subsequent cartilage damage, especially when new or increasing,2–6 and in many studies, but not all, BML are associated with pain 6–16. Evidence is conflicting as to whether pain severity is correlated to BML size6 12 13 15 17 18 or not,9 11 19–21 or to BML location 12–14. This inconsistency may relate to limitations of the MRI-based BML scoring systems currently in use, particularly regarding relative insensitivity to small lesions or subtle changes.…”