The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis

  1. David T. Felson, MD, MPH;
  2. Christine E. Chaisson, MPH;
  3. Catherine L. Hill, MD, MSc;
  4. Saara M.S. Totterman, MD;
  5. M. Elon Gale, MD;
  6. Katherine M. Skinner, PhD;
  7. Lewis Kazis, ScD; and
  8. Daniel R. Gale, MD
  1. From the Boston University Arthritis Center, Boston Medical Center, Veterans Affairs Boston Healthcare System, the Center for Health Quality, Outcomes and Economic Research, Veterans Affairs Health Services Research and Development Field Program, and Boston University School of Public Health, Boston, and Bedford Veterans Affairs Medical Center, Bedford Massachusetts; and University of Rochester Medical Center, Rochester, New York.

    Abstract

    Background: The cause of pain in osteoarthritis is unknown. Bone has pain fibers, and marrow lesions, which are thought to represent edema, have been noted in osteoarthritis.

    Objective: To determine whether bone marrow lesions on magnetic resonance imaging (MRI) are associated with pain in knee osteoarthritis.

    Design: Cross-sectional observational study.

    Setting: Veterans Affairs Medical Center.

    Patients: 401 persons (mean age, 66.8 years) with knee osteoarthritis on radiography who were drawn from clinics in the Veterans Administration health care system and from the community. Of these persons, 351 had knee pain and 50 had no knee pain.

    Measurements: Knee radiography and MRI of one knee were performed in all participants. Those with knee pain quantified the severity of their pain. On MRI, coronal T2-weighted fat-saturated images were used to score the size of bone marrow lesions, and each knee was characterized as having any lesion or any large lesion. The prevalence of lesions and large lesions in persons with and without knee pain was compared; in participants with knee pain, the presence of lesions was correlated with severity of pain.

    Results: Bone marrow lesions were found in 272 of 351 (77.5%) persons with painful knees compared with 15 of 50 (30%) persons with no knee pain (P < 0.001). Large lesions were present almost exclusively in persons with knee pain (35.9% vs. 2%; P < 0.001). After adjustment for severity of radiographic disease, effusion, age, and sex, lesions and large lesions remained associated with the occurrence of knee pain. Among persons with knee pain, bone marrow lesions were not associated with pain severity.

    Conclusions: Bone marrow lesions on MRI are strongly associated with the presence of pain in knee osteoarthritis.

    Article and Author Information

    • Acknowledgments: The authors thank Sara McLaughlin, field coordinator, and other field staff; Stephen Evans and Wei Li, programmers for this study; and Dr. Michael LaValley for advice on data analysis and interpretation. They also thank Kitty Bentzler for her considerable technical expertise in production of the manuscript. Finally, they thank the study participants for generously giving their time.

    • Grant Support: By Bayer Corp., grant AR20613 from the National Institutes of Health, grant SDR 91006.S from the Veterans Administration, and an Arthritis Foundation Clinical Sciences Grant.

    • Requests for Single Reprints: David T. Felson, MD, MPH, Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118.

    • Current Author Addresses: Dr. Felson, Ms. Chaisson, and Dr. Hill: Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118.

    • Dr. Totterman: Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 694, Rochester, NY 14624-8648.

    • Drs. M.E. Gale and D. Gale: Radiology Department, Boston Veterans Affairs Medical Center, 1505 Huntington Avenue, Boston, MA 02130.

    • Drs. Skinner and Kazis: Health Services Research (152), Health Services Research and Development Field Program, Veterans Affairs Medical Center Bedford (Building 70), 200 Springs Road, Bedford, MA 01730.

    • Author Contributions: Conception and design: D.T. Felson, S.M.S. Totterman, K.M. Skinner, L. Kazis, D.R. Gale.

    • Analysis and interpretation of the data: D.T. Felson, C.E. Chaisson, K.M. Skinner, L. Kazis, D.R. Gale.

    • Drafting of the article: D.T. Felson, C.E. Chaisson, K.M. Skinner.

    • Critical revision of the article for important intellectual content: C.L. Hill, S.M.S. Totterman, K.M. Skinner, L. Kazis, D.R. Gale.

    • Final approval of the article: D.T. Felson, C.L. Hill, K.M. Skinner.

    • Provision of study materials or patients: C.L. Hill, M.E. Gale, K.M. Skinner, L. Kazis, D.R. Gale.

    • Statistical expertise: D.T. Felson.

    • Obtaining of funding: D.T. Felson.

    • Administrative, technical, or logistic support: D.T. Felson, C.E. Chaisson, M.E. Gale, D.R. Gale.

    • Collection and assembly of data: D.T. Felson, C.E. Chaisson, C.L. Hill, L. Kazis, D.R. Gale.

    Summary for Patients

    • Summaries for Patients:The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis Ann Intern Med April 3, 2001 134:S93
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    1. Ann Intern Med April 3, 2001 vol. 134 no. 7 541-549
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