骨髓病变、关节积液和滑膜炎与膝骨关节炎疼痛的相关性

Correlation Between the Pain of Knee Osteoarthritis and Bone Marrow Lesions,Joint Effusion,or Synovitis

目的:探讨磁共振成像(MRI)显示的软骨下骨髓病(BML)、关节积液和滑膜炎与膝骨关节炎(OA)患者疼痛的相关性。方法:80例膝OA患者行MRI检查。用波士顿利兹骨关节炎评分(BLOKS)评定的最大BML、关节积液和滑膜炎作为预测因子,用西安大略和麦克马斯特大学骨关节炎量表(WOMAC)评定的负重和非负重膝疼痛作为结果,采用单变量和多变量Logistic回归分析,研究MRI表现与膝关节症状的关系。结果:在负重情况下,按最大BML评分,膝疼痛校正相对危险度(RR)分别为1.0,1.3,1.9和2.0(P=0.005)。按积液评分,校正RR分别为1.0,1.8,2.1和2.7(P=0.000 3)。按滑膜炎评分,校正RR分别为1.0,1.7,1.9和2.0(P=0.021);在非负重情况下,按最大BML评分,膝疼痛校正RR分别为1.0,1.1,1.6和1.8(P=0.04)。按积液评分,校正RR分别为1.0,1.4,1.6和2.1(P=0.03)。按滑膜炎评分,校正RR分别为1.0,0.7,0.8和0.5(P=0.45)。结论:MRI显示的最大骨髓病变、关节积液和滑膜炎与膝负重疼痛独立相关,而与非负重疼痛相关性较小。这些MRI特征可能为膝OA提供新的治疗靶点。

Objective： To evaluate whether the presence of subchondral bone marrow lesions （BML）, joint effusion, and synovitis in magnetic resonance images （MRI） are associated with knee pain a- mong the patients suffering osteoarthritis（OA）. Methods： A total of 80 eases with knee OA were examined by MRI. Using univariate and multivariate logistic regressions with maximal BML, joint effusion and synovitis defined by Boston Leeds Osteoarthritis Knee Score （BLOKS） as predictors, and knee pain using weight-bearing and non weight-bearing Western Ontario and Me- Master University OA Index pain questions as the outcome, we tested the association between MRI findings and knee symptoms. Results： In the case of weight-bearing pain, adjusted relative risk（RR） of knee pain were 1.0, 1.3, 1.9 and 2.0 （P=0. 005） for maximal BML scores, adjus- ted RR were 1.0, 1.8, 2.1, and 2.7（P=0. 0003） for effusion scores, and adjusted RR were 1.0, 1.7, 1.9, and 2.0 （P=0. 021） for synovitis scores. In the case of non weight-bearing pain, ad- justed RR of knee pain were 1.0, 1.1, 1.6, and 1.8 （P=O. 04） for maximal BML scores, adjusted RR were 1.0, 1.4, 1.6, and 2.1 （P=0.03） for effusion scores, and adjusted RR were 1.0, 0.7, 0.8, and 0. 5（P=0. 45） for synovitis scores. Conclusion： Maximal BML, joint effusion and synovitis in MRI are independently associated with weight-bearing and less so with non weight- bearing knee pain. These MRI features may offer new treatment targets for knee OA.