Bone Marrow Lesions and Osteoarthritis

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Here are some extracts from a novel article on the nature of osteoarthritis.

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Bone Marrow Lesions correlate with Osteoarthritis knee pain

<http://www.biomech.com/current/runstart.shtml>

By L Rochelle Roniger

Bone marrow lesions in patients with knee osteoarthritis are associated with

pain, according to the results of a study reported in the April 3 issue of

the ls of Internal Medicine.

Researchers led by T. Felson, MD, a rheumatologist and professor of

medicine and public health at Boston University School of Medicine, used

knee radiography and magnetic resonance imaging to examine one knee of each

of 401 people with knee osteoarthritis identified by radiography. The

study’s participants, 351 of whom had knee pain, were drawn from Veterans

Administration clinics and the community.

Of the study participants with knee pain, 78% had bone marrow lesions, as

determined by T2-weighted fat-saturated MRI to score lesion size. By

comparison, only 30% of those without knee pain had bone marrow lesions, a

statistically significant difference. Large lesions were seen in 40% of

those with knee pain, compared to 2% of the pain-free group. The researchers

defined bone marrow lesions as discrete areas of increased signal adjacent

to the subcortical bone in either the femur or the tibia. Each lesion was

scored on a scale of 0 to 3, with definite bone marrow lesions receiving a

score of at least 1 and large lesions at least 2....... However, bone marrow

lesions were not associated with pain severity.

" We don't really understand what causes pain in this disorder, " said Felson,

who is also director of the National Institutes of Health Multipurpose

Arthritis and Musculoskeletal Diseases Center. Possible contributors to

pain concomitant with knee osteoarthritis include synovitis (inflammation of

the joint lining) and the buildup of large quantities of fluid in the joint,

he said. ...... synovitis may also be associated with pain, Felson said.

Bone marrow edema lesions may develop as a result of excessive pressure on

the knees, according to Felson. But the study’s implications for treatment

of painful knee osteoarthritis are still in question.

" Biomechanical therapies that reorient joint loading somehow may be

therapeutically helpful, " he said.

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Dr Mel C Siff

Denver, USA

Supertraining/