Moisio Kirsten, Eckstein Felix, Chmiel Joan S, Guermazi Ali, Prasad Pottumarthi, Almagor Orit, Song Jing, Dunlop Dorothy, Hudelmaier Martin, Kothari Ami, Sharma Leena
Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Arthritis Rheum. 2009 Dec;60(12):3703-10. doi: 10.1002/art.25014.
It is unclear how articular cartilage loss contributes to pain in patients with knee osteoarthritis (OA). Full-thickness cartilage defects expose the subchondral bone plate. The relationship between denuded bone and pain has not been examined. The aim of this study was to investigate whether the percent of denuded bone is associated with moderate-to-severe knee pain or frequent knee pain and longitudinally with frequent knee pain 2 years after the baseline evaluation.
We studied 182 persons with knee OA (305 knees). Applying specialized magnetic resonance imaging techniques, manual segmentation was used to compute cartilage-covered and denuded bone areas for each surface. Moderate-to-severe knee pain was defined as a score of >or=40 mm on a knee-specific 100-mm visual analog scale, and frequent knee pain was defined as pain on most days during the past month. Logistic regression and generalized estimating equations were used in analyses, adjusting for age, sex, body mass index, and bone marrow lesions.
Cross-sectional analyses revealed that moderate-to-severe knee pain was associated with percent denuded bone in the medial compartment (adjusted odds ratio [OR] 3.90, 95% confidence interval [95% CI] 1.33-11.47), in the medial and patellar surfaces together, and in the lateral and patellar surfaces. Frequent knee pain was associated with percent denuded bone in the patellar surface (adjusted OR 3.11, 95% CI 1.24-7.81), in the medial and patellar surfaces, and in the lateral and patellar surfaces. Longitudinal analyses (in 168 knees without frequent knee pain at baseline) revealed that percent denuded bone in the medial and patellar surfaces was associated with frequent incident knee pain (adjusted OR 4.19, 95% CI 1.56-11.22).
These results support a relationship between subchondral bone plate exposure and prevalent and incident knee pain in patients with knee OA.
尚不清楚关节软骨损伤如何导致膝骨关节炎（OA）患者疼痛。全层软骨缺损会暴露软骨下骨板。裸露骨与疼痛之间的关系尚未得到研究。本研究的目的是调查裸露骨的比例是否与中重度膝关节疼痛或频繁膝关节疼痛相关，以及在基线评估2年后是否与频繁膝关节疼痛存在纵向关联。
我们研究了182例膝OA患者（305个膝关节）。应用专门的磁共振成像技术，通过手动分割计算每个表面的软骨覆盖面积和裸露骨面积。中重度膝关节疼痛定义为在特定膝关节的100毫米视觉模拟量表上得分≥40毫米，频繁膝关节疼痛定义为过去一个月中大多数日子都有疼痛。分析采用逻辑回归和广义估计方程，并对年龄、性别、体重指数和骨髓病变进行校正。
横断面分析显示，中重度膝关节疼痛与内侧间室的裸露骨比例相关（校正比值比[OR] 3.90，95%置信区间[95%CI] 1.33 - 11.47），与内侧和髌面一起，以及外侧和髌面相关。频繁膝关节疼痛与髌面的裸露骨比例相关（校正OR 3.11, 95%CI 1.24 - 7.81），与内侧和髌面，以及外侧和髌面相关。纵向分析（在168个基线时无频繁膝关节疼痛的膝关节中）显示，内侧和髌面的裸露骨比例与频繁发生的膝关节疼痛相关（校正OR 4.19, 95%CI 1.56 - 11.22）。
这些结果支持了软骨下骨板暴露与膝OA患者普遍存在的和新发的膝关节疼痛之间的关系。
