Antony Benny, Venn Alison, Cicuttini Flavia, March Lyn, Blizzard Leigh, Dwyer Terence, Halliday Andrew, Cross Marita, Jones Graeme, Ding Changhai
Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
Arthritis Res Ther. 2016 Jan 26;18:31. doi: 10.1186/s13075-016-0938-9.
Subchondral bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA) and are associated with pain and structural progression in knee OA. However, little is known about clinical significance and determinants of BMLs of the knee joint in younger adults. We aimed to describe the prevalence and environmental (physical activity), structural (cartilage defects, meniscal lesions) and clinical (pain, stiffness, physical dysfunction) correlates of BMLs in younger adults and to determine whether cholesterol levels measured 5 years prior were associated with current BMLs in young adults.
Subjects broadly representative of the Australian young adult population (n = 328, aged 31-41 years, female 48.7 %) underwent T1- and proton density-weighted fat-suppressed magnetic resonance imaging (MRI) in their dominant knee. BMLs, cartilage defects, meniscal lesions and cartilage volume were measured. Knee pain was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and physical activity was measured by the International Physical Activity Questionnaire (IPAQ). Cholesterol levels including high-density lipoprotein (HDL) were assessed 5 years prior to MRI.
The overall prevalence of BML was 17 % (grade 1: 10.7 %, grade 2: 4.3 %, grade 3: 1.8 %). BML was positively associated with increasing age and previous knee injury but not body mass index. Moderate physical activity (prevalence ratio (PR):0.93, 95 % CI: 0.87, 0.99) and HDL cholesterol (PR:0.36, 95 % CI: 0.15, 0.87) were negatively associated with BML, while vigorous activity (PR:1.02, 95 % CI: 1.01, 1.03) was positively associated with medial tibiofemoral BMLs. BMLs were associated with more severe total WOMAC knee pain (>5 vs ≤5, PR:1.05, 95 % CI: 1.02, 1.09) and WOMAC dysfunction (PR:1.75, 95 % CI: 1.07, 2.89), total knee cartilage defects (PR:2.65, 95 % CI: 1.47, 4.80) and total meniscal lesion score (PR:1.92, 95 % CI: 1.13, 3.28).
BMLs in young adults are associated with knee symptoms and knee structural lesions. Moderate physical activity and HDL cholesterol are beneficially associated with BMLs; in contrast, vigorous physical activity is weakly but positively associated with medial tibiofemoral BMLs.
软骨下骨髓损伤（BMLs）在骨关节炎（OA）发病机制中起关键作用，且与膝关节OA的疼痛及结构进展相关。然而，关于年轻成年人膝关节BMLs的临床意义及决定因素知之甚少。我们旨在描述年轻成年人中BMLs的患病率及其与环境因素（体力活动）、结构因素（软骨缺损、半月板损伤）和临床因素（疼痛、僵硬、身体功能障碍）的相关性，并确定5年前测量的胆固醇水平是否与年轻成年人当前的BMLs相关。
选取大致代表澳大利亚年轻成年人群体的受试者（n = 328，年龄31 - 41岁，女性占48.7%），对其优势膝关节进行T1加权和质子密度加权脂肪抑制磁共振成像（MRI）检查。测量BMLs、软骨缺损、半月板损伤及软骨体积。采用西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评估膝关节疼痛，通过国际体力活动问卷（IPAQ）测量体力活动。在MRI检查前5年评估包括高密度脂蛋白（HDL）在内的胆固醇水平。
BML的总体患病率为17%（1级：10.7%，2级：4.3%，3级：1.8%）。BML与年龄增长及既往膝关节损伤呈正相关，但与体重指数无关。中等强度体力活动（患病率比（PR）：0.93，95%置信区间（CI）：0.87，0.99）和HDL胆固醇（PR：0.36，95% CI：0.15，0.87）与BML呈负相关，而剧烈活动（PR：1.02，95% CI：1.01，1.03）与胫股内侧BML呈正相关。BMLs与更严重的WOMAC膝关节总疼痛（>5分对比≤5分，PR：1.05，95% CI：1.02，1.09）、WOMAC功能障碍（PR：1.75，95% CI：1.07，2.89）、全膝关节软骨缺损（PR：2.65，95% CI：1.47，4.80）及半月板总损伤评分（PR：1.92，95% CI：1.13，3.28）相关。
年轻成年人的BMLs与膝关节症状及膝关节结构损伤相关。中等强度体力活动和HDL胆固醇与BMLs呈有益关联；相反，剧烈体力活动与胫股内侧BMLs呈弱但正相关。
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