Institute for Infection and Immunity, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK.
Pain Centre Versus Arthritis and NIHR Nottingham BRC, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
Osteoarthritis Cartilage. 2022 May;30(5):746-755. doi: 10.1016/j.joca.2022.01.008. Epub 2022 Feb 3.
Bone marrow lesions (BMLs) are associated with pain in osteoarthritis (OA), but histological scores for OA focus on cartilage pathology. We developed a new scoring system, the Osteoarthritis Bone Score (OABS), to characterise OA-related BMLs.
BML/non-BML tissues identified by Magnetic Resonance Imaging (MRI) in 10 knee OA subjects were harvested at total knee replacement (TKR). Osteochondral tissue from a further 140 TKR and 23 post-mortem (PM) cases was assessed. Histological features distinguishing MRI-defined BML/non-BML tissues on qualitative analysis were classified as present (0) or absent (1), summated for the OABS, validated by Rasch analysis and sensitivity to distinguish between sample groups. Immunohistochemistry for PGP9.5 assessed innervation.
Subchondral characteristics associated with BML tissues were cysts, fibrosis, hypervascularity, cartilage islands, trabecular thickening, loss of tidemark integrity and inflammatory cell infiltration. PGP9.5 immunoreactive perivascular nerves were associated with BMLs. OABS performed well as a measurement tool, displayed good reliability (Cronbach alpha = 0.68), had a 2-factor structure (trabecular/non-trabecular), with moderate correlation between the two factors (r = 0.56, 95% CI 0.46, 0.65). OABS scores were higher in TKR than PM cases with chondropathy, median difference 1.5 (95% CI -2, 0). OABS and Mankin scores similarly distinguished TKR from non-OA controls, but only OABS was higher in BML than non-BML tissues, median difference -4 (95% CI -5 to -2).
OABS identifies and validly quantifies histopathological changes associated with OA BMLs. Histopathology underlying BMLs may represent 2 inter-related pathological processes affecting trabecular/non-trabecular structures. Increased vascularity/perivascular innervation in BMLs might contribute to pain.
骨髓病变（BMLs）与骨关节炎（OA）疼痛有关，但 OA 的组织学评分侧重于软骨病理学。我们开发了一种新的评分系统，即骨关节炎骨评分（OABS），用于描述与 OA 相关的 BMLs。
通过磁共振成像（MRI）在 10 例膝关节 OA 患者的全膝关节置换术（TKR）中识别 BML/非 BML 组织，并从另外 140 例 TKR 和 23 例尸检（PM）病例中获取骨软骨组织。通过定性分析对 MRI 定义的 BML/非 BML 组织进行区分的组织学特征被归类为存在（0）或不存在（1），并对 OABS 进行总和，通过 Rasch 分析进行验证，并对样本组进行区分的敏感性。用 PGP9.5 进行免疫组织化学染色评估神经支配。
与 BML 组织相关的软骨下特征包括囊肿、纤维化、血管增生、软骨岛、小梁增厚、潮线完整性丧失和炎症细胞浸润。PGP9.5 免疫反应性血管周围神经与 BML 相关。OABS 作为一种测量工具表现良好，具有良好的可靠性（Cronbach alpha=0.68），具有 2 个因子结构（小梁/非小梁），两个因子之间的相关性中等（r=0.56，95%CI 0.46，0.65）。TKR 病例的 OABS 评分高于 PM 病例的软骨病，中位数差异为 1.5（95%CI-2，0）。OABS 和 Mankin 评分同样可以区分 TKR 与非 OA 对照，但只有 OABS 在 BML 组织中的评分高于非 BML 组织，中位数差异为-4（95%CI-5 至-2）。
OABS 可识别和有效量化与 OA BML 相关的组织病理学变化。BML 下的组织病理学可能代表影响小梁/非小梁结构的 2 个相互关联的病理过程。BML 中增加的血管生成/血管周围神经支配可能与疼痛有关。
