Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
Osteoarthritis Cartilage. 2022 Sep;30(9):1270-1277. doi: 10.1016/j.joca.2022.06.004. Epub 2022 Jun 22.
Although subchondral bone marrow lesions (BMLs) and synovitis have been well acknowledged as important sources of pain in knee osteoarthritis (KOA), it is unclear if synovitis plays the mediating role in the relationship between BMLs and knee pain.
We analyzed 600 subjects with magnetic resonance imaging (MRI) in the Foundation for National Institutes of Health Osteoarthritis Biomarkers Consortium (FNIH) cohort at baseline and 24-month. BMLs and synovitis were measured according to the MRI Osteoarthritis Knee Score (MOAKS) scoring system. BMLs were scored in five subregions. A summary synovitis score of effusion and Hoffa-synovitis was calculated. Knee pain was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Linear regression models were applied to analyze the natural direct effect (NDE) of BMLs and synovitis with knee pain, respectively, and natural indirect effect (NIE) mediated by synovitis.
590 participants (58.8% females, with a mean age of 61.5) were included in the present analyses. For NDE, knee pain was cross-sectionally associated with medial femorotibial BMLs (β = 0.23, 95% CI: 0.09, 0.38) and synovitis (β = 0.40, 95% CI: 0.20, 0.60). Longitudinal associations retained significant [medial femorotibial BMLs (β = 0.37, 95% CI: 0.21, 0.53); synovitis (β = 0.72, 95% CI: 0.45, 0.99)]. In the NIE analyses, synovitis mediated the association between medial femorotibial BML and knee pain at baseline (β = 0.051, 95% CI: 0.01, 0.09) and over 24 months (β = 0.079, 95% CI: 0.023, 0.15), with the mediating proportion of 17.8% and 22.4%, respectively.
Synovitis partially mediates the association between medial femorotibial BMLs and knee pain.
虽然软骨下骨髓病变（BML）和滑膜炎已被公认为膝关节骨关节炎（KOA）疼痛的重要来源，但尚不清楚滑膜炎是否在 BML 与膝关节疼痛之间的关系中起中介作用。
我们对基础国立卫生研究院骨关节炎生物标志物联盟（FNIH）队列中的 600 名接受磁共振成像（MRI）检查的受试者进行了分析，这些受试者在基线和 24 个月时进行了检查。根据 MRI 骨关节炎膝关节评分（MOAKS）评分系统测量 BML 和滑膜炎。BML 在五个亚区进行评分。计算渗出液和 Hoffa 滑膜的综合滑膜炎评分。使用 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）评估膝关节疼痛。应用线性回归模型分别分析 BML 和滑膜炎与膝关节疼痛的直接自然效应（NDE）和滑膜炎介导的间接自然效应（NIE）。
本研究共纳入 590 名参与者（58.8%为女性，平均年龄 61.5 岁）。对于 NDE，膝关节疼痛与内侧股骨胫骨 BML（β=0.23，95%CI：0.09，0.38）和滑膜炎（β=0.40，95%CI：0.20，0.60）呈横断面相关。纵向关联保留显著[内侧股骨胫骨 BML（β=0.37，95%CI：0.21，0.53）；滑膜炎（β=0.72，95%CI：0.45，0.99）]。在 NIE 分析中，滑膜炎介导了内侧股骨胫骨 BML 与基线时膝关节疼痛之间的关联（β=0.051，95%CI：0.01，0.09）和 24 个月时的关联（β=0.079，95%CI：0.023，0.15），介导比例分别为 17.8%和 22.4%。
滑膜炎部分介导了内侧股骨胫骨 BML 与膝关节疼痛之间的关联。
