Synovitis mediates the association between bone marrow lesions and knee pain in osteoarthritis: data from the Foundation for the National Institute of Health (FNIH) Osteoarthritis Biomarkers Consortium,Osteoarthritis and Cartilage

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Synovitis mediates the association between bone marrow lesions and knee pain in osteoarthritis: data from the Foundation for the National Institute of Health (FNIH) Osteoarthritis Biomarkers Consortium
Osteoarthritis and Cartilage ( IF 7.2 ) Pub Date : 2022-06-22 , DOI: 10.1016/j.joca.2022.06.004
X Wang ₁ , T Chen ₂ , W Liang ₃ , T Fan ₄ , Z Zhu ₄ , P Cao ₄ , G Ruan ₅ , Y Zhang ₄ , S Chen ₄ , Q Wang ₄ , S Li ₄ , Y Huang ₃ , M Zeng ₄ , D J Hunter ₆ , J Li ₇ , C Ding ₈

Affiliation

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.
Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China.
Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Australia.
Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.

Objectives

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.

Methods

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.

Results

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.

Conclusion

Synovitis partially mediates the association between medial femorotibial BMLs and knee pain.

中文翻译：

滑膜炎介导骨关节炎中骨髓损伤和膝关节疼痛之间的关联：来自美国国立卫生研究院 (FNIH) 骨关节炎生物标志物联盟基金会的数据

目标

虽然软骨下骨髓病变（BMLs）和滑膜炎已被公认为膝骨关节炎（KOA）疼痛的重要来源，但尚不清楚滑膜炎是否在BMLs与膝关节疼痛之间的关系中起中介作用。

方法

我们在基线和 24 个月时分析了美国国立卫生研究院骨关节炎生物标志物联盟 (FNIH) 队列中的 600 名磁共振成像 (MRI) 受试者。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 在五个子区域进行评分。计算积液和霍法滑膜炎的滑膜炎总分。使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。线性回归模型分别用于分析 BML 和滑膜炎伴膝痛的自然直接效应 (NDE) 和滑膜炎介导的自然间接效应 (NIE)。

结果

590 名参与者（58.8% 为女性，平均年龄为 61.5 岁）被纳入本分析。对于濒死体验，膝关节疼痛与内侧股胫骨 BML ( β = 0.23, 95% CI: 0.09, 0.38) 和滑膜炎 ( β = 0.40, 95% CI: 0.20, 0.60) 相关。纵向关联保持显着 [内侧股胫骨 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，滑膜炎在基线（ β = 0.051, 95% CI: 0.01, 0.09）和超过 24 个月（β = 0.079, 95% CI: 0.023, 0.15）时介导了内侧股胫骨 BML 和膝关节疼痛之间的关联，其中中介比例分别为17.8%和22.4%。