Sjogren's syndrome
The Natural History of Bone Marrow Lesions in Community-Based Middle-Aged Women Without Clinical Knee Osteoarthritis

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Objective

Bone marrow lesions (BML) have been implicated in the pathogenesis of osteoarthritis, yet their exact role, etiology, and natural history remain unclear. The aim of this study was to examine the natural history of BML in a healthy population and identify risk factors associated with their persistence and incidence.

Methods

One hundred forty-eight healthy middle-aged women had magnetic resonance imaging performed on their dominant knee at baseline and 2 years later to assess the presence, natural history, and risk factors for persistence and incidence of BML.

Results

Approximately 46% of BML present at baseline completely resolved over 2 years. “Large” BML had the potential to improve, while the majority of “very large” remained stable. In those women with no BML at baseline, approximately 9% developed a BML over 2 years, the majority in the medial compartment. There was a trend toward weight being a risk factor for the development of “very large” BML (P = 0.08).

Conclusions

The natural history of BML may be different in healthy persons compared with diseased states. The trend for weight as a risk factor for development of a “very-large” BML suggests there is potential to identify modifiable risk factors for BML in asymptomatic people and warrants further investigation.

Section snippets

Participants

Eligible participants were part of a previous cross-sectional study, having been recruited from a database established from the Victorian state electoral roll (Australia) between April 2002 and August 2003 (13). Women were eligible if they were aged 40 to 67 years, had not had a hysterectomy, and had agreed to be recontacted regarding further research studies. Women who had experienced significant knee pain or injury in the last 5 years that necessitated treatment by health professionals, or

Results

One hundred forty-eight women of the 176 (84%) completed follow-up. Twenty-eight women did not undergo a second MRI because of death (n = 1), migration (n = 1), knee injury (n = 4), surgery (n = 1), withdrawal of consent (n = 3), and being unable to be contacted (n = 18). Apart from being younger (mean age (±SD) was 49.5 (±6.3) years, P = 0.02 for difference), the baseline characteristics of these women were not significantly different to those who completed the longitudinal component of the

Discussion

In this study of asymptomatic women without clinical knee OA, we found that approximately 46% of BML present at baseline completely resolved over 2 years and approximately 9% of women who were free of a BML developed a BML. Of the 14 subjects with a “large” BML present at baseline, 2 remained stable, 3 increased in size, and 9 completely resolved. However, the majority (88%) of “very-large” BML at baseline remained stable over 2 years. The majority of subjects developed their new BML in the

Acknowledgment

This research was funded by the National Health and Medical Research Council of Australia (Grants 219279, 284484, and 334267). Drs. Wluka and Hanna are recipients of NHMRC Public Health Training Fellowships (317840 and 418961, respectively). P.A. Berry and M.L. Davies-Tuck are recipients of Australian Post-graduate Association Scholarships. We appreciate the assistance of Roy Morgan Research Australia in the conduct of this research.

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