David T. Felson, MD, MPH; Christine E. Chaisson, MPH; Catherine L. Hill, MD, MSc; Saara M.S. Totterman, MD; M. Elon Gale, MD; Katherine M. Skinner, PhD; Lewis Kazis, ScD; Daniel R. Gale, MD
Acknowledgments: The authors thank Sara McLaughlin, field coordinator, and other field staff; Stephen Evans and Wei Li, programmers for this study; and Dr. Michael LaValley for advice on data analysis and interpretation. They also thank Kitty Bentzler for her considerable technical expertise in production of the manuscript. Finally, they thank the study participants for generously giving their time.
Grant Support: By Bayer Corp., grant AR20613 from the National Institutes of Health, grant SDR 91006.S from the Veterans Administration, and an Arthritis Foundation Clinical Sciences Grant.
Requests for Single Reprints: David T. Felson, MD, MPH, Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118.
Current Author Addresses: Dr. Felson, Ms. Chaisson, and Dr. Hill: Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118.
Dr. Totterman: Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 694, Rochester, NY 14624-8648.
Drs. M.E. Gale and D. Gale: Radiology Department, Boston Veterans Affairs Medical Center, 1505 Huntington Avenue, Boston, MA 02130.
Drs. Skinner and Kazis: Health Services Research (152), Health Services Research and Development Field Program, Veterans Affairs Medical Center Bedford (Building 70), 200 Springs Road, Bedford, MA 01730.
Author Contributions: Conception and design: D.T. Felson, S.M.S. Totterman, K.M. Skinner, L. Kazis, D.R. Gale.
Analysis and interpretation of the data: D.T. Felson, C.E. Chaisson, K.M. Skinner, L. Kazis, D.R. Gale.
Drafting of the article: D.T. Felson, C.E. Chaisson, K.M. Skinner.
Critical revision of the article for important intellectual content: C.L. Hill, S.M.S. Totterman, K.M. Skinner, L. Kazis, D.R. Gale.
Final approval of the article: D.T. Felson, C.L. Hill, K.M. Skinner.
Provision of study materials or patients: C.L. Hill, M.E. Gale, K.M. Skinner, L. Kazis, D.R. Gale.
Statistical expertise: D.T. Felson.
Obtaining of funding: D.T. Felson.
Administrative, technical, or logistic support: D.T. Felson, C.E. Chaisson, M.E. Gale, D.R. Gale.
Collection and assembly of data: D.T. Felson, C.E. Chaisson, C.L. Hill, L. Kazis, D.R. Gale.
Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, et al. The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis. Ann Intern Med. 2001;134:541-549. doi: 10.7326/0003-4819-134-7-200104030-00007
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Published: Ann Intern Med. 2001;134(7):541-549.
Knee osteoarthritis affects 11% to 15% of the U.S. population 65 years of age or older (1) and is a leading cause of disability in the elderly. The major source of disability and care seeking for patients with osteoarthritis is pain in the knee (2).
The cause of knee pain in patients with osteoarthritis is unclear. Osteoarthritis has been considered a disease whose characteristic pathologic feature is loss of hyaline articular cartilage, but that tissue contains no pain fibers. Pain fibers are present in several other structures, however, that are often affected by pathologic processes in knee osteoarthritis, including the joint capsule, ligaments in and around the knee joint, the outer third of the meniscus, and possibly the synovium (although for this last tissue, evidence is conflicting [3, 4]). In addition, bone in the periosteum and bone marrow is richly innervated with nociceptive fibers and represents a potential source of pain in patients with knee osteoarthritis.
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