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Bone Marrow Edema and Its Relation to Progression of Knee Osteoarthritis

David T. Felson, MD, MPH; Sara McLaughlin, MPH; Joyce Goggins, MPH; Michael P. LaValley, PhD; M. Elon Gale, MD; Saara Totterman, MD; Wei Li, MBA; Catherine Hill, MD, MSc; and Daniel Gale, MD
[+] Article, Author, and Disclosure Information

From Boston University and the Veterans Affairs Boston Health Care System, Boston, Massachusetts; and University of Rochester, Rochester, New York.

Acknowledgments: The authors thank field staff and study participants for generously giving their time. They also thank Dr. Kenneth Pritzker for valuable discussions on the pathology of bone marrow edema.

Grant Support: By the National Institutes of Health (AR47785) and by an Arthritis Foundation Clinical Sciences Grant.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: David T. Felson, MD, MPH, Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118.

Current Author Addresses: Drs. Felson, LaValley, and Hill and Ms. McLaughlin, Ms. Goggins, and Ms. Li: Boston University School of Medicine, 715 Albany Street, A203, Boston, MA 02118.

Drs. M.E. Gale and D. Gale: Radiology Department, Veterans Affairs Boston Health Care System, 150 Huntington Avenue, Boston, MA 02130.

Dr. Totterman: Department of Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 694, Rochester, NY 14624-8648.

Author Contributions: Conception and design: D.T. Felson.

Analysis and interpretation of the data: D.T. Felson, J. Goggins, M.P. LaValley, S. Totterman, W. Li.

Drafting of the article: D.T. Felson.

Critical revision of the article for important intellectual content: M.P. LaValley, C. Hill, D. Gale.

Final approval of the article: D.T. Felson.

Provision of study materials or patients: D.T. Felson, J. Goggins.

Statistical expertise: D.T. Felson, M.P. LaValley.

Obtaining of funding: D.T. Felson.

Administrative, technical, or logistic support: D.T. Felson, J. Goggins, M.P. LaValley, M.E. Gale, W. Li, D. Gale.

Collection and assembly of data: D.T. Felson, S. McLaughlin.

Ann Intern Med. 2003;139(5_Part_1):330-336. doi:10.7326/0003-4819-139-5_Part_1-200309020-00008
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Patients were recruited to participate in a natural history study of symptomatic knee osteoarthritis. All patients in the current study are a subset of patients whose recruitment has been described in detail elsewhere (8). Briefly, patients were recruited from two prospective studies, one in men and one in women, of quality of life among veterans; from clinics at Boston Medical Center in Boston, Massachusetts; and from advertisements in local newspapers. Potential participants were asked two questions: “Do you have pain, aching, or stiffness in one or both knees on most days?” and “Has a doctor ever told you that you have knee arthritis?” For patients who answered yes to both questions, we conducted a follow-up interview in which we asked about other types of arthritis that could cause knee symptoms. If no other forms of arthritis were identified, then the individual was eligible for recruitment. A series of knee radiographs were obtained for each patient to determine whether radiographic osteoarthritis was present. If patients had a definite osteophyte on any view in the symptomatic knee, they were eligible for the study. Because they had frequent knee symptoms and radiographic osteoarthritis, all patients met American College of Rheumatology criteria for symptomatic knee osteoarthritis (14).

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Grahic Jump Location
Figure 1. This lesion was scored as grade 2 in size on a scale of 0 to 3.
Bone marrow edema lesion (B) on magnetic resonance imaging.
Grahic Jump Location
Grahic Jump Location
Figure 2. MRI = magnetic resonance imaging.
Flow of patients through the study.
Grahic Jump Location




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Summary for Patients

Association of Bone Marrow Changes with Worsening of Knee Osteoarthritis

The summary below is from the full report titled “Bone Marrow Edema and Its Relation to Progression of Knee Osteoarthritis.” It is in the 2 September 2003 issue of Annals of Internal Medicine (volume 139, pages 330-336). The authors are D.T. Felson, S. McLaughlin, J. Goggins, M.P. LaValley, M.E. Gale, S. Totterman, W. Li, C. Hill, and D. Gale.


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